Malignant Peritoneal Mesothelioma: An In-Depth and Up-to-Date Review of Pathogenesis, Diagnosis, Management and Future Directions

Our plain-English summary of Malignant Peritoneal Mesothelioma: An In-Depth and Up-to-Date Review of Pathogenesis, Diagnosis, Management and Future Directions, by J.B. Karpes, R. Shamavonian, S. Dewhurst, et al (Cancers, 2023).

The study

• Authors: J.B. Karpes, R. Shamavonian, S. Dewhurst, E. Cheng, R. Wijayawardana, N. Ahmadi, D.L. Morris
• Journal: Cancers
• Published: 2023;15(19)
• Type of article: Review
• Cited by: 27 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant peritoneal mesothelioma (MPM) is an extremely rare malignancy usually confined to the abdominal cavity. With an aggressive natural history, morbidity and mortality are consequences of progressive locoregional effects within the peritoneal cavity. The first reported case was in the early 20th century, however, due to the rare nature of the disease and a large gap in understanding of the clinicopathological effects, the next reported MPM cases were only published half a decade later. Since then, there has been exponential growth in our understanding of the disease, however, there are no prospective data and a paucity of literature regarding management. Traditionally, patients were treated with systemic therapy and the outcomes were very poor, with a median survival of less than one year. However, with the advent of cytoreductive surgery and locoregional chemotherapy, there have been significant improvements in survival. Even more recently, with an improved understanding of the molecular pathogenesis of MPM, there have been reports of improved outcomes with novel therapies. Given the disastrous natural history of MPM, the limited data, and the lack of universal treatment guidelines, an in-depth review of the past, present, and future of MPM is critical to improve treatment regimens and, subsequently, patient outcomes.

In plain English

This was a narrative literature review, not a new study. The authors, from St George Hospital in Sydney, Australia, searched PubMed, Google Scholar and Scopus for English-language publications on malignant peritoneal mesothelioma (MPM), a cancer of the lining of the abdomen. They selected 60 of more than 135 relevant items and summarized what other studies reported on its history, causes, diagnosis and treatment. Citing earlier literature, they reported that MPM accounts for up to 30 percent of mesotheliomas. They also reported that 30–50 percent of MPM cases have an association with asbestos, compared with more than 80 percent of pleural mesothelioma cases, and that the average latency for MPM is about 20 years. No asbestos fiber types were specified. Cited studies reported a median survival of about one year with systemic chemotherapy alone. One cited study of 401 patients treated with cytoreductive surgery and heated intraperitoneal chemotherapy (HIPEC) reported a five-year overall survival of 47 percent. The authors concluded that this combined treatment has become the gold standard for appropriately selected patients. They noted that there are no prospective data and little literature on management.

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 literature review (no new data)
• Who was studied: Published literature on malignant peritoneal mesothelioma, searched in PubMed, Google Scholar and Scopus with no restriction on publication year and limited to English. Of more than 135 relevant studies, reports and reviews, 60 were selected.
• Exposure: Asbestos exposure, discussed as a risk factor for MPM based on cited literature, with no fiber types specified. Other listed risk factors included erionite, thorotrast, talcum, therapeutic irradiation and genetic syndromes.
• Main results:
  • Cited literature: more than 80 percent of pleural mesothelioma cases have a link to prior asbestos exposure, compared with 30–50 percent of MPM cases.
  • Cited literature: the average latency between asbestos exposure and MPM is about 20 years, versus about 30–40 years for pleural mesothelioma.
  • Cited literature: MPM makes up up to 30 percent of all mesothelioma cases.
  • Cited studies: systemic chemotherapy (single or dual agent) in MPM had response rates below 20 percent and a median survival of about one year.
  • Cited study (Yan et al.): among 401 patients treated with at least cytoreductive surgery and HIPEC, five-year overall survival was 47 percent and overall median survival was 53 months.
  • Cited study: among 72 patients treated with cytoreductive surgery and HIPEC at four Canadian centres between 2000 and 2021, five-year overall survival was 61%.
  • Cited study: a 2022 report from an Australian unit on 81 MPM patients treated from 1999 to 2021 found morbidity of 43.2 percent and mortality under five percent. Several of this review's authors are authors of that report.
  • The review reports that the 2018 PSOGI consensus guidelines recommend an informal screening program of annual abdominal imaging for people with prior asbestos exposure.
• The authors' conclusion: The authors concluded that cytoreductive surgery and HIPEC have emerged as the gold standard of treatment in appropriately selected MPM patients. They identified completeness of cytoreduction as the single most important prognostic factor.
• Limitations the authors state:
  • There are no prospective data and little literature on the management of MPM.
  • Because the disease is rare, most genomic studies of MPM are based on single cases.
  • Data on MRI and PET imaging specifically for MPM are scarce.

Topics

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Peritoneal Cavity, Systemic Therapy, Median Overall Survival, Cytoreductive Surgery, Chemotherapy.

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