Mesothelioma: a review

Our plain-English summary of Mesothelioma: a review, by F.E. Mott (Ochsner Journal, 2012).

The study

• Author: F.E. Mott
• Journal: Ochsner Journal
• Published: 2012;12(1):70-9
• Cited by: 64 articles, as counted by NIH iCite
• Read it: PubMed · Free full text

Abstract

Mesothelioma is an insidious disease with long latency after asbestos exposure. New cases are continually diagnosed, although levels are declining with recognition of the asbestos risk and efforts to remove asbestos from the workplace. Treatment for early stage disease with surgery and radiation is potentially curative, but many patients either are too ill to undergo aggressive surgery or present with advanced disease. Chemotherapy with cisplatin and pemetrexed is considered standard, although relapse is common. Second-line therapy is disappointing. New targeted therapies may pose promise and are being addressed in various clinical trial settings. Palliative care remains an important component of the management of this devastating illness.

In plain English

This was a narrative review by a single author at the Ochsner Clinic Foundation in New Orleans. It reviewed published research on mesothelioma, mostly pleural, covering causes, symptoms, pathology, diagnosis, staging and treatment. It described asbestos workers as at highest risk, with family members also at risk from fibers brought home on clothing. It stated that serpentine fibers make up 90% of the type seen in the US and are considered less carcinogenic than amphibole fibers. Cited registry data recorded 182 cases in the greater New Orleans area and 309 statewide in Louisiana from 2000 to 2008. On treatment, the review described a 2003 trial in untreated malignant pleural mesothelioma. In that trial, median overall survival was 12.1 months with cisplatin plus pemetrexed versus 9.3 months with cisplatin alone; the review called the combination standard first-line therapy for unresectable malignant pleural mesothelioma. The author concluded that treatment has improved and patients are living longer. The author also concluded that relapses are common, second-line therapies are far from satisfactory, and targeted therapies have yet to prove sufficient activity.

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 review of published literature and registry data on mesothelioma; no new study was conducted
• Who was studied: Published studies and cancer registry data on mesothelioma patients, mainly pleural mesothelioma, with US SEER and Louisiana Tumor Registry figures (Louisiana 2000 to 2008 and 2009)
• Exposure: Asbestos exposure, mainly in asbestos workers, and in family members through fibers brought home on clothing. Fibers are described as amphibole or serpentine. The review also discussed radiation therapy, carbon nanotubes (in mice) and the SV-40 virus as possible other causes.
• Main results:
  • Cited SEER registry data recorded 182 mesothelioma cases in the greater New Orleans area and 309 statewide in Louisiana for 2000 to 2008. The review states that 2009 Louisiana Tumor Registry data documented 12 cases in the New Orleans area and 57 statewide, that males were three times more likely to be diagnosed than females, and that more than half of patients presented with stage III or IV disease.
  • Citing a 1980 review, the article stated that the lifetime risk of mesothelioma for an asbestos worker was described as 10%. The same source said up to 70% of all mesothelioma cases involved documented asbestos exposure.
  • The review stated that serpentine fibers make up 90% of the type seen in the US and are considered less carcinogenic than the amphibole type.
  • In a cited 2003 phase III trial in untreated malignant pleural mesothelioma, cisplatin plus pemetrexed compared with cisplatin alone gave a response rate of 41.3% versus 16.7%, a median time to progression of 5.7 versus 3.9 months, and a median overall survival of 12.1 versus 9.3 months.
  • The review states that cisplatin plus pemetrexed is considered standard first-line therapy for unresectable malignant pleural mesothelioma. It has also become a standard recommendation in the adjuvant combined modality approach to resectable disease.
  • In a cited series of 183 patients treated with extrapleural pneumonectomy, perioperative deaths were 3.8%. Median survival was 19 months and 5-year survival was 15%.
  • In a cited randomized phase II trial in untreated patients, adding bevacizumab to cisplatin-gemcitabine did not improve the response rate (25% vs 22%), progression-free survival (6.9 vs 6.0 months) or overall survival (15.6 vs 14.7 months).
• The authors' conclusion: The author concluded that treatment, especially trimodality approaches, has improved and patients are living longer. The author also concluded that relapses and progression are common, second-line therapies are far from satisfactory, and targeted therapies have yet to prove sufficient activity.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Latency, Asbestos Exposure, Chemotherapy, Cisplatin, Pemetrexed (Alimta), Second-Line Therapy, Clinical Trial.

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