Understanding the new therapeutic options for mesothelioma

Our plain-English summary of Understanding the new therapeutic options for mesothelioma, by H.L. Kindler (The Lancet. Oncology, 2021).

The study

• Author: H.L. Kindler
• Journal: The Lancet. Oncology
• Published: 2021;22(10):1353-1355
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This article was a short commentary, not a new study. The author discussed recent drug trials for mesothelioma and focused on the RAMES trial by Pinto and colleagues, published in the same journal. As the author described it, RAMES was a phase 2 trial run at 26 hospitals in Italy. It enrolled patients with malignant pleural mesothelioma whose disease had progressed after first-line pemetrexed plus cisplatin or carboplatin. Of these, 80 received gemcitabine with ramucirumab and 81 received gemcitabine with placebo. The author reported that overall survival in RAMES was 13.8 months with ramucirumab versus 7.5 months with gemcitabine alone, and progression-free survival was 6.4 versus 3.3 months. Response rates did not differ between the groups, and toxicity was modest. The author also summarised the CheckMate 743 trial, in which overall survival was 18.1 months with ipilimumab plus nivolumab versus 14.1 months with chemotherapy. The author cautioned against drawing phase 3 conclusions from a phase 2 trial. The author concluded that it was unclear where the RAMES regimen now fits and that a phase 3 trial of it might not be worthwhile.

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: Commentary (a Lancet Oncology 'Comment' piece) on the RAMES trial and other recent mesothelioma treatment trials; no new data were collected
• Who was studied: No population was studied by the author. The comment describes the RAMES trial's patients: people with malignant pleural mesothelioma recruited from 26 hospitals in Italy, randomly allocated to gemcitabine with ramucirumab (n=80) or with placebo (n=81). Their median age was 69 years (range 44 to 81), 119 (74%) were men, and all were White.
• Exposure: No asbestos exposure is discussed. The treatment discussed in RAMES was gemcitabine with or without the VEGFR-2 antibody ramucirumab, given as second-line treatment after pemetrexed plus cisplatin or carboplatin.
• Main results:
  • As reported in the comment, RAMES patients given gemcitabine plus ramucirumab had overall survival of 13.8 months versus 7.5 months with gemcitabine alone
  • As reported in the comment, progression-free survival in RAMES was 6.4 months in the ramucirumab group versus 3.3 months with gemcitabine alone
  • As reported in the comment, RAMES showed no difference in response rates between groups, and toxicity was modest
  • As summarised by the author, in the CheckMate 743 trial overall survival was 18.1 months with ipilimumab plus nivolumab versus 14.1 months with chemotherapy across all histological subtypes
  • As summarised by the author, in CheckMate 743 patients with non-epitheloid tumours had survival of 8.8 months with chemotherapy and 18.1 months with immunotherapy
• The authors' conclusion: The author concluded that, since ipilimumab plus nivolumab became the approved first-line treatment, it is unclear where the RAMES regimen fits, and that a phase 3 trial of this regimen might not be worthwhile
• Limitations the authors state:
  • The author noted that RAMES did not report information on subsequent lines of therapy
  • The author cautioned that phase 3 conclusions should not be drawn from a randomised phase 2 trial

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma.

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• Methylation profile landscape in mesothelioma: possible implications in early detection, disease progression, and therapeutic options — X. Zhang, N. Tang, et al. (2015)
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• Preoperative assessment and therapeutic options for patients with malignant pleural mesothelioma — S. Paul, S. Neragi-Miandoab, et al. (2004)

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