In-vitro proliferation assay with recycled ascitic cancer cells in malignant pleural mesothelioma: A case report

Our plain-English summary of In-vitro proliferation assay with recycled ascitic cancer cells in malignant pleural mesothelioma: A case report, by T. Anayama, M. Taguchi, T. Tatenuma, et al (World Journal of Clinical Cases, 2019).

The study

• Authors: T. Anayama, M. Taguchi, T. Tatenuma, H. Okada, R. Miyazaki, K. Hirohashi, M. Kume, K. Matsusaki, K. Orihashi
• Journal: World Journal of Clinical Cases
• Published: 2019;7(23):4036-4043
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: We report the first case, to the best of our knowledge, of massive ascites due to recurrent malignant pleural mesothelioma that was controlled using KM-cell-free and concentrated ascites reinfusion therapy (KM-CART). The tumor cells derived via KM-CART were utilized secondarily in an in vitro cell growth assay using the collagen gel droplet-embedded culture drug sensitivity test (CD-DST) to investigate anticancer drug susceptibility.

Case Summary: A 56-year-old man presented with recurrent malignant mesothelioma with massive ascites; more than 4000 mL of ascitic fluid was removed, filtered, and concentrated using KM-CART, and the cell-free ascitic fluid was reinfused into the patient to improve quality of life. Cancer cells isolated secondarily in an in vitro proliferation assay using CD-DST exhibited low sensitivity to pemetrexed and high sensitivity to gemcitabine. Treatment with gemcitabine maintained stable disease for 4 mo.

Conclusion: The combination of KM-CART and CD-DST may be a promising treatment option for malignant ascites associated with malignant mesothelioma.

©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.

In plain English

This was a case report about one 56-year-old man in Japan with malignant pleural mesothelioma. He had been occupationally exposed to asbestos from age 24 to 30; the article does not name the fiber type. His mesothelioma, of the epithelioid type, was removed by surgery (extrapleural pneumonectomy), and it was staged p-Stage III. Lung metastases appeared 13 months later and were treated with pemetrexed alone. At 21 months he developed massive malignant ascites, a fluid build-up in the abdomen. The authors drained 4050 mL of fluid, filtered and concentrated it with a system called KM-CART, and reinfused 610 mL into his vein. His pain and breathlessness eased. Cancer cells collected during filtering were tested in the laboratory against drugs. Pemetrexed did not reduce their growth, while gemcitabine reduced it to 21.9% of the untreated control. Gemcitabine kept his disease stable for 4 months. He died 2 years and 4 months after surgery. The authors concluded that combining the two techniques may offer an option for personalized treatment. They noted that cells taken from ascites may be less viable than surgical tissue.

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: case report (single patient)
• Who was studied: One 56-year-old man with malignant pleural mesothelioma, treated at Kochi Medical School, Kochi University, Japan
• Exposure: Occupational asbestos exposure from age 24 to 30 years (fiber type and job not stated). He also had a smoking history recorded as 30 pack-years.
• Main results:
  • After extrapleural pneumonectomy, pathology showed diffuse malignant pleural mesothelioma, epithelioid type, p-T2N2M0, p-Stage III
  • After lung metastases appeared 13 months after surgery, single-agent pemetrexed achieved stable disease
  • KM-CART for massive malignant ascites at 21 months: 4050 mL of fluid was drained and processed, and 610 mL of concentrate with protein 8.0 g/dL was reinfused
  • After KM-CART, the patient's weight fell by 1.7 kg, and his abdominal pain and breathlessness resolved
  • In the laboratory drug sensitivity test (CD-DST) on the patient's ascitic tumor cells, pemetrexed did not reduce growth (109.4% of control), while gemcitabine reduced growth to 21.9% of control
  • The tumor cells were also less susceptible to cisplatin, carboplatin, nedaplatin, paclitaxel, docetaxel and vinorelbine
  • Second-line gemcitabine kept the patient's disease stable for 4 months
  • The patient died 2 years and 4 months after the initial surgery. No increase in ascites was observed until 4 months before death.
• The authors' conclusion: The authors concluded that combining KM-CART with CD-DST on recycled ascitic cancer cells may provide a unique option for personalized treatment of massive malignant ascites. They described this as, to their knowledge, the first such report.
• Limitations the authors state:
  • CD-DST was designed for fresh surgical tumor tissue. Mesothelioma cells taken from ascites may be less viable, which may have affected the assay's growth results.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Ascites, Collagen, Mesothelioma, Quality of Life, Pemetrexed (Alimta), Gemcitabine.

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