Prolonged survival with systemic chemotherapy in an advanced malignant mesothelioma: A case report

Our plain-English summary of Prolonged survival with systemic chemotherapy in an advanced malignant mesothelioma: A case report, by M.A. Elghali, R. Bourigua, I. Belaid, et al (Rare Tumors, 2021).

The study

• Authors: M.A. Elghali, R. Bourigua, I. Belaid, S. Nasri, S. Mestiri, S. Yaacoub, A. Makni, R. Letaief
• Journal: Rare Tumors
• Published: 2021;13:2036361320984527
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Peritoneal mesotheliomas are very rare tumors. Their prognosis is poor, average survival does not exceed 1 year after peritoneal cytoreduction. Systemic chemotherapy is considered to have no proven value in the management of peritoneal mesotheliomas. Objective responses with systemic chemotherapy are very rare. We report here a case of an advanced peritoneal mesothelioma which achieved an unexpected partial response with chemotherapy, allowing the patient to have a right colectomy. The patient was referred to a specialized center on HIPEC, but taking in account the long awaiting interval, the HIPEC was judged to be inefficient and then the poursuit of 6 cycles of systemic chemotherapy was decided. The patient is still alive without any symptom and with a good performance status at 59 months after diagnosis. Throughout our case, we provide an encouraging evidence of the role of initial systemic chemotherapy in the downstaging of initially unresectable primary malignant mesothelioma and in the improvement of overall survival.

© The Author(s) 2021.

In plain English

This article was a case report about one patient, written by authors from Farhat Hached University Hospital in Sousse, Tunisia. A 60-year-old man with no history of exposure to asbestos had a large build-up of fluid in the abdomen (ascites). A biopsy taken during keyhole surgery showed malignant peritoneal mesothelioma. Because the disease was widespread, the patient was given palliative chemotherapy. After 3 cycles of pemetrexed and cisplatin, the tumors partly shrank and the ascites disappeared. Health insurance issues forced a switch to paclitaxel and carboplatin for 3 cycles. The disease stayed stable, but the patient developed grade 3 nerve damage (peripheral neuropathy). Carboplatin alone followed for 5 cycles, with no significant change. About two and a half years after chemotherapy began, surgeons removed a remaining mass along with the right part of the colon. HIPEC, a heated abdominal chemotherapy, was recommended but judged inefficient because of a long waiting time, so 6 more chemotherapy cycles were decided on instead. The patient was alive and in excellent condition 59 months after diagnosis. The authors concluded that the case gave encouraging evidence for chemotherapy in initially inoperable disease.

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 (single patient)
• Who was studied: One 60-year-old man with malignant peritoneal mesothelioma, diagnosed by biopsy during laparoscopy. The authors were based at hospitals in Sousse and Tunis, Tunisia. No dates of treatment are given.
• Exposure: The patient had no history of asbestos exposure. The report concerns treatment: systemic chemotherapy (pemetrexed plus cisplatin, then paclitaxel plus carboplatin, then carboplatin alone) followed by surgery.
• Main results:
  • After 3 cycles of pemetrexed (500 mg/m2) and cisplatin (100 mg/m2), the patient had a partial response by RECIST1.1 criteria and the ascites completely disappeared.
  • Because of health insurance issues, treatment switched to paclitaxel (175 mg/m2) and carboplatin (AUC5) for 3 cycles. The disease was stable, but the patient developed grade 3 peripheral neuropathy.
  • Carboplatin alone (AUC 5) was then given for 5 cycles, with no significant change on CT scan.
  • At 2.5 years after chemotherapy began, a second laparoscopy found no ascites or peritoneal nodules. A mass near the right colon was removed together with the right colon (right colectomy). Pathology confirmed the same tumor type.
  • HIPEC was indicated, but because of the long waiting interval it was judged inefficient, and continuing with 6 cycles of systemic chemotherapy was decided. The article does not explicitly confirm that all 6 cycles were given.
  • CT scans every 6 months showed no progression. The patient had survived 59 months after diagnosis and remained in excellent general condition.
• The authors' conclusion: The authors stated that, to their knowledge, a 59-month overall survival with tumor stability and excellent performance status had never been reported. They concluded that the case provided encouraging evidence for systemic chemotherapy in patients with initially unresectable disease.

Topics

Medical terms in this study, explained in our Lexicon: Chemotherapy, Mesothelioma, Peritoneal Mesothelioma, Prognosis, Cytoreductive Surgery, HIPEC, Performance Status, Unresectable.

Related studies

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• Meta-Analysis of Survival and Development of a Prognostic Nomogram for Malignant Pleural Mesothelioma Treated with Systemic Chemotherapy — R. Kotecha, R. Tonse, et al. (2021)
• Post-chemotherapy T-cell recovery is a marker of improved survival in patients with advanced thoracic malignancies — M.J. McCoy, R.A. Lake, et al. (2012)
• A phase II trial of prolonged, continuous infusion of low-dose gemcitabine plus cisplatin in patients with advanced malignant pleural mesothelioma — O. Arrieta, D. López-Macías, et al. (2014)
• Chronic inflammation in tumor stroma is an independent predictor of prolonged survival in epithelioid malignant pleural mesothelioma patients — K. Suzuki, K. Kadota, et al. (2011)
• Low ERCC1 expression in malignant pleural mesotheliomas treated with cisplatin and vinorelbine predicts prolonged progression-free survival — Z.G. Zimling, J.B. Sørensen, et al. (2012)

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