Oral Anlotinib Maintenance Therapy for an Advanced Malignant Peritoneal Mesothelioma Diagnosed by Laparoscopy After Initial Misdiagnosis to Obtain Longer Progression-Free Survival: Case Report and Literature Review

Our plain-English summary of Oral Anlotinib Maintenance Therapy for an Advanced Malignant Peritoneal Mesothelioma Diagnosed by Laparoscopy After Initial Misdiagnosis to Obtain Longer Progression-Free Survival: Case Report and Literature Review, by F.J. Qu, Y. Zhou, H. Wang (OncoTargets and Therapy, 2023).

The study

• Authors: F.J. Qu, Y. Zhou, H. Wang
• Journal: OncoTargets and Therapy
• Published: 2023;16:961-972
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant peritoneal mesothelioma (MPeM) is a rare and highly invasive malignant tumor with a lack of specificity in clinical manifestations, which can easily lead to misdiagnosis and missed diagnosis. Due to the difficulty of early diagnosis, most patients are already in the advanced stage when diagnosed, and the prognosis is poor. At present, there is no standard treatment strategy, and the existing treatment methods are not effective, the duration of remission is short, which cannot meet the clinical needs. Here we describe a patient with advanced MPeM, initially misdiagnosed as ovarian cancer, who responded to treatment with bevacizumab in combination with albumin-bound paclitaxel and cisplatin. In preparation for cytoreductive surgery (CRS), MPeM was confirmed by laparoscopic peritoneal nodule biopsy combined with histological and immunohistochemical results. Subsequently, due to intolerable neurotoxicity after chemotherapy, she received oral anlotinib therapy on April 25, 2022, and remained stable disease (SD) with the medication, having achieved more than 14 months of progression-free survival (PFS) as of the date of our manuscript submission. The patient's total treatment time was over 19 months. These treatments delayed tumor progression, reduced drug side effects, maintained a good quality of life, and further extended overall survival (OS). Our experience is that on the one hand, it is necessary to increase the clinician's understanding of the disease, and make full use of tissue samples and immunohistochemical staining to reduce the occurrence of misdiagnosis. On the other hand, based on preliminary evidence, we found that oral anlotinib offers a viable maintenance treatment strategy for patients with advanced mesothelioma, which needs to be further explored in future studies.

© 2023 Qu et al.

In plain English

This article was a case report with a literature review from a hospital in Dalian, China. It described one 66-year-old woman with advanced malignant peritoneal mesothelioma who denied any history of asbestos exposure. Based on imaging, a very high CA125 blood marker and tests on cells from abdominal fluid, she was first diagnosed with ovarian cancer spread through the abdomen. From December 2021 she received bevacizumab, albumin-bound paclitaxel and cisplatin, and her tumors shrank (partial remission). A laparoscopic biopsy in February 2022 showed peritoneal mesothelioma, mainly epithelial. Planned surgery was abandoned because the disease was too widespread. After severe hand and foot numbness from chemotherapy, she switched in April 2022 to oral anlotinib. Her disease stayed stable, and high blood pressure was the main side effect. Progression-free survival exceeded 14 months at submission, though CA125 began rising again in January 2023. The authors noted that one patient gives very limited data. They concluded that anlotinib provided a targeted maintenance option for this disease that needs testing in well-designed trials.

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 literature review
• Who was studied: One 66-year-old woman with abdominal distension, treated at Affiliated Dalian Third People's Hospital of Dalian Medical University, China, from late 2021 to 2023. She had a past history of right breast cancer treated in 2010.
• Exposure: No asbestos exposure was reported: the patient denied any history of asbestos exposure. The exposure studied was treatment: bevacizumab plus albumin-bound paclitaxel and cisplatin, followed by oral anlotinib maintenance therapy.
• Main results:
  • The patient was first diagnosed with extensive abdominal metastasis of ovarian cancer, based on cells from the abdominal fluid, imaging and tumor markers.
  • After two cycles of bevacizumab, albumin-bound paclitaxel and cisplatin, the treatment response was judged a partial remission.
  • At laparoscopy the disease was too extensive for surgery. Cytoreductive surgery was abandoned and only a biopsy of peritoneal nodules was taken.
  • The biopsy led to a final diagnosis of malignant peritoneal mesothelioma, mainly epithelial differentiation.
  • The patient developed severe hand and foot numbness with tingling from chemotherapy and refused further chemotherapy.
  • Oral anlotinib was started on April 25, 2022, at 10 mg once a day on days 1 to 14 of every 3-week cycle.
  • During anlotinib maintenance, progression-free survival reached more than 14 months by the time of submission, with stable disease on CT.
  • The main side effect during anlotinib treatment was high blood pressure, which the authors reported could be well controlled.
  • The CA125 blood marker began rising again in January 2023. Anlotinib was continued because imaging remained stable and the patient had no symptoms.
• The authors' conclusion: The authors concluded that anlotinib monotherapy kept this patient's tumors stable for more than 14 months, offering a targeted treatment option for malignant peritoneal mesothelioma that needs further study. They also concluded that obtaining tissue samples by biopsy or laparoscopy and using multiple immune markers can reduce misdiagnosis.
• Limitations the authors state:
  • Only one patient was observed, so the clinical data are very limited. The authors stated that more experience and well-designed trials are needed.

Topics

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Misdiagnosis, Progression-Free Survival, Prognosis, Ovarian Cancer, Bevacizumab, Cisplatin, Cytoreductive Surgery.

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• Preoperative Circulating Tumor DNA in Patients with Peritoneal Carcinomatosis is an Independent Predictor of Progression-Free Survival — J.M. Baumgartner, V.M. Raymond, et al. (2018)
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