The Third Italian Consensus Conference for Malignant Pleural Mesothelioma: State of the art and recommendations

Our plain-English summary of The Third Italian Consensus Conference for Malignant Pleural Mesothelioma: State of the art and recommendations, by S. Novello, C. Pinto, V. Torri, et al (Critical Reviews in Oncology/hematology, 2016).

The study

• Authors: S. Novello, C. Pinto, V. Torri, L. Porcu, M. Di Maio, M. Tiseo, G. Ceresoli, C. Magnani, S. Silvestri, A. Veltri, M. Papotti, G. Rossi, U. Ricardi, L. Trodella, F. Rea, F. Facciolo, A. Granieri, V. Zagonel, G. Scagliotti
• Journal: Critical Reviews in Oncology/hematology
• Published: 2016;104:9-20
• Type of article: Consensus statement
• Cited by: 64 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant Pleural Mesothelioma (MPM) remains a relevant public health issue, and asbestos exposure is the most relevant risk factor. The incidence has considerably and constantly increased over the past two decades in the industrialized countries and is expected to peak in 2020-2025. In Italy, a standardized-rate incidence in 2011 among men was 3.5 and 1.25 per 100,000 in men and women, respectively, and wide differences are noted among different geographic areas. The disease remains challenging in terms of diagnosis, staging and treatment and an optimal strategy has not yet been clearly defined. The Third Italian Multidisciplinary Consensus Conference on Malignant Pleural Mesothelioma was held in Bari (Italy) in January 30-31, 2015. This Consensus has provided updated recommendations on the MPM management for health institutions, clinicians and patients.

Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

In plain English

This article is a consensus report, not an original study. It set out the state of the art and recommendations of the Third Italian Consensus Conference on malignant pleural mesothelioma, held in Bari in January 2015. Panels of Italian specialists reviewed published evidence on epidemiology, diagnosis, surgery, radiotherapy, chemotherapy, and psychological, palliative and legal care. A formal grading method (GRADE) was used only for questions comparing treatments. Citing Italian registry data, the report stated that in 2011 incidence was 3.49 cases per 100,000 person-years in men and 1.25 in women, and that 10.2% of cases were due to non-occupational asbestos exposure. It said that no test was sensitive and specific enough for early detection in people without symptoms. It found no evidence of pleural mesothelioma risk from swallowed fibers. It noted that studies had underlined a causal role for talc containing asbestos fibers. For first-line chemotherapy, it named a platinum drug combined with pemetrexed or raltitrexed as the standard. The authors concluded that current therapies had very limited efficacy and that the overall prognosis remained quite poor.

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: Consensus conference report and review of evidence with recommendations (GRADE method applied only to treatment-comparison questions)
• Who was studied: Not a patient study. The report reflects multidisciplinary panels of Italian specialists (epidemiologists, pathologists, radiologists, surgeons, oncologists, radiation oncologists, psychologists and others) at the Third Italian Consensus Conference, Bari, January 2015. The evidence reviewed concerned malignant pleural mesothelioma, with Italian registry data for incidence.
• Exposure: Asbestos exposure as the main risk factor for malignant pleural mesothelioma, both occupational and non-occupational (environmental and domestic). The report also discussed talc containing asbestos fibers, fibrous fluoro-edenite (Biancavilla, Sicily), silicon carbide whiskers and carbon nanotubes. The article does not name specific asbestos fiber types.
• Main results:
  • Citing Italian registry data, MPM incidence in Italy in 2011 was 3.49 cases per 100,000 person-years in men and 1.25 in women. This amounted to 1,428 incident cases (1,035 in men and 393 in women).
  • The Italian mesothelioma surveillance system documented that 10.2% of MPM cases were due to non-occupational asbestos exposure.
  • The proportion of hereditary MPM cases in Italy was reported as between 1.3 and 2.5%, considering only population-based surveys.
  • A monitoring campaign in Modena found an average airborne concentration of around 0.1 fibers per liter. By linear extrapolation from WHO estimates, the report stated this would correspond to a lifelong excess of about one MPM case (from 0.4 to 2.5) per 100,000 persons.
  • The report stated that there was no evidence of pleural mesothelioma risk from ingested fibers in water. It said airborne exposure from asbestos-contaminated water could occur when water fiber levels are in the millions per liter.
  • Epidemiological studies and case reports from the Italian mesothelioma registry (ReNaM) were said to have underlined the causal role of talc containing asbestos fibers.
  • No diagnostic test was considered sensitive and specific enough for early diagnosis of mesothelioma in people without symptoms.
  • The consensus position was that average latency is unaffected by exposure level. One panel member, C. Bianchi, disagreed and held that more intense asbestos exposure is linked to a shorter latency period.
  • A platinum-based doublet containing a third-generation antifolate (pemetrexed or raltitrexed) was named the front-line standard of care.
  • A 2015 meta-analysis cited by the report (printed as 1.512 patients treated with pleurectomy/decortication and 1.391 treated with extrapleural pneumonectomy) found that 30-day perioperative mortality was significantly higher after extrapleural pneumonectomy.
  • A cited Italian estimate put the economic burden of mesothelioma at 250,000 Euro per case.
• The authors' conclusion: The authors concluded that current therapies had very limited efficacy and that the overall prognosis remained quite poor. They called for effective early diagnosis and treatment strategies, and listed future research areas.
• Limitations the authors state:
  • Using dose-response relationships to weigh different exposure periods requires assumptions about factors that are often not precisely known. These include the relative potency of different asbestos types, exposure intensity, and the length of the preclinical phase.
  • Information on airborne asbestos fibers in the environment from Italian regions was described as scanty.
  • The GRADE evidence-grading method was applied only to treatment-comparison questions, not to diagnosis or epidemiology.
  • The panel was not unanimous on some recommendations, such as single-agent chemotherapy for palliation in second line.

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: Pleural Mesothelioma, State-of-the-Art Defense, Asbestos Exposure, Staging.

Related studies

• Second Italian consensus conference on malignant pleural mesothelioma: state of the art and recommendations — C. Pinto, S. Novello, et al. (2013)
• Expert opinions of the first italian consensus conference on the management of malignant pleural mesothelioma — C. Pinto, A. Ardizzoni, et al. (2011)
• Recommendations for uniform definitions of surgical techniques for malignant pleural mesothelioma: a consensus report of the international association for the study of lung cancer international staging committee and the international mesothelioma interest group — D. Rice, V. Rusch, et al. (2011)
• Consensus Report of the 2015 Weinman International Conference on Mesothelioma — M. Carbone, S. Kanodia, et al. (2016)
• Malignant mesothelioma due to non-occupational asbestos exposure from the Italian national surveillance system (ReNaM): epidemiology and public health issues — A. Marinaccio, A. Binazzi, et al. (2015)
• Epidemiological patterns of asbestos exposure and spatial clusters of incident cases of malignant mesothelioma from the Italian national registry — M. Corfiati, A. Scarselli, et al. (2015)

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