Current treatment strategies in malignant pleural mesothelioma with a treatment algorithm

Our plain-English summary of Current treatment strategies in malignant pleural mesothelioma with a treatment algorithm, by M. Sayan, M.F. Eren, A. Gupta, et al (Advances in Respiratory Medicine, 2019).

The study

• Authors: M. Sayan, M.F. Eren, A. Gupta, N. Ohri, A. Kotek, I. Babalioglu, S. Oskeroglu Kaplan, O. Duran, O. Derinalp Or, F. Cukurcayir, N. Kurtul, B. Ceylaner Bicakci, T. Kutuk, S. Senyurek, A. Turk, S.K. Jabbour, B. Atalar
• Journal: Advances in Respiratory Medicine
• Published: 2019;87(5):289-297
• Type of article: Review
• Cited by: 11 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma (MPM) is arare disease with apoor prognosis. The main therapeutic options for MPM include surgery, chemotherapy, and radiation therapy (RT). Although multimodality therapy has been reported to improve survival, not every medically operable patient is able to undergo all recommended therapy. With improvements in surgical techniques and systemic therapies, as well as advancements in RT, there has been apotential new paradigm in the management of this disease. In this review, we discuss the current literature on MPM management and propose afunctional treatment algorithm.

In plain English

This article was a review, not a new study. The authors summarized published research on treating malignant pleural mesothelioma (MPM) with surgery, chemotherapy and radiation therapy, and proposed a treatment algorithm. The algorithm is a figure not reproduced in the available text. Asbestos appears only as background, and the review did not study exposure. On surgery, the review cited a meta-analysis by Taioli et al. that found no significant difference in two-year survival between pleurectomy/decortication (P/D) and extrapleural pneumonectomy (EPP), but higher 30-day mortality after EPP (4.5% vs 1.7%). It also cited the MARS 1 trial, in which median survival was 14.4 months with EPP versus 19.5 months without. On chemotherapy, it cited a 448-patient trial in which pemetrexed-cisplatin gave longer median survival than cisplatin alone (12.1 vs 9.3 months). The review stated that, in prospective studies of trimodality therapy with EPP, only about 50% of patients were able to undergo all therapy. The authors concluded that surgery is indicated mainly as part of trimodality therapy and that whether EPP or extended-P/D is superior remains highly debated.

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: Review of published literature on MPM treatment, with a proposed treatment algorithm; no new data were collected
• Who was studied: Published studies on treatment of malignant pleural mesothelioma. The article does not describe search methods or the number of studies reviewed. Its tables list 14 studies of surgical techniques and 18 studies of trimodality therapy.
• Exposure: Not an exposure study. The review concerns treatments: surgery (EPP, P/D, extended-P/D), chemotherapy, immunotherapy and radiation therapy. Asbestos and erionite are mentioned only as background risk factors.
• Main results:
  • In a meta-analysis by Taioli et al. cited by the review, there was no significant difference in two-year overall survival between P/D and EPP (23.8% vs 25%; p = 0.8). Perioperative 30-day mortality was higher after EPP than after P/D (4.5% vs 1.7%; p < 0.05).
  • In the MARS 1 feasibility trial cited by the review, 50 patients were randomized. Median overall survival was lower in the EPP group (14.4 months vs 19.5 months), with a hazard ratio for death of 2.75 (95% CI 1.21 to 6.26; p = 0.016).
  • In a phase III trial by Vogelzang et al. of 448 medically inoperable, chemotherapy-naive patients, cisplatin-pemetrexed gave longer median overall survival than cisplatin alone (12.1 vs 9.3 months; p = 0.020).
  • In a trial by Zalcman et al., adding bevacizumab to cisplatin-pemetrexed increased overall survival (18.8 vs 16.1 months; p = 0.0167). Grade 3 to 4 adverse events occurred in 71% of patients receiving bevacizumab and 62% of those receiving cisplatin-pemetrexed alone.
  • The review stated that, as reported in multiple prospective studies, radiation therapy improves local control and survival as part of trimodality therapy with EPP. It added that only about 50% of the patients are able to undergo all therapy.
  • In the SMART phase III trial of 203 patients, procedure-tract recurrence did not differ significantly between prophylactic radiotherapy and deferred radiotherapy (9% vs 16%; p = 0.14).
• The authors' conclusion: The authors concluded that surgery for MPM is indicated mainly as part of trimodality therapy, and that whether EPP or extended-P/D is superior remains highly debated, with a shift towards extended-P/D. They also concluded that the best treatment is determined through a multidisciplinary approach in experienced cancer centers.
• Limitations the authors state:
  • The authors note that the evidence base lacks level I evidence favoring one surgical procedure, and that randomized trial data comparing the procedures are lacking.

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: Pleural Mesothelioma, Prognosis, Chemotherapy, Multimodal Therapy.

Related studies

• Identifying patients with suspected lung cancer in primary care: derivation and validation of an algorithm — J. Hippisley-Cox, C. Coupland (2011)
• Current surgical strategies for malignant pleural mesothelioma — T. Takuwa, S. Hasegawa (2016)
• Analysis of Treatment Strategies and Outcomes in Malignant Peritoneal Mesothelioma: Insights From a Multi-Center Study — S. Yaşar, F. Yılmaz, et al. (2024)
• Surgical treatment of peritoneal carcinomatosis: current treatment modalities — Y. Kulu, B. Müller-Stich, et al. (2014)
• Malignant pleural mesothelioma: update, current management, and newer therapeutic strategies — M. Pistolesi, J. Rusthoven (2004)
• Testing mapping algorithms of the cancer-specific EORTC QLQ-C30 onto EQ-5D in malignant mesothelioma — D.T. Arnold, D. Rowen, et al. (2015)

Browse return to medical research.