SEOM clinical guidelines for the treatment of malignant pleural mesothelioma (2020)

Our plain-English summary of SEOM clinical guidelines for the treatment of malignant pleural mesothelioma (2020), by E. Nadal, J. Bosch-Barrera, S. Cedrés, et al (Clinical & Translational Oncology, 2021).

The study

• Authors: E. Nadal, J. Bosch-Barrera, S. Cedrés, J. Coves, R. García-Campelo, M. Guirado, R. López-Castro, A.L. Ortega, D. Vicente, J. de Castro-Carpeño
• Journal: Clinical & Translational Oncology
• Published: 2021;23(5):980-987
• Type of article: Guideline, Review
• Cited by: 19 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Mesothelioma is a rare and aggressive tumour with dismal prognosis arising in the pleura and associated with asbestos exposure. Its incidence is on the rise worldwide. In selected patients with early-stage MPM, a maximal surgical cytoreduction in combination with additional antitumour treatment may be considered in selected patients assessed by a multidisciplinary tumor board. In patients with unresectable or advanced MPM, chemotherapy with platinum plus pemetrexed is the standard of care. Currently, no standard salvage therapy has been approved yet, but second-line chemotherapy with vinorelbine or gemcitabine is commonly used. Novel therapeutic approaches based on dual immunotherapy or chemotherapy plus immunotherapy demonstrated promising survival benefit and will probably be incorporated in the future.

In plain English

This article is a clinical practice guideline on malignant pleural mesothelioma, not a study of patients. The Spanish Society of Medical Oncology (SEOM) and the Spanish Lung Cancer Group chose a panel of medical oncologists, who searched the literature and wrote graded recommendations. Its background states that asbestos exposure, mainly at work or living with exposed workers, is the most frequent cause. The panel recommended that diagnosis rest on an adequate biopsy, with chest CT with intravenous contrast as the initial evaluation. Surgery to remove all visible tumor should be considered only for selected patients with early-stage, epithelioid disease without N2 lymph node involvement. It should be performed by experienced surgeons in highly specialized centers, given its substantial morbidity and mortality. For patients unsuitable for surgery, the standard was 4 to 6 cycles of cisplatin plus pemetrexed. Gemcitabine or vinorelbine could be offered second-line, and clinical trials were encouraged. The guideline also cited a separate trial, CheckMate-743, which reported median overall survival of 18.1 months with nivolumab plus ipilimumab versus 14.1 months with chemotherapy. The authors concluded that platinum plus pemetrexed is standard care for unresectable or advanced disease.

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: Clinical practice guideline based on a literature review by an expert panel, with recommendations graded using the Infectious Diseases Society of America system
• Who was studied: No patients were studied. The guideline covers patients with malignant pleural mesothelioma. It was written by Spanish medical oncologists for SEOM and the Spanish Lung Cancer Group (2020).
• Exposure: Not studied. The guideline is about treatment. Its background states that asbestos exposure, mainly occupational or para-occupational (for example, living with exposed industry workers), is the most frequent cause of malignant pleural mesothelioma. It does not name specific fiber types.
• Main results:
  • Recommendation: diagnosis of malignant pleural mesothelioma should always be based on an adequate biopsy (graded IIA)
  • Recommendation: a chest CT scan with intravenous contrast should be performed as the initial evaluation in patients with suspected malignant pleural mesothelioma (graded IIB). The guideline also notes that chest radiography might show pleural effusion or thickening.
  • Recommendation: surgery for maximal cytoreduction (extrapleural pneumonectomy or pleurectomy/decortication) should only be considered in selected patients with early-stage disease (confined to the pleural envelope, no N2 lymph node involvement) and epithelioid histology. The stated reason is the substantial morbidity and mortality of these procedures.
  • Recommendation: these operations should be performed in highly specialized centers by experienced thoracic surgeons
  • Recommendation: extended pleurectomy/decortication is the preferred surgical method
  • Recommendation: prophylactic radiotherapy of chest wall procedure tracts should not be routinely offered (graded IA)
  • Recommendation: for patients not suitable for surgery, the standard first-line treatment is 4 to 6 cycles of cisplatin plus pemetrexed
  • Recommendation: second-line chemotherapy with gemcitabine or vinorelbine can be offered (graded IIB). Participation in clinical trials should be encouraged because second-line chemotherapy has limited efficacy.
  • From a separate trial cited by the guideline (CheckMate-743), not from this article: in previously untreated patients, nivolumab plus ipilimumab gave median overall survival of 18.1 months versus 14.1 months with platinum plus pemetrexed (HR 0.74, p = 0.002)
• The authors' conclusion: The authors concluded that platinum plus pemetrexed chemotherapy is the standard of care for patients with unresectable or advanced malignant pleural mesothelioma

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Mesothelioma, Prognosis, Pleura, Asbestos Exposure, Cytoreductive Surgery, Tumor Board, Unresectable.

Related studies

• Malignant pleural mesothelioma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up — R.A. Stahel, W. Weder, et al. (2010)
• Clinical features and current treatment of diffuse malignant pleural mesothelioma — V.W. Rusch (1995)
• Gemcitabine and vinorelbine as second-line or beyond treatment in patients with malignant pleural mesothelioma pretreated with platinum plus pemetrexed chemotherapy — G. Toyokawa, M. Takenoyama, et al. (2014)
• Peritoneal mesothelioma: PSOGI/EURACAN clinical practice guidelines for diagnosis, treatment and follow-up — S. Kusamura, V. Kepenekian, et al. (2021)
• Platinum-based doublet chemotherapy in pre-treated malignant pleural mesothelioma (MPM) patients: a mono-institutional experience — G. Pasello, S. Nicotra, et al. (2011)
• Malignant pleural mesothelioma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up — P. Baas, D. Fennell, et al. (2015)

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