Malignant peritoneal mesothelioma literature review: past, present, and future

Our plain-English summary of Malignant peritoneal mesothelioma literature review: past, present, and future, by S.N. Gregory, A.L. Sarvestani, A.M. Blakely (Digestive Medicine Research, 2022).

The study

• Authors: S.N. Gregory, A.L. Sarvestani, A.M. Blakely
• Journal: Digestive Medicine Research
• Published: 2022;5
• Cited by: 15 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background And Objective: Malignant peritoneal mesothelioma (MPM) is an insidious neoplasm that arises from the mesothelial lining of the abdominal cavity. Historically, outcomes of MPM were dismal, as MPM is relatively resistant to cytotoxic chemotherapy. However, with advances in technology and improved understanding of tumor pathophysiology, treatments for MPM have produced encouraging 5-year survival. The standard of care for patients with resectable disease remains cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC). Patients with inoperable MPM can be offered several systemic treatments, including chemotherapy, immune checkpoint inhibitors, or investigational treatments. Our objective is to provide an overview of our current knowledge concerning MPM and latest advances in treatment.

Methods: Narrative overview of the literature published in English from database origin until January 31, 2022 relating to MPM was searched in PubMed database, Google Scholar, and ClinicalTrials.gov.

Key Content And Findings: CRS-HIPEC has offered improved survival for surgical candidates, however outcomes for inoperable MPM remains dismal. With advancements in technology and better understanding of underlying MPM biology, new treatment approaches are arising and imperative.

Conclusions: MPM is a rare and lethal disease of the peritoneum. CRS-HIPEC remains the standard of care for resectable disease. In 2022, several clinical trials are available for patients with MPM offering future advances in therapy and further understanding of this rare disease process.

In plain English

This article was a narrative review, not a new study. The authors searched PubMed, Google Scholar and ClinicalTrials.gov for English-language articles on malignant peritoneal mesothelioma (MPM), a cancer of the abdominal lining, published up to January 31, 2022. Citing earlier studies, they wrote that asbestos remains the most identifiable risk factor, though only 10–33% of MPM cases have a positively identified previous asbestos exposure, and that MPM takes 20 years to develop after exposure. They also noted that talc-based products have been associated with mesothelioma and ovarian cancer because they contain small amounts of asbestos minerals such as chrysotile and amphiboles. In the studies reviewed, surgery to remove visible tumor followed by heated chemotherapy inside the abdomen (CRS-HIPEC) gave selected patients a median survival of 30–100 months and a 5-year survival of 40–70%. For disease that could not be removed surgically, median survival was 1 year. The authors concluded that CRS-HIPEC remains the standard of care for patients whose disease can be surgically removed and who are in good general condition (performance status). They wrote that less effective treatments are available for advanced disease that cannot be removed.

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
• Who was studied: Published English-language literature on malignant peritoneal mesothelioma, from database inception to January 31, 2022. Included study types were randomized and non-randomized prospective trials, retrospective studies, case reports, reviews and meta-analyses.
• Exposure: Not an exposure study. Citing other literature, the review discussed asbestos as a risk factor, and talc-based products containing small amounts of asbestos minerals such as chrysotile and amphiboles. Its main focus was treatment.
• Main results:
  • Citing other studies, the review stated that asbestos remains the most identifiable risk factor for MPM, but only 10–33% of MPM cases have positively identified previous asbestos exposure.
  • The review stated that MPM takes 20 years to develop after exposure, so recalling the exposure can be difficult.
  • Citing other studies, the review stated that MPM makes up 20–30% of all mesothelioma in developed countries.
  • Citing other studies, CRS combined with HIPEC improved the prognosis of selected MPM patients to a median survival of 30–100 months and an overall 5-year survival of 40–70%.
  • Citing another study, the review gave median survival for unresectable MPM as 1 year.
  • The review stated that CRS followed by HIPEC is the standard of care for patients with resectable disease and good performance status.
  • The review stated that approximately one-third of women with MPM are initially misdiagnosed with ovarian cancer.
  • The review stated that pemetrexed with cisplatin is considered the standard first-line systemic treatment for unresectable disease.
• The authors' conclusion: The authors concluded that CRS-HIPEC remains the standard of care. They stated elsewhere in the article that this applies to patients with resectable disease and good performance status. They concluded that it is associated with long-term survival in patients whose tumor is completely or nearly completely removed. They added that less effective options are available for advanced nonresectable disease, including systemic therapy, immune checkpoint inhibitors, investigational agents, NIPEC and PIPAC.
• Limitations the authors state:
  • The authors noted that prospective randomized data are not available for the comparison of selective versus complete parietal peritonectomy.
  • The authors noted that the cohorts in the reviewed phase II intraperitoneal chemotherapy protocols were small, from a single institution, and non-randomized.
  • The authors noted that the evidence for the efficacy of immune checkpoint inhibitors in MPM has been limited.

Topics

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Neoplasm, Chemotherapy, Cytoreductive Surgery, HIPEC, checkpoint inhibitors, Peritoneum, Clinical Trial.

Related studies

• Surgical treatment of malignant peritoneal mesothelioma: past, present, and future — H.R. Alexander (2010)
• Asbestos use and asbestos-related diseases in Asia: past, present and future — G.V. le, K. Takahashi, et al. (2011)
• Exposure to asbestos: past, present and future — E. Pira, F. Donato, et al. (2018)
• Manipulating microRNAs for the Treatment of Malignant Pleural Mesothelioma: Past, Present and Future — G. Reid, T.G. Johnson, et al. (2020)
• Hamster Polyomavirus Research: Past, Present, and Future — B. Jandrig, H. Krause, et al. (2021)
• The ghost of public health journalism: past, present, and future — G.S. Cooper, R.C. Brown (2010)

Browse return to medical research.