Successful treatment of simultaneous malignant pleural mesothelioma and pulmonary adenocarcinoma: A case report

Our plain-English summary of Successful treatment of simultaneous malignant pleural mesothelioma and pulmonary adenocarcinoma: A case report, by Y. Amakusa, T. Suzuki, Y. Hikosaka, et al (Oncology Letters, 2024).

The study

• Authors: Y. Amakusa, T. Suzuki, Y. Hikosaka, M. Takemura, T. Oguri
• Journal: Oncology Letters
• Published: 2024;27(4):155
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

The present report described the case of a 74-year-old male patient with asbestos exposure whose chest computed tomography revealed a right lower lobe nodule and right pleural effusion. Pleural biopsy led to the diagnosis of epithelial malignant pleural mesothelioma (cT2N0M0, stage IB). Combination therapy with cisplatin + pemetrexed led to the complete remission of malignant pleural mesothelioma; however, the right lower lobe nodule grew in size over time. The patient was subsequently diagnosed with lung adenocarcinoma (cT1aN0M0, stage IA1) by computed tomography-guided biopsy performed 18 months after chemotherapy initiation and achieved remission of lung adenocarcinoma with stereotactic radiotherapy. The patient was alive without recurrence at the 12-month follow-up. The present case illustrated that multiple active regimens are currently available for malignant pleural mesothelioma and lung cancer that can aid in the treatment of complex cases.

Copyright: © Amakusa et al.

In plain English

This was a case report about one patient: a 74-year-old man in Japan with about 30 years of work-related asbestos exposure and more than 30 years of smoking. The article did not name the asbestos fiber type. A pleural biopsy taken by thoracoscopy showed epithelioid malignant pleural mesothelioma, stage IB. The patient declined surgery. He received four courses of cisplatin plus pemetrexed, then pemetrexed alone, which was stopped after three courses because of drug-induced pneumonia. The pleural masses shrank and later disappeared. However, a nodule in the right lower lobe of the lung grew about 5 mm over 18 months. A CT-guided biopsy 20 months after the first visit led to a diagnosis of stage IA1 lung adenocarcinoma, suggesting invasive mucinous adenocarcinoma. The patient again declined surgery and had stereotactic radiotherapy, after which the nodule shrank. Twelve months after radiotherapy, neither cancer had recurred. The authors concluded that the several treatments now available for both cancers should aid the treatment of complex cases. They noted that this case does not mean surgery can be avoided.

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 (single patient)
• Who was studied: One 74-year-old male patient referred to Gamagori City Hospital, Japan, in November 2019 after a routine annual check-up chest X-ray; smoking history of more than 30 years
• Exposure: Occupational asbestos exposure for about 30 years; fiber type, products and job not specified. The patient also had a smoking history of more than 30 years.
• Main results:
  • A thoracoscopic pleural biopsy was diagnosed as epithelioid mesothelioma, staged as malignant pleural mesothelioma cT2N0M0, stage IB
  • After four courses of cisplatin plus pemetrexed, follow-up CT showed reduction of the pleural masses
  • Maintenance pemetrexed was stopped after three courses because of drug-induced pneumonia
  • The pleural mass disappeared, but the nodule in the S10 segment of the right lower lobe grew about 5 mm in the 18 months after initial diagnosis
  • A CT-guided biopsy of the nodule led to a diagnosis of lung adenocarcinoma, cT1aN0M0, stage IA1, in the right lower lobe; the pathology suggested invasive mucinous adenocarcinoma
  • The patient refused surgery and received stereotactic radiotherapy (3 days, maximum total dose 58.9 Gy), after which the nodule shrank
  • Twelve months after radiotherapy, there was no recurrence of mesothelioma or lung cancer
• The authors' conclusion: The authors concluded that the multiple active treatment regimens currently available for malignant pleural mesothelioma and lung cancer should aid the treatment of complex cases like this one
• Limitations the authors state:
  • The authors stated that the success of radiotherapy in this case does not mean surgery can be avoided, or that radiotherapy should be preferred
  • The authors stated that the long-term effect of these treatments on recurrence still needs to be studied

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Adenocarcinoma, Asbestos Exposure, Pleural Effusion, Pleural Biopsy, Cisplatin, Pemetrexed (Alimta), Lung Adenocarcinoma.

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