The 2019 ERS/ESTS/EACTS/ESTRO Guidelines on the Management of Patients With Malignant Pleural Mesothelioma

Our plain-English summary of The 2019 ERS/ESTS/EACTS/ESTRO Guidelines on the Management of Patients With Malignant Pleural Mesothelioma, by T.A. Gelzinis (Journal of Cardiothoracic and Vascular Anesthesia, 2021).

The study

• Author: T.A. Gelzinis
• Journal: Journal of Cardiothoracic and Vascular Anesthesia
• Published: 2021;35(2):378-388
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant pleural mesothelioma is a rare aggressive cancer, with insidious growth, and is associated with poor outcomes that have not improved over the years. A task force made up of members of the European Respiratory Society (ERS)/European Society of Thoracic Surgeons (ESTS)/European Association for Cardio-Thoracic Surgery (EACTS)/European Society for Radiotherapy and Oncology (ESTRO) societies, who are experts in the field of malignant mesothelioma, reviewed the literature from 2009 to 2018 to update the 2009 guidelines concerning epidemiology, diagnosis, staging, and treatment, including surgical, radiotherapy, and medical management, as well as palliative care to provide the best evidence-based recommendations for this patient population.

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In plain English

This single-author review summarized the 2019 European guidelines on malignant pleural mesothelioma, a cancer of the lining around the lungs. A task force from four European societies had systematically reviewed 2009 to 2018 literature to update 2009 guidelines. No new patients were studied. More than 80% of patients had prior asbestos exposure, the article states. The panel found no biomarker with a validated role in diagnosis, prognosis or follow-up; pleural plaques were called a marker of asbestos exposure. It suggested germline genetic testing for selected patients. First-line chemotherapy remained platinum and pemetrexed for suitable patients, adding bevacizumab, if available, for those able to tolerate it and cisplatin but not macroscopic complete resection; bevacizumab lacked US and European regulatory approval for mesothelioma. Surgery (extended pleurectomy/decortication) was limited to highly selected patients. The panel advised against routine preventive drain-site radiotherapy and recommended talc poudrage for recurrent fluid; pending further trial evidence, it suggested chest/abdominal CT every 3 to 6 months after active treatment. Immunotherapy was judged to need more trial results. The author noted the outlook had changed little in 10 years.

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: Review article (special article) summarizing the 2019 ERS/ESTS/EACTS/ESTRO guidelines on malignant pleural mesothelioma; no original data
• Who was studied: No patients studied directly; the article summarizes guidelines from a multidisciplinary European task force that systematically reviewed the published literature from 2009 to 2018 on malignant pleural mesothelioma
• Exposure: Not a study of a specific exposure. As background, the article describes asbestos (chrysotile, crocidolite, amosite, anthophyllite, tremolite, actinolite) as the main cause, and also mentions erionite and fluoro-edenite
• Main results:
  • The panel concluded that no biomarker for malignant pleural mesothelioma currently has a validated role in diagnosis, prognosis or clinical follow-up
  • Pleural plaques were described as a marker of asbestos exposure that can occur in exposed people who do not have mesothelioma
  • The task force suggested germline genetic testing for selected patients with mesothelioma
  • First-line drug treatment recommendations remained platinum and pemetrexed (with folic acid and vitamin B12 supplementation) in patients suitable for chemotherapy
  • The experts suggested adding bevacizumab, if available, to cisplatin/pemetrexed in patients stable enough to tolerate bevacizumab and cisplatin, but not macroscopic complete resection
  • The article notes bevacizumab was not yet approved for malignant pleural mesothelioma by the US Food and Drug Administration or the European Medicines Agency
  • In highly selected patients, surgery may be appropriate, with extended pleurectomy/decortication (EP/D) as the procedure of choice
  • The task force did not recommend prophylactic drain-site radiotherapy in routine clinical care
  • Patients who are candidates for multimodal treatment should be informed of the risks (and referred to expert centers for trials or registries)
  • Talc poudrage was the recommended procedure to control recurrent pleural effusions caused by malignant pleural mesothelioma
  • Immunotherapy was judged to need further development and more positive trial results before definitive recommendations
  • Pending further evidence from clinical trials, the task force suggested a chest/abdominal CT scan every 3 to 6 months after active treatment
• The authors' conclusion: The author concluded that, despite much research, the outlook for patients with malignant pleural mesothelioma has not changed much during the past 10 years
• Limitations the authors state:
  • There are no high-quality randomized trials supporting a specific combination of treatments
  • There are no evidence-based recommendations on follow-up of patients treated mainly with chemotherapy

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, Thoracic Surgery, Malignant Mesothelioma, Epidemiology, Staging, Palliative Care.

Related studies

• A survey of opinions and beliefs concerning surgery for malignant pleural mesothelioma amongst 802 members of the European Association for Cardio-Thoracic Surgery (EACTS), the European Society of Thoracic Surgeons (ESTS) and the Society of Thoracic Surgeons (STS) — T. Treasure, E. Internullo, et al. (2011)
• British Thoracic Society Guideline for the investigation and management of malignant pleural mesothelioma — I. Woolhouse, L. Bishop, et al. (2018)
• Commentary: Surgeon versus mesothelioma in a thoracic cage match — C.D. Hoang (2020)
• Guidelines of the European Respiratory Society and the European Society of Thoracic Surgeons for the management of malignant pleural mesothelioma — A. Scherpereel, P. Astoul, et al. (2010)
• Guidelines of the French Speaking Society for Chest Medicine for management of malignant pleural mesothelioma — A. Scherpereel, French Speaking Society for Chest Medicine (SPLF) Experts Group (2007)
• Diagnostic surgical pathology in lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines — A.M. Schwartz, M.K. Rezaei (2013)

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