Prolonged Progression-Free Survival in a Patient With Malignant Pleural Mesothelioma Following Korean Herbal Medicine Treatment Alone: A Case Report

Our plain-English summary of Prolonged Progression-Free Survival in a Patient With Malignant Pleural Mesothelioma Following Korean Herbal Medicine Treatment Alone: A Case Report, by S.S. Yoon, E.H. Kim, J.Y. Lee, et al (Integrative Cancer Therapies, 2020).

The study

• Authors: S.S. Yoon, E.H. Kim, J.Y. Lee, S.W. Yoon
• Journal: Integrative Cancer Therapies
• Published: 2020;19:1534735420908345
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Korean herbal medicine treatment (KHMT) involves treating with a combination of natural products, which have been used for thousands of years. Recently, it has been reported to be effective and safe in cancer patients. This case report demonstrates the efficacy of KHMT in a 49-year-old man with malignant pleural mesothelioma (MPM), a rare and highly aggressive cancer. The patient showed recurrent pleural effusion and was diagnosed with epithelioid MPM at cT3NxM0 stage III in December 2017. The multidisciplinary care team recommended multimodal treatment based on an extrapleural pneumonectomy, but he refused this because the treatment was aggressive and the effectiveness was unclear. He decided to undergo pemetrexed plus cisplatin chemotherapy if his condition worsened. He visited the Korean Medicine Cancer Center for alternative treatment options. A KHMT regimen, consisting of twice-daily Gunchil-dan and thrice-daily Bangam-tang, was initiated in December 2017. Since commencement of KHMT, computed tomography and X-ray imaging scans have shown no significant interval changes and progression. At 21 months into treatment (September 2019), no significant adverse events have occurred. Given that the median overall survival of patients with MPM is approximately 1 year, the ongoing progression-free survival of this patient for 21 months is relatively long. This case, therefore, suggests that KHMT is a potential treatment option for MPM patients.

In plain English

This case report described one 49-year-old man with epithelioid malignant pleural mesothelioma, stage III (cT3NxM0). He had worked at an automobile factory and was exposed to chemicals on an intermittent basis. The article does not mention asbestos. He was first treated for tuberculous pleuritis for 6 months without effect, and mesothelioma was diagnosed in December 2017. He refused the recommended surgery-based treatment and agreed to consider pemetrexed plus cisplatin chemotherapy if his pleural effusion worsened. Instead he took only Korean herbal medicine: twice-daily Gunchil-dan capsules (a Rhus verniciflua Stokes extract) and thrice-daily Bangam-tang, a herbal decoction. CT scans through June 2019 showed no significant interval changes, and his disease was rated stable. No adverse events of Grade 3 or higher were observed. At 21 months, in September 2019, he was alive without progression. The authors concluded that the herbal treatment could be a beneficial and safe alternative, said a randomized controlled trial is needed, and noted that spontaneous regression could not be excluded. One patient's course does not show how often this would happen.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Case report of a single patient treated with Korean herbal medicine alone
• Who was studied: One 49-year-old man with epithelioid malignant pleural mesothelioma, stage III (cT3NxM0), diagnosed in December 2017 after 6 months of ineffective treatment for a misdiagnosis of tuberculous pleuritis. He had worked at an automobile factory and was exposed to chemicals intermittently. He was treated at the Korean Medicine Cancer Center, Kyung Hee University Hospital at Gangdong, Seoul.
• Exposure: The treatment studied was Korean herbal medicine alone, started in December 2017. It consisted of twice-daily Gunchil-dan, a capsule containing 350 mg Rhus verniciflua Stokes extract with the allergen urushiol removed, and thrice-daily Bangam-tang, a multi-herb decoction. The patient's occupational history was intermittent exposure to chemicals at an automobile factory. No asbestos or fiber exposure is mentioned in the article.
• Main results:
  • The herbal regimen had been given for 21 months at the time of writing, September 2019.
  • CT scans of the patient in September 2018, January 2019 and June 2019 showed no significant interval changes.
  • By Response Evaluation Criteria in Solid Tumors version 1.1, the patient had stable disease.
  • No significant adverse events were observed, defined as events of Grade 3 or higher by the National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0.
  • Carcinoembryonic antigen and carbohydrate antigen 19-9, examined as experimental markers, were both in the normal range.
  • The patient's progression-free survival was 21 months, and he was still alive at the time of writing.
• The authors' conclusion: The authors concluded that this case suggests Korean herbal medicine treatment could be a beneficial and safe alternative for patients with malignant pleural mesothelioma. They said further investigation, such as a randomized controlled trial, is needed to evaluate this possibility.
• Limitations the authors state:
  • The possibility of spontaneous regression of the mesothelioma cannot be excluded.
  • Pathologic findings with hematoxylin and eosin staining and immunohistochemistry were not supplemented, because no tissue samples were left.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Progression-Free Survival, Pleural Mesothelioma, Pleural Effusion, Epithelioid, Multidisciplinary Team, Extrapleural Pneumonectomy (EPP), Pemetrexed (Alimta), Cisplatin.

Related studies

• Low ERCC1 expression in malignant pleural mesotheliomas treated with cisplatin and vinorelbine predicts prolonged progression-free survival — Z.G. Zimling, J.B. Sørensen, et al. (2012)
• Phase II study of first-line bortezomib and cisplatin in malignant pleural mesothelioma and prospective validation of progression free survival rate as a primary end-point for mesothelioma clinical trials (European Organisation for Research and Treatment of Cancer 08052) — M.E. O'Brien, R.M. Gaafar, et al. (2013)
• Progression free survival rate at 9 and 18 weeks predict overall survival in patients with malignant pleural mesothelioma: an individual patient pooled analysis of 10 European Organisation for Research and Treatment of Cancer Lung Cancer Group studies and an independent study validation — B. Hasan, L. Greillier, et al. (2014)
• Long progression-free survival by pemetrexed continuation maintenance therapy following cisplatin-based chemotherapy in malignant pleural mesothelioma — T. Takeda, H. Itano, et al. (2014)
• Validation of Progression-Free Survival as a Surrogate Endpoint for Overall Survival in Malignant Mesothelioma: Analysis of Cancer and Leukemia Group B and North Central Cancer Treatment Group (Alliance) Trials — X. Wang, X. Wang, et al. (2017)
• Preoperative Circulating Tumor DNA in Patients with Peritoneal Carcinomatosis is an Independent Predictor of Progression-Free Survival — J.M. Baumgartner, V.M. Raymond, et al. (2018)

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