Malignant pleural mesothelioma: an update on investigation, diagnosis and treatment

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Abstract

Malignant pleural mesothelioma is an aggressive malignancy of the pleural surface, predominantly caused by prior asbestos exposure. There is a global epidemic of malignant pleural mesothelioma underway, and incidence rates are predicted to peak in the next few years.

This article summarises the epidemiology and pathogenesis of malignant pleural mesothelioma, before describing some key factors in the patient experience and outlining common symptoms. Diagnostic approaches are reviewed, including imaging techniques and the role of various biomarkers. Treatment options are summarised, including the importance of palliative care and methods of controlling pleural effusions. The evidence for chemotherapy, radiotherapy and surgery is reviewed, both in the palliative setting and in the context of trimodality treatment. An algorithm for managing malignant pleural effusion in malignant pleural mesothelioma patients is presented. Finally new treatment developments and novel therapeutic approaches are summarised.

Abstract

This article on mesothelioma describes pathogenesis, symptoms, diagnostic approaches and treatment options http://ow.ly/cjkb305aQGz

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Combined Nivolumab and Ipilimumab or Monotherapy in Untreated Melanoma

James Larkin, Vanna Chiarion-Sileni, Rene Gonzalez … (2015)

New England Journal of Medicine, 373(1), 23-34

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Phase III study of pemetrexed in combination with cisplatin versus cisplatin alone in patients with malignant pleural mesothelioma.

Nicholas J Vogelzang, James J Rusthoven, James Symanowski … (2003)

Patients with malignant pleural mesothelioma, a rapidly progressing malignancy with a median survival time of 6 to 9 months, have previously responded poorly to chemotherapy. We conducted a phase III trial to determine whether treatment with pemetrexed and cisplatin results in survival time superior to that achieved with cisplatin alone. Chemotherapy-naive patients who were not eligible for curative surgery were randomly assigned to receive pemetrexed 500 mg/m2 and cisplatin 75 mg/m2 on day 1, or cisplatin 75 mg/m2 on day 1. Both regimens were given intravenously every 21 days. A total of 456 patients were assigned: 226 received pemetrexed and cisplatin, 222 received cisplatin alone, and eight never received therapy. Median survival time in the pemetrexed/cisplatin arm was 12.1 months versus 9.3 months in the control arm (P =.020, two-sided log-rank test). The hazard ratio for death of patients in the pemetrexed/cisplatin arm versus those in the control arm was 0.77. Median time to progression was significantly longer in the pemetrexed/cisplatin arm: 5.7 months versus 3.9 months (P =.001). Response rates were 41.3% in the pemetrexed/cisplatin arm versus 16.7% in the control arm (P <.0001). After 117 patients had enrolled, folic acid and vitamin B12 were added to reduce toxicity, resulting in a significant reduction in toxicities in the pemetrexed/cisplatin arm. Treatment with pemetrexed plus cisplatin and vitamin supplementation resulted in superior survival time, time to progression, and response rates compared with treatment with cisplatin alone in patients with malignant pleural mesothelioma. Addition of folic acid and vitamin B12 significantly reduced toxicity without adversely affecting survival time.

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Relevance of breast cancer hormone receptors and other factors to the efficacy of adjuvant tamoxifen: patient-level meta-analysis of randomised trials

Michael Gnant, Early Breast Cancer Trialists' Collaborative Group (EBCTCG) (2011)

Summary Background As trials of 5 years of tamoxifen in early breast cancer mature, the relevance of hormone receptor measurements (and other patient characteristics) to long-term outcome can be assessed increasingly reliably. We report updated meta-analyses of the trials of 5 years of adjuvant tamoxifen. Methods We undertook a collaborative meta-analysis of individual patient data from 20 trials (n=21 457) in early breast cancer of about 5 years of tamoxifen versus no adjuvant tamoxifen, with about 80% compliance. Recurrence and death rate ratios (RRs) were from log-rank analyses by allocated treatment. Findings In oestrogen receptor (ER)-positive disease (n=10 645), allocation to about 5 years of tamoxifen substantially reduced recurrence rates throughout the first 10 years (RR 0·53 [SE 0·03] during years 0–4 and RR 0·68 [0·06] during years 5–9 [both 2p<0·00001]; but RR 0·97 [0·10] during years 10–14, suggesting no further gain or loss after year 10). Even in marginally ER-positive disease (10–19 fmol/mg cytosol protein) the recurrence reduction was substantial (RR 0·67 [0·08]). In ER-positive disease, the RR was approximately independent of progesterone receptor status (or level), age, nodal status, or use of chemotherapy. Breast cancer mortality was reduced by about a third throughout the first 15 years (RR 0·71 [0·05] during years 0–4, 0·66 [0·05] during years 5–9, and 0·68 [0·08] during years 10–14; p<0·0001 for extra mortality reduction during each separate time period). Overall non-breast-cancer mortality was little affected, despite small absolute increases in thromboembolic and uterine cancer mortality (both only in women older than 55 years), so all-cause mortality was substantially reduced. In ER-negative disease, tamoxifen had little or no effect on breast cancer recurrence or mortality. Interpretation 5 years of adjuvant tamoxifen safely reduces 15-year risks of breast cancer recurrence and death. ER status was the only recorded factor importantly predictive of the proportional reductions. Hence, the absolute risk reductions produced by tamoxifen depend on the absolute breast cancer risks (after any chemotherapy) without tamoxifen. Funding Cancer Research UK, British Heart Foundation, and Medical Research Council.

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Author and article information

Journal

Journal ID (nlm-ta): Eur Respir Rev

Journal ID (iso-abbrev): Eur Respir Rev

Journal ID (publisher-id): ERR

Journal ID (hwp): errev

Title: European Respiratory Review

Publisher: European Respiratory Society

ISSN (Print): 0905-9180

ISSN (Electronic): 1600-0617

Publication date (Print): December 2016

Volume: 25

Issue: 142

Pages: 472-486

Affiliations

[1 ]Academic Respiratory Unit, University of Bristol, Bristol ,UK

[2 ]North Bristol NHS Trust, Bristol, UK

[3 ]Queen Elizabeth University Hospital, Glasgow, UK

[4 ]Institute of Cancer Sciences, University of Glasgow, Glasgow, UK

[5 ]Respiratory Trials Unit, University of Oxford, Churchill Hospital, Oxford, UK

[6 ]Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, UK

[7 ]Dept of Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK

[8 ]Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK

Author notes

Anna C Bibby, Academic Respiratory Unit, 2nd Floor Learning & Research Building, Southmead Hospital, Bristol, BS10 5NB, UK. E-mail: Anna.Bibby@ 123456bristol.ac.uk

Article

Publisher ID: ERR-0063-2016

DOI: 10.1183/16000617.0063-2016

PMC ID: 9487555

PubMed ID: 27903668

SO-VID: 17719a2e-695f-4f73-b034-ec6d299882bc

License:

ERR articles are open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.

History

Date received : 01 July 2016

Date accepted : 12 October 2016

Funding

Funded by: NHS Research Scotland Career Research Fellowship, doi ;

Funded by: North Bristol NHS Trust Springboard Award, doi ;

Funded by: carefusion, doi ;

Funded by: European Respiratory Society, doi 10.13039/100008593;

Award ID: (RESPIRE2 – 2015–7160)

Award ID: (STRTF 2015-9508).

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Malignant pleural mesothelioma: an update on investigation, diagnosis and treatment

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Most cited references 147

Combined Nivolumab and Ipilimumab or Monotherapy in Untreated Melanoma

Phase III study of pemetrexed in combination with cisplatin versus cisplatin alone in patients with malignant pleural mesothelioma.

Relevance of breast cancer hormone receptors and other factors to the efficacy of adjuvant tamoxifen: patient-level meta-analysis of randomised trials

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