Treatment of malignant mesothelioma (review)

Our plain-English summary of Treatment of malignant mesothelioma (review), by S. Mikulski (International Journal of Oncology, 1995).

The study

• Author: S. Mikulski
• Journal: International Journal of Oncology
• Published: 1995;7(6):1415-20
• Read it: PubMed · Publisher

Abstract

Malignant mesothelioma (MM) has a very variable natural history. Its known relationship to asbestos exposure is often difficult to establish in a particular patient in view of a long preceding latency period of up to 40+ years. Survival depends on several prognostic factors including histological type, stage, performance status, resectability, and response to radiation and chemotherapy (CT). The assessment of the therapeutic impact on survival is usually difficult due to the different treatment philosophies and selections of patients in various clinical trials. Combined modality treatment approaches seem to offer the best outcomes, with occasional long-term disease-free survivors. Unresectable MM presents a difficult therapeutic challenge. In patients treated with systemic CT the median survival time (MST) in the range of 6 to 12 months and the 2 year survival of <20% are typical. The MST in excess of 20 months and the 2 year survival in the range of 40% have been reported in a few multimodality therapy trials in patients with at least partially resectable MM. Despite some encouraging therapeutic results in selected patients, the overall response to treatment(s) remains unsatisfactory, and new treatments must be sought.

In plain English

This 1995 single-author review summarized published treatment results for malignant mesothelioma and reported no new patient data. It surveyed published series on supportive care alone, surgery, radiotherapy, chemotherapy and combined treatment. Most covered pleural mesothelioma, with brief sections on peritoneal, pericardial and tunica vaginalis testis mesothelioma. Citing earlier studies, the author wrote that 50 to 75% of cases are associated with asbestos exposure. The author summarized that in patients given systemic chemotherapy, median survival of 6 to 12 months and two-year survival under 20% are typical. A few multimodality trials in patients with at least partly resectable tumors reported median survival over 20 months and two-year survival around 40%. The author noted that response rates from small studies of 10 to 20 patients may range from 30 to 40%, while larger cooperative group trials of the same combinations usually range from 0 to 15%. The author concluded that combined approaches seem to produce the best results, but overall response remains grossly unsatisfactory and new treatments must be sought. The author noted that the disease's very variable course makes treatment effects hard to judge.

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 of published clinical series and trials on treatment of malignant mesothelioma (no new patient data)
• Who was studied: Patients with malignant mesothelioma described in previously published studies, mainly pleural, with sections on peritoneal, pericardial and tunica vaginalis testis mesothelioma. The review gives no search method and no total patient count.
• Exposure: The review is about treatments: supportive care, pleurectomy, extrapleural pneumonectomy, radiotherapy, chemotherapy and combined modality therapy. Asbestos appears only as background drawn from earlier studies; no fiber types are discussed.
• Main results:
  • Author's summary of the literature: in patients treated with systemic chemotherapy, median survival of 6 to 12 months and two-year survival under 20% are typical.
  • Author's summary: median survival over 20 months and two-year survival around 40% were reported in a few multimodality trials in patients with at least partially resectable mesothelioma.
  • Author's observation on chemotherapy: response rates from small studies of 10 to 20 patients may range from 30 to 40%, while larger cooperative group trials of the same combinations usually range from 0 to 15%.
  • Cited series (Alberts et al): 262 South African patients treated between 1965 and 1985 with various therapies had a median survival of 9.6 months. The series failed to show convincing evidence that available therapies change the course of the disease.
  • Cited conference abstract (Sugarbaker et al): 94 consecutive patients with stage I and II resectable pleural mesothelioma received extrapleural pneumonectomy, chemotherapy and radiotherapy. Overall survival was 48% at 2 years and 22% at 5 years, with a median survival of 23 months.
  • Peritoneal mesothelioma: according to the reviewed literature, median survival of untreated patients in most series is 4 to 12 months.
  • Pericardial mesothelioma: more than 100 cases had been reported, and most of these patients had no documented asbestos exposure.
• The authors' conclusion: The author concluded that combined modality approaches seem to produce the best results. Despite encouraging results in selected patients, overall response to therapy remains grossly unsatisfactory, and new treatment strategies must be sought, particularly for patients who failed previous treatments.
• Limitations the authors state:
  • The author stated that the impact of treatment on survival is extremely difficult to assess reliably, mainly because the natural course of the disease varies so much.
  • The author stated that survival figures after surgery are hard to interpret because studies used different treatment philosophies and selected patients differently.
  • The author noted possible publication bias: small positive chemotherapy studies are reported quickly, while larger series with lower response rates may never be reported.
  • For one cited non-randomized comparison of multimodal therapy with best supportive care, the author noted that the groups were imbalanced.

Topics

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Asbestos Exposure, Latency, Performance Status, Chemotherapy, Clinical Trial, Unresectable, Median Survival.

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