The value of adriamycin in the treatment of diffuse malignant pleural mesothelioma

Our plain-English summary of The value of adriamycin in the treatment of diffuse malignant pleural mesothelioma, by B.S. Yap, R.S. Benjamin, M.A. Burgess, et al (Cancer, 1978).

The study

• Authors: B.S. Yap, R.S. Benjamin, M.A. Burgess, G.P. Bodey
• Journal: Cancer
• Published: 1978;42(4):1692-6
• Cited by: 47 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy.

Abstract

Thirty-six patients with diffuse malignant pleural mesothelioma were seen over a period of 15 years. The median age was 60 years (range, 21 to 75 years), and the male to female ratio was 2.3 to 1. The most common symptoms were chest pain and shortness of breath and all patients presented with pleural effusion on chest x-ray. The diagnosis was established by tissue biopsy in all cases. The median survival time for all patients was 12.5 months. Twenty-one patients were treated with an adriamycin-containing regimen and in this group, the median survival time from histological diagnosis was 14 months. In contrast, the median survival time for the 15 patients, who did not receive adriamycin, was 6 months (p = 0.009). The median survival time from the initiation of chemotherapy was 9 months for the adriamycin group and 2 months for patients treated with other type of chemotherapy (p = 0.001). Adriamycin appears to be of benefit in the treatment of diffuse malignant pleural mesothelioma.

In plain English

This was a review of patients with diffuse malignant pleural mesothelioma seen at the M. D. Anderson Hospital and Tumor Institute in Houston, Texas. Of 44 patients referred between 1961 and 1976, a review of tissue slides confirmed the diagnosis in 36: 25 men and 11 women, with a median age of 60. A definite history of asbestos exposure was found in 9 of them (25%). Since 1971, 21 patients had received treatment regimens that included the drug adriamycin. The other 15 were untreated or received surgery, radiation or other chemotherapy. Median survival from diagnosis was 12.5 months for all patients. It was 14 months in the adriamycin group and 6 months in the other group (p = 0.009), even though the adriamycin group included more patients whose cancer had spread. Measured from the start of chemotherapy, median survival was 9 months with adriamycin and 2 months for the 7 patients given other drugs (p = 0.001). Only 10 adriamycin-treated patients had measurable tumors, and 2 of them had a partial response. The authors noted that tumor response was hard to judge on chest x-rays. They concluded that adriamycin appears to be of benefit in this 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: Retrospective review of one hospital's patients (case series) comparing survival of patients who did and did not receive adriamycin-containing treatment
• Who was studied: 44 patients referred with diffuse malignant pleural mesothelioma to The University of Texas System Cancer Center, M. D. Anderson Hospital and Tumor Institute, Houston, between 1961 and 1976. Review of slides confirmed the diagnosis in 36 (25 men, 11 women, median age 60, range 21 to 75), who form the basis of the report. 21 received adriamycin-containing regimens and 15 did not.
• Exposure: The exposure studied was treatment, not asbestos. Adriamycin-containing chemotherapy combinations (given since 1971) were compared with no treatment or with surgery, radiation or other chemotherapy. Adriamycin was given at no less than 40 mg/m2 every 3 to 4 weeks. Asbestos exposure history was recorded only as a patient characteristic.
• Main results:
  • A definite history of asbestos exposure was obtained in 9 of the 36 patients (25%).
  • All 36 patients: median survival from histologic diagnosis was 12.5 months (range 1 to 120 months).
  • Median survival from diagnosis was 14 months (range 4 to 120+ months) in the adriamycin group (21 patients) and 6 months (range 1 to 46+ months) in the nonadriamycin group (15 patients).
  • The authors reported this 8-month survival difference as significant (p = 0.009), even though the adriamycin group had considerably more patients with regional and distant metastases.
  • Median survival from the start of chemotherapy was 9 months (range 4 to 24+ months) for the 21 adriamycin-treated patients. It was 2 months (range 2 to 12 months) for the 7 nonadriamycin patients who received other chemotherapy (p = 0.001).
  • Patients who received both adriamycin and local therapy (9 patients) had a median survival of 20 months. Patients who received local therapy only (6 patients) had a median survival of 3 months (p = 0.04).
  • In the adriamycin group, only 10 of the 21 patients had measurable disease. Of these 10, 2 achieved a partial response (greater than 50% reduction in tumor mass) and 5 had stable disease.
  • In the nonadriamycin group, 6 of the 15 patients had measurable disease. 1 patient given COMF chemotherapy had a partial response lasting 3 months, and 3 patients had stable disease.
• The authors' conclusion: The authors concluded that adriamycin appears to be of benefit (an active agent) in the treatment of diffuse malignant pleural mesothelioma.
• Limitations the authors state:
  • The authors stated that judging objective tumor response was often difficult, because chest x-ray findings were diffuse and abnormalities remained from earlier surgery or radiotherapy. Many patients also had no measurable disease.
  • The authors noted a rather low response rate in this study.

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, Pleural Effusion, Chest X-Ray, Biopsy, Median Overall Survival, Chemotherapy.

Related studies

• Diffuse pulmonary malignant mesothelioma: response to doxorubicin and 5-azacytidine — A.P. Chahinian, Y. Suzuki, et al. (1978)
• Constant infusion schedule for adriamycin: a phase I-II clinical trial of a 30-day schedule by ambulatory pump delivery system — J. Lokich, A. Bothe, et al. (1983)
• An experimental model for treatment of mesothelioma — W.E. Smith, D.D. Hubert, et al. (1981)
• Randomized comparison of cyclophosphamide, imidazole carboxamide, and adriamycin versus cyclophosphamide and adriamycin in patients with advanced stage malignant mesothelioma: a Sarcoma Intergroup Study — M.K. Samson, L.P. Wasser, et al. (1987)
• High liposomal doxorubicin tumour tissue distribution, as determined by radiopharmaceutical labelling with (99m)Tc-LD, is associated with the response and survival of patients with unresectable pleural mesothelioma treated with a combination of liposomal doxorubicin and cisplatin — O. Arrieta, L.A. Medina, et al. (2014)
• Clinical features and current treatment of diffuse malignant pleural mesothelioma — V.W. Rusch (1995)

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