Malignant mediastinal mesothelioma treated with anlotinib: a case report and review of the literature

Our plain-English summary of Malignant mediastinal mesothelioma treated with anlotinib: a case report and review of the literature, by Y. Zhang, W. He, K. Zhan, et al (Frontiers in Oncology, 2023).

The study

• Authors: Y. Zhang, W. He, K. Zhan, L. Zhang, H. Cao, R. Xu
• Journal: Frontiers in Oncology
• Published: 2023;13:1153233
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant mesothelioma that originates from mediastinal (MMM) is a rare form of malignant pleural mesothelioma (MPM). The prognosis of advanced stage MPM was poor, and the traditional treatment was chemotherapy. Here, we present a patient with MMM that was treated with anlotinib, a multitargeted tyrosine kinase inhibitor (TKI) who had a 24-month progression-free survival (PFS). Further review of the literature showed that, despite some explorations of applying small-molecule multitargeted TKIs in the treatment of MPM, until today, no large series had a positive result. Anlotinib had been approved by the China Food and Drug Administration on treating non-small cell lung cancer, soft tissue sarcoma, renal cell carcinoma, and medullary thyroid cancer. We assumed that the ability of anlotinib to target more tyrosine kinase receptors than most of other TKIs could contribute to the long duration of PFS in this case, but further study is needed to further validate the efficacy of anlotinib in treatment of MPM.

Copyright © 2023 Zhang, He, Zhan, Zhang, Cao and Xu.

In plain English

This article reports one patient with malignant mediastinal mesothelioma, which the authors call a rare form of malignant pleural mesothelioma, and reviews published treatment studies. The patient, a 65-year-old woman, was admitted to Shenzhen People's Hospital, China, in November 2017 after seven months of cough and hoarseness. The authors reported she had no history of remarkable asbestos exposure. A biopsy of a mediastinal mass confirmed mesothelioma. She first received radiation with pemetrexed and cisplatin chemotherapy, and the disease progressed in October 2018. From November 2018 she took the oral drug anlotinib, a multitargeted tyrosine kinase inhibitor. Her best response was stable disease. She had level 2 high blood pressure, which was controlled with medication. Progression was recorded in November 2020, a progression-free survival of 24 months, and she died in December 2020. Trial results in the review come from other studies. The authors concluded that anlotinib could be a potential treatment option for malignant mesothelioma. They noted there were no data on anlotinib in this disease and that further study is needed.

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 of a single patient, with a review of the literature on treatment of malignant pleural mesothelioma
• Who was studied: One 65-year-old woman with cough and hoarseness for 7 months, admitted to Shenzhen People's Hospital, China, in November 2017, with a mediastinal mass diagnosed as mesothelioma
• Exposure: No asbestos exposure was studied. The patient was reported to have no history of remarkable asbestos exposure. The treatment described was second-line anlotinib, 12 mg by mouth once daily for 14 days of each 21-day cycle, after first-line radiation (64 Gy in 30 fractions) with pemetrexed and cisplatin
• Main results:
  • A fine needle biopsy of the mediastinal lesion (3.5 by 3.8 cm) showed tumor cells positive for calretinin and HBME-1 on immunohistochemistry, which the authors took as confirming mesothelioma. Abdominal CT found no distant organ metastasis.
  • First-line radiation with four cycles of pemetrexed and cisplatin chemotherapy, given from January 2018, was followed by stable disease on imaging.
  • In October 2018 she had pleural effusions on both sides containing malignant cells, and the disease was considered to have progressed.
  • The patient refused second-line chemotherapy and was started on single-agent anlotinib on 2 November 2018. Her best response was stable disease.
  • During anlotinib treatment she had level 2 blood pressure elevation, which was well controlled with amlodipine besylate 5 mg per day.
  • Disease progression (dysphagia and an enlarged mass on chest CT) was noted on 28 November 2020, giving a recorded progression-free survival of 24 months on anlotinib.
  • After the second progression she accepted only best supportive care and died on 19 December 2020.
• The authors' conclusion: The authors concluded that this case indicated anlotinib could be a potential treatment option for malignant mesothelioma. They suggested that anlotinib's ability to target more tyrosine kinase receptors than most other such drugs, together with tolerable side effects, might explain the long duration of treatment in this case.
• Limitations the authors state:
  • The authors stated that no data existed on anlotinib, alone or combined with other therapies, in mesothelioma, so the treatment decision was based on the doctors' experience.
  • The authors stated that further study is needed to validate the efficacy of anlotinib in malignant pleural mesothelioma.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Pleural Mesothelioma, Prognosis, Chemotherapy, Tyrosine Kinase Inhibitor, Progression-Free Survival, Non-Small Cell Lung Cancer, Sarcoma.

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