Scientific Advances and New Frontiers in Mesothelioma Therapeutics

Our plain-English summary of Scientific Advances and New Frontiers in Mesothelioma Therapeutics, by L. Mutti, T. Peikert, B.W.S. Robinson, et al (Journal of Thoracic Oncology, 2018).

The study

• Authors: L. Mutti, T. Peikert, B.W.S. Robinson, A. Scherpereel, A.S. Tsao, M. de Perrot, G.A. Woodard, D.M. Jablons, J. Wiens, F.R. Hirsch, H. Yang, M. Carbone, A. Thomas, R. Hassan
• Journal: Journal of Thoracic Oncology
• Published: 2018;13(9):1269-1283
• Type of article: Review
• Cited by: 84 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma (MPM) is a rare and aggressive cancer that arises from the mesothelial surface of the pleural and peritoneal cavities, the pericardium, and rarely, the tunica vaginalis. The incidence of MPM is expected to increase worldwide in the next two decades. However, even with the use of multimodality treatment, MPM remains challenging to treat, with a 5-year survival rate of less than 5%. The International Association for the Study of Lung Cancer has gathered experts in different areas of mesothelioma research and management to summarize the most significant scientific advances and new frontiers related to mesothelioma therapeutics.

Published by Elsevier Inc.

In plain English

This article was a review, not an original study. Experts gathered by the International Association for the Study of Lung Cancer summarized treatment research for malignant pleural mesothelioma (MPM). It covered blood biomarkers, surgery, chemotherapy, radiation, drugs that block blood-vessel growth, immunotherapy, anti-inflammatory approaches and virus-based therapy. Citing other work, the authors noted that about 80% of MPM cases result from occupational or environmental asbestos exposure. In the MAPS trial of 448 patients with unresectable MPM, adding bevacizumab to cisplatin-pemetrexed gave median overall survival of 18.8 versus 16.1 months. The SMART trial of 203 patients found no benefit from immediate radiotherapy to pleural procedure sites to prevent tumor spread there, versus radiotherapy deferred until such spread was diagnosed. The DETERMINE trial of tremelimumab did not meet its overall survival end point. The review reported tumor response rates of up to 30% with standard chemotherapy. It also reported on prospective monitoring of highly asbestos-exposed groups: only around 14% of individuals who were later diagnosed had raised serum mesothelin before their diagnosis. The authors concluded that, despite repeated failures, better understanding of mesothelioma biology is paving the way for better therapies.

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: narrative review by an expert panel (no original data)
• Who was studied: No study population of its own; the review summarized published clinical trials and laboratory studies of treatments for malignant pleural mesothelioma
• Exposure: The review concerned treatments, not asbestos exposure. As background, citing other work, the authors stated that about 80% of MPM cases result from occupational or environmental asbestos exposure
• Main results:
  • Reported from the MAPS trial (448 patients with unresectable MPM): median overall survival was 18.8 months with cisplatin-pemetrexed plus bevacizumab versus 16.1 months with cisplatin-pemetrexed alone (hazard ratio 0.77, p = 0.017)
  • Reported from the SMART trial (203 patients): immediate prophylactic radiotherapy to procedure tracts (n = 102) showed no benefit compared with radiotherapy deferred until procedure tract metastasis was diagnosed (n = 101)
  • Reported from the DETERMINE trial: tremelimumab did not improve overall survival compared with placebo (median 7.7 versus 7.3 months)
  • Reported from KEYNOTE-028 (previously treated patients with PD-L1-positive MPM given pembrolizumab): 5 of 25 patients (20%) had a partial response
  • Standard platinum and antifolate chemotherapy gave a tumor response rate of up to 30% in a randomized phase 3 trial, with overall survival of approximately 1 year
  • Reported from prospective monitoring of cohorts with high asbestos exposure: serum mesothelin was increased before diagnosis in only around 14% of individuals, meaning those later diagnosed, not the whole exposed cohort
• The authors' conclusion: The authors concluded that, although there have been repeated failures in developing new treatments, better understanding of mesothelioma biology is paving the way for better therapies and outcomes
• Limitations the authors state:
  • Limitation of the evidence reviewed, as the authors stated it: there are very few randomized studies of possible therapies for MPM
  • Limitation of the evidence reviewed, as the authors stated it: no randomized trials compare immunotherapy with standard therapy

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Pleural Mesothelioma, Pericardium, Tunica Vaginalis, Lung Cancer.

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