Long-term benefit from immune modulation and anti-inflammatory treatment in metastatic mesothelioma

Our plain-English summary of Long-term benefit from immune modulation and anti-inflammatory treatment in metastatic mesothelioma, by A.G. Dalgleish, E. McLean, N. Patel, et al (Respiratory Medicine Case Reports, 2020).

The study

• Authors: A.G. Dalgleish, E. McLean, N. Patel, N. Rahman
• Journal: Respiratory Medicine Case Reports
• Published: 2020;29:100971
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

A 64 year old male heating engineer was investigated for a persistent cough and found to have epithelioid mesothelioma with pleural effusion, lung nodules and increased thoracic lymph nodes. He declined standard of care treatment following his own research and he was enrolled in a named patient programme of IMM-101. He was advised to correct his low vitamin D3 level and to start using anti-inflammatories such as aspirin, bromelain and low dose Naltrexone. At review one year later a CT scan showed no change and he continued on the regimen. Four years after the diagnosis a CT scan showed that there was a modest but definite progression of the left malignant pleural thickening, and a new right-sided effusion, enlargement of several intrathoracic nodes which had been noted on the early scans. The chest wall lump eventually broke down and required local radiotherapy. He then developed abdominal pain and found to have peritoneal disease. Last year he obtained the cannabinoids CBD and THC which slowed down the disease and a CT scan after he had been on this for six months, showed that his disease was fairly stable with marginal progression.

© 2019 Published by Elsevier Ltd.

In plain English

This case report described one patient, a 64-year-old male heating engineer. A persistent cough led to a diagnosis of epithelioid mesothelioma with a pleural effusion, pleural nodules and enlarged chest lymph nodes. The article does not describe any asbestos exposure for him. He declined standard surgery and chemotherapy. He received IMM-101, a heat-killed bacterial preparation intended to boost the immune response, through a named patient programme. He was also advised to correct a low vitamin D3 level and to take aspirin, bromelain and low-dose naltrexone. No significant side effects were reported apart from a local reaction where the injections were given. A CT scan one year later showed no change. A scan three years further on showed slow progression. Four years after diagnosis a tumour grew in the chest wall at the biopsy site, and it responded to local radiotherapy. Disease later appeared in the peritoneum (the lining of the abdomen). A lung metastasis measured 10mm at baseline and 13mm at 46, 54 and 65 months. The authors concluded that this approach should be tested in trials. One author sits on the advisory board of the company that supplied IMM-101.

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 (a single patient)
• Who was studied: One 64-year-old male heating engineer with a persistent cough, found to have epithelioid mesothelioma with pleural effusion, pleural nodules and increased thoracic lymph nodes; treated in the UK (author affiliations in London and Oxford); scans followed from baseline to 65 months
• Exposure: No asbestos exposure is described for this patient; only his job (heating engineer) is given. The treatment reported was IMM-101 (heat-killed whole cell Mycobacterium obuense, injected into the skin), plus advice to correct low vitamin D3 and to use aspirin, bromelain and low-dose naltrexone; zoledronic acid was later started for osteoporosis
• Main results:
  • IMM-101 caused no significant toxicities apart from a local reaction at the injection site
  • A CT scan at one-year review showed no change
  • At a review three years further on, CT showed slow progression
  • Four years after diagnosis he had an enlarging chest wall lesion at the original biopsy site, with modest but definite progression of the left malignant pleural thickening
  • The chest wall lump broke down and responded to local radiotherapy
  • He then developed abdominal pain and was found to have peritoneal disease
  • A right upper lobe lung metastasis measured 10mm at baseline and 13mm on CT studies at 46, 54 and 65 months
  • After radiotherapy he took no other treatment apart from a cannabis oil preparation, which he felt improved his symptoms
• The authors' conclusion: The authors concluded that the case suggests this immune-modulatory and anti-inflammatory approach should be trialled in similar cases of mesothelioma, particularly in patients who refuse standard surgery and chemotherapy

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Epithelioid, Pleural Effusion, CT Scan, Pleural Thickening, Intrathoracic.

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