To slay a dragon: Timing of chemotherapy in resectable pleural mesothelioma

Our plain-English summary of To slay a dragon: Timing of chemotherapy in resectable pleural mesothelioma, by B.M. Burt, R.T. Ripley, S.S. Groth (The Journal of Thoracic and Cardiovascular Surgery, 2019).

The study

• Authors: B.M. Burt, R.T. Ripley, S.S. Groth
• Journal: The Journal of Thoracic and Cardiovascular Surgery
• Published: 2019;157(2):767-768
• Type of article: Editorial, Comment
• Read it: PubMed · Publisher

In plain English

This is a short editorial commentary on a study by Verma and colleagues in the same journal. It reports no new patient data and does not discuss asbestos exposure. The authors stated that surgery for malignant pleural mesothelioma (pleurectomy/decortication or extrapleural pneumonectomy) should be done only as part of combined treatment, which often includes chemotherapy. The best order of chemotherapy and surgery is unknown and was being tested in a randomized phase II trial. They summarized the Verma study, which used the National Cancer Database to compare chemotherapy before surgery (induction) with chemotherapy after surgery (adjuvant) in patients with node-negative epithelial or biphasic disease. In that study, overall survival was similar in the two groups, but complications and deaths after surgery were higher in the induction group. The authors noted that many patients cannot receive chemotherapy after surgery, and that the Verma study did not have these data. Citing early trials in patients whose tumors could not be removed, they called results for checkpoint-blockade immunotherapy encouraging. The authors concluded that innovative treatment approaches are needed to meaningfully affect survival.

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: Editorial commentary (opinion piece) on another published study. It contains no original data.
• Who was studied: No patients were studied by these authors. The commentary discusses an analysis by Verma and colleagues of the National Cancer Database. That analysis covered patients undergoing surgery for node-negative epithelial or biphasic malignant pleural mesothelioma, compared in propensity-matched groups.
• Exposure: Asbestos exposure is not discussed. The topic is treatment: the timing of chemotherapy before (induction) versus after (adjuvant) surgery for malignant pleural mesothelioma.
• Main results:
  • This is the authors' position, not a study finding. They stated that surgery for malignant pleural mesothelioma should be performed only as part of multimodality treatment, which often includes chemotherapy, because surgery alone cannot effectively treat microscopic disease.
  • Not this article's own data: the authors reported that in the Verma and colleagues study, overall survival was similar in the induction and adjuvant chemotherapy groups.
  • Not this article's own data: the authors reported that in the Verma and colleagues study, postoperative morbidity and mortality were higher in the induction chemotherapy group.
  • Not this article's own data: citing published trials and analyses of checkpoint blockade in patients with unresectable mesothelioma, the authors stated that objective response rates were about 20% and durable clinical response rates about 50%.
• The authors' conclusion: The authors concluded that innovative treatment approaches to malignant pleural mesothelioma are needed to meaningfully affect survival. They anticipated that adding checkpoint blockade to multimodal treatment that includes surgery may improve survival.
• Limitations the authors state:
  • About the Verma study (not this commentary): the authors noted that many patients cannot receive chemotherapy after surgery, and that data on this were not available in that study.
  • The authors noted that published data on checkpoint blockade in mesothelioma came only from patients with unresectable disease in phase I and II trials and retrospective analyses.

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: Chemotherapy, Pleural Mesothelioma.

Related studies

• How does the timing of chemotherapy affect outcome following radical surgery for malignant pleural mesothelioma? — A.J. Sharkey, K.J. O'Byrne, et al. (2016)
• The timing of chemotherapy in the management plan for medically operable early-stage malignant pleural mesothelioma — K. Shohdy, O. Abdel-Rahman (2019)
• Prognostic significance of metabolic response by positron emission tomography after neoadjuvant chemotherapy for resectable malignant pleural mesothelioma — Y. Tsutani, T. Takuwa, et al. (2013)
• Prognostic Role of Programmed Cell Death 1 Ligand 1 in Resectable Pleural Mesothelioma — H.S. Lee, M. Hamaji, et al. (2021)
• The pyrophysiology and sexuality of dragons — S.T. Georgy, J.G. Widdicombe (2002)
• Models for mesothelioma incidence following exposure to fibers in terms of timing and duration of exposure and the biopersistence of the fibers — G. Berry (1999)

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