Therapeutic approach to malignant mesothelioma

Our plain-English summary of Therapeutic approach to malignant mesothelioma, by J. Aisner (Chest, 1989).

The study

• Author: J. Aisner
• Journal: Chest
• Published: 1989;96(1 Suppl):95S-97S
• Type of article: Review
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 000049).

Summary of the article

This review, presented at the 5th World Conference on Lung Cancer, described treatment approaches for malignant mesothelioma, a rare tumour associated with asbestos exposure at work and in the environment. The author noted a sharply rising incidence, due in part to increased asbestos use from World War II, and said data on optimal management were only beginning to develop. Before 1980, favourable prognostic factors were female sex, early stage and long duration of symptoms, and treatment could not be shown to matter. A more recent analysis found performance status, absence of chest pain, and chemotherapy or pleuropneumonectomy to be favourable. Aggressive surgery had earlier given 2-year survival of 10-37% and 5-year survival of 10% or less, but refined techniques and earlier presentation had made pleurectomy and pleuropneumonectomy more common. Radiotherapy alone could not be shown to improve survival (median about 10 months), though doses up to 60 Gy could now be given safely. Chemotherapy reports were mostly anecdotal. Intraperitoneal cisplatin and doxorubicin produced dramatic responses in peritoneal disease, with less striking responses in pleural disease. Combined-modality regimens of surgery, chemotherapy and irradiation were described, with some peritoneal patients alive and disease-free for 4+ years. The author concluded that people exposed to asbestos should be observed carefully so that early disease is found, and that patients should be referred to specialist centres for clinical trials.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This article was a short narrative review of treatment for malignant mesothelioma. It reported no new patient data. The author described earlier analyses: before 1980 the significant prognostic factors were female sex, early stage and long duration of symptoms, and treatment could not be shown to matter. A more recent analysis found performance status, absence of chest pain, and chemotherapy or pleuropneumonectomy in pleural disease to be favorable prognostic factors. Past aggressive surgery was described as giving 2-year survivals of 10-37% and 5-year survivals of 10% or less. Radiotherapy alone could not be shown to improve survival. Chemotherapy studies in large-volume disease had shown no measurable survival effect for whole groups, though some individuals responded dramatically. Intracavitary chemotherapy, given directly into a body cavity, produced dramatic responses in peritoneal disease, while responses in pleural disease were less striking. With combined surgery, chemotherapy and radiation for peritoneal mesothelioma, some patients were alive and free of disease for 4 or more years. The author concluded that aggressive combined-modality treatment studies were clearly appropriate and that patients should be referred to specialist centers.

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: Narrative review / commentary on treatment approaches (conference paper); no original patient data
• Who was studied: No study population of its own; the article discussed published reports on patients with malignant mesothelioma (pleural and peritoneal)
• Exposure: Not studied; asbestos exposure in the workplace and environment was mentioned only as background, with no fiber types specified
• Main results:
  • In the analyses the author described for patients before 1980, the significant prognostic factors were female sex, early stage and long duration of symptoms, and treatment could not be shown to be an important variable
  • In a more recent analysis described by the author, the favorable prognostic factors were performance status, absence of chest pain, and chemotherapy or pleuropneumonectomy (pleural disease); these were prognostic factors for survival
  • In the past, more aggressive surgical procedures gave relatively high morbidity, with 2-year survivals of 10-37% and 5-year survivals of 10% or less
  • Radiotherapy alone could not be shown to improve survival in malignant mesothelioma, where the median survival was described as about 10 months; newer equipment allowed chest irradiation up to 60 Gy to be given safely
  • Chemotherapy studies in large-volume disease had not shown a measurable impact on survival of the entire group, though some individuals had dramatic responses with longer survival
  • Intracavitary chemotherapy (particularly intraperitoneal), with drugs such as cisplatin and doxorubicin, produced dramatic antitumor responses in peritoneal disease; the response in pleural disease was less striking
  • A combined approach for peritoneal mesothelioma (surgical debulking, alternating intracavitary cisplatin and doxorubicin for 10 cycles, then whole abdominal irradiation) left some patients alive and free of disease for 4 or more years
  • Preliminary studies were described as suggesting that combined-modality treatment in earlier disease can shift overall and long-term survival
• The authors' conclusion: The author concluded that, because median survival in the past had been less than a year, aggressive combined-modality treatment studies were clearly appropriate. The author also stated that patients should be referred to centers with specific interest and expertise in this disease.
• Limitations the authors state:
  • The author noted that the chemotherapy literature was confused by the anecdotal nature of most reported treatment series. Summaries of these small series did not take drug dose or schedule into account.
  • The author noted that patient characteristics in the radiotherapy series were not well defined

Topics

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

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Lung Cancer, Asbestos Exposure, Performance Status, Chemotherapy, Cisplatin, Doxorubicin, Clinical Trial.

Related studies

• Abrogating G₂/M checkpoint through WEE1 inhibition in combination with chemotherapy as a promising therapeutic approach for mesothelioma — P. Indovina, E. Marcelli, et al. (2014)
• Ponatinib is a potential therapeutic approach for malignant pleural mesothelioma — Y.W. Yang, A. Marrufo, et al. (2021)
• Current approach to malignant mesothelioma of the pleura — J. Aisner (1995)
• A feasibility study evaluating Surgery for Mesothelioma After Radiation Therapy: the "SMART" approach for resectable malignant pleural mesothelioma — B.C. Cho, R. Feld, et al. (2014)
• Multimodality approach in management of malignant pleural mesothelioma — S. Neragi-Miandoab (2006)
• A novel translational approach for human malignant pleural mesothelioma: heparanase-assisted dual virotherapy — Y. Watanabe, T. Kojima, et al. (2010)

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