The future of mesothelioma treatment: time to shift gear

Our plain-English summary of The future of mesothelioma treatment: time to shift gear, by M. Maio, L. Calabrò (The Lancet. Respiratory Medicine, 2019).

The study

• Authors: M. Maio, L. Calabrò
• Journal: The Lancet. Respiratory Medicine
• Published: 2019;7(7):554-555
• Type of article: Comment
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This was a short commentary, not an original study. The authors discussed another group's trial: the phase 3 part of the LUME-Meso study by Scagliotti and colleagues, in patients with advanced malignant pleural mesothelioma. They noted that standard treatment for unresectable pleural mesothelioma was still a platinum-based drug plus pemetrexed, with median overall survival of around 1 year. As the commentary described it, the earlier phase 2 part of LUME-Meso had reported improved progression-free survival when nintedanib was added to chemotherapy (hazard ratio 0.56, 95% CI 0.34 to 0.91). In the phase 3 part, 458 patients were randomly assigned to cisplatin and pemetrexed plus nintedanib (229) or placebo (229). Median progression-free survival (6.8 vs 7.0 months) and median overall survival (14.4 vs 16.1 months) were similar between the groups. The authors suggested testing drugs that target blood-vessel growth in carefully selected patient subgroups through small studies. They wrote that whether immune checkpoint drugs will begin a new era in mesothelioma therapy remains to be established.

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: Commentary (a journal 'Comment' article) on another research group's published randomised phase 3 trial (LUME-Meso, by Scagliotti and colleagues); not original research by these authors
• Who was studied: The commentary concerns patients with advanced or unresectable malignant pleural mesothelioma. The trial it discusses (LUME-Meso phase 3) enrolled 458 patients with epithelioid histology and an Eastern Cooperative Oncology performance status score of 0 or 1. The commentary gives no country or study dates for that trial.
• Exposure: No asbestos exposure is discussed. The treatment examined in the trial under comment was nintedanib (a triple angiokinase inhibitor) or placebo, each added to cisplatin and pemetrexed chemotherapy.
• Main results:
  • As reported in the commentary, in the phase 3 LUME-Meso trial by Scagliotti and colleagues, median progression-free survival was 6.8 months in the nintedanib group vs 7.0 months in the placebo group. Median overall survival was 14.4 months vs 16.1 months. The two groups were similar.
  • As described in the commentary, the earlier phase 2 LUME-Meso study had observed improved progression-free survival when nintedanib was added to standard chemotherapy in untreated patients (HR 0.56, 95% CI 0.34 to 0.91; p=0.017). For overall survival the HR was 0.77 (0.46 to 1.29; p=0.319).
  • The commentary notes that an exploratory analysis by Scagliotti and colleagues suggested improved overall and progression-free survival in nintedanib-treated patients who had a high platelet count at baseline. The commentary authors called this intriguing and possibly worth further exploration.
  • The authors stated that the standard treatment for unresectable pleural mesothelioma was still a platinum-based drug plus pemetrexed. They gave median overall survival for these patients as around 1 year.
• The authors' conclusion: The authors suggested that the anti-angiogenic approach might be explored in selected patient subgroups through small proof-of-principle studies, rather than large phase 3 trials in unselected patients. They wrote that whether immune checkpoint targeting will begin a new era in mesothelioma therapy remains to be established.

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma.

Related studies

• Nintedanib in combination with pemetrexed and cisplatin for chemotherapy-naive patients with advanced malignant pleural mesothelioma (LUME-Meso): a double-blind, randomised, placebo-controlled phase 3 trial — G.V. Scagliotti, R. Gaafar, et al. (2019)
• LUME-Meso: Design and Rationale of the Phase III Part of a Placebo-Controlled Study of Nintedanib and Pemetrexed/Cisplatin Followed by Maintenance Nintedanib in Patients With Unresectable Malignant Pleural Mesothelioma — G.V. Scagliotti, R. Gaafar, et al. (2017)
• Combined hyaluronate-based films loaded with pemetrexed and cisplatin for the treatment of malignant pleural mesothelioma: Preliminary evaluation in an orthotopic tumor recurrence model — F. Sonvico, S. Barbieri, et al. (2018)
• Phase I Trial of Cediranib in Combination with Cisplatin and Pemetrexed in Chemonaive Patients with Unresectable Malignant Pleural Mesothelioma (SWOG S0905) — A.S. Tsao, J. Moon, et al. (2017)
• Antifibrotic treatment response and prognostic predictors in patients with idiopathic pulmonary fibrosis and exposed to occupational dust — V. Casillo, S. Cerri, et al. (2019)
• Time trend of mesothelioma incidence in the United States and projection of future cases: an update based on SEER data for 1973 through 2005 — B. Price, A. Ware (2009)

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