Update on biology and management of mesothelioma

Our plain-English summary of Update on biology and management of mesothelioma, by R. Asciak, V. George, N.M. Rahman (European Respiratory Review, 2021).

The study

• Authors: R. Asciak, V. George, N.M. Rahman
• Journal: European Respiratory Review
• Published: 2021;30(159)
• Type of article: Review
• Cited by: 57 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma is an aggressive, incurable cancer that is usually caused by asbestos exposure several decades before symptoms arise. Despite widespread prohibition of asbestos production and supply, its incidence continues to increase. It is heterogeneous in its presentation and behaviour, and diagnosis can be notoriously difficult. Identification of actionable gene mutations has proven challenging and current treatment options are largely ineffective, with a median survival of 10-12 months.However, the past few years have witnessed major advances in our understanding of the biology and pathogenesis of mesothelioma. This has also revealed the limitations of existing diagnostic algorithms and identified new treatment targets.Recent clinical trials have re-examined the role of surgery, provided new options for the management of associated pleural effusions and heralded the addition of targeted therapies. The increasing complexity of mesothelioma management, along with a desperate need for further research, means that a multidisciplinary team framework is essential for the delivery of contemporary mesothelioma care.This review provides a synthesised overview of the current state of knowledge and an update on the latest research in the field.

Copyright ©ERS 2021.

In plain English

This article is a commissioned, peer-reviewed narrative review. It reported no new study of its own but summarised published research on malignant pleural mesothelioma, a cancer of the lining of the chest cavity. Citing earlier work, the authors wrote that 85% of mesothelioma in males is attributable to occupational asbestos exposure, that only up to 10% of occupationally exposed people develop it, and that 30 to 40 years separate first exposure and disease. They reported that amphibole fibres (amosite, crocidolite, anthophyllite, tremolite) carry a higher mesothelioma risk than chrysotile, which can be partly cleared from the lungs within months. They also reviewed other possible factors: erionite, radiation, simian virus 40 (described as controversial) and inherited gene mutations. On treatment, they described a median survival of 10 to 12 months and a lack of high-quality evidence for surgery, and reported that cisplatin with pemetrexed extended median survival from 9.3 to 12.1 months compared with cisplatin alone in a cited trial. The authors concluded that new cases are still diagnosed despite asbestos bans because of the lag between exposure and diagnosis, and that effective treatments that significantly prolong survival are lacking.

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 (commissioned, peer-reviewed article in a thoracic oncology series); no original data collected
• Who was studied: No study population of its own; the review covered published research on malignant pleural mesothelioma
• Exposure: Asbestos as the main cause reviewed, comparing amphiboles (amosite, crocidolite, anthophyllite, tremolite) with serpentine chrysotile. Other factors reviewed: erionite, ionising radiation, simian virus 40 and genetic mutations
• Main results:
  • Citing earlier studies, the authors stated that 85% of mesothelioma in males is attributable to occupational asbestos exposure, but only up to 10% of people with occupational exposure develop mesothelioma
  • Citing earlier work, the review described a latency of 30 to 40 years between first asbestos exposure and mesothelioma
  • Citing an earlier study, the review stated that chrysotile fibres can be partially digested and cleared from the lungs within months, whereas amphibole fibres persist
  • Citing an earlier source, the review stated that about 20% of mesothelioma cases are not recognised to be associated with asbestos exposure
  • Citing an earlier study, the review stated that cigarette smoking does not appear to be associated with increased mesothelioma risk
  • Citing an animal study, the review reported mesothelioma in 40 of 40 rats injected intrapleurally with erionite, compared with 19 of 40 rats injected with asbestos
  • The review described the role of simian virus 40 in mesothelioma as controversial
  • Citing a 2003 trial of 456 previously untreated patients, the review reported that cisplatin with pemetrexed improved median survival from 9.3 to 12.1 months compared with cisplatin alone
  • Citing the MARS feasibility trial, the review reported that extrapleural pneumonectomy as part of a trimodality approach was suggested to shorten survival compared with chemotherapy alone, with a post-operative mortality rate of 19%
• The authors' conclusion: The authors concluded that new mesothelioma cases are still diagnosed despite asbestos bans because of the lag between exposure and diagnosis. They added that factors other than asbestos may be involved, that effective treatments that significantly prolong survival are lacking, and that the outcomes of surgery remain controversial
• Limitations the authors state:
  • The authors noted, as a limitation of the evidence in the field, that documenting and quantifying asbestos exposure is difficult because exposure may not be recalled or may be recalled erroneously
  • The authors noted a lack of high-quality evidence supporting maximal surgical resection

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, Pleural Mesothelioma, Asbestos Exposure, Median Survival, Clinical Trial, Pleural Effusion, Multidisciplinary Team.

Related studies

• Biology and management of malignant pleural mesothelioma — P.A. Zucali, G. Giaccone (2006)
• Surgical biology for the clinician: peritoneal mesothelioma: current understanding and management — T.C. Chua, T.D. Yan, et al. (2009)
• Malignant pleural mesothelioma: update, current management, and newer therapeutic strategies — M. Pistolesi, J. Rusthoven (2004)
• Surgical Management of Malignant Pleural Mesothelioma: An Update of Clinical Evidence — C. Cao, Z. Akhunji, et al. (2015)
• Lung cancer: Biology and treatment options — H. Lemjabbar-Alaoui, O.U. Hassan, et al. (2015)
• The human proton-coupled folate transporter: Biology and therapeutic applications to cancer — S.K. Desmoulin, Z. Hou, et al. (2012)

Browse return to medical research.