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Sørensen JB, Baas P, Szépligeti SK, Pedersen AB, Johnsen SP, Carroll R, Schoemaker MJ, Rault C, Daumont MJ, Ehrenstein V. Patient characteristics, treatment patterns, and survival outcomes for patients with malignant pleural mesothelioma in Denmark between 2011 and 2018: a nationwide population-based cohort study. Acta Oncol 2024; 63:649-657. [PMID: 39114950 PMCID: PMC11332510 DOI: 10.2340/1651-226x.2024.34802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 05/31/2024] [Indexed: 08/21/2024]
Abstract
BACKGROUND Malignant pleural mesothelioma (MPM) is a rare thoracic malignancy with poor prognosis and limited treatment options. Immunotherapy shows potential for improved outcomes; however, real-world evidence on its use will take time to accumulate. This study examined patient characteristics, treatment patterns, overall survival (OS), and predictors of mortality among patients diagnosed with MPM in Denmark prior to the introduction of newer treatments. METHODS This historical cohort study based on routinely collected Danish National Registry data included adults newly diagnosed with MPM between 01 January 2011 and 31 May 2018. Summary statistics were used to describe patient characteristics and initial treatment. OS was estimated using Kaplan-Meier methods; Cox regression was used to compare patient mortality against the (age/sex-matched) general population and to investigate mortality predictors. RESULTS Overall, 880 patients were included; 44% had advanced MPM, 37% had non-advanced MPM, and 19% had unknown MPM stage. Median age at diagnosis was 71.9 years, and 82% of the patients were male. Within 180 days of diagnosis, no treatment was recorded for 215 patients (54%) with advanced MPM and 150 (46%) with non-advanced MPM. Median time-to-initial treatment (interquartile range) was 47 days (31-111) overall, 40 days (28-77) in patients with advanced MPM, and 53 days (35-121) with non-advanced MPM. Median OS was 13.7 months overall (non-advanced MPM: 18.0 months vs. advanced MPM: 10.0 months). Predictors of higher mortality were older age at diagnosis, histology, and advanced MPM stage. INTERPRETATION These findings provide a baseline upon which to evaluate MPM epidemiology as newer treatments are adopted in routine practice.
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Affiliation(s)
| | - Paul Baas
- Department of Thoracic Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Alma B Pedersen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Søren P Johnsen
- Danish Center for Health Services Research, Department for Clinical Medicine, Aalborg University Aalborg, Denmark
| | - Robert Carroll
- Centre for Observational Research and Data Science, Bristol Myers Squibb, Uxbridge, UK
| | | | | | - Melinda J Daumont
- Worldwide Health Economics & Outcomes Research, Bristol Myers Squibb, Braine-L'Alleud, Belgium
| | - Vera Ehrenstein
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
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Porcel JM. Mesotelioma pleural. Med Clin (Barc) 2022; 159:240-247. [DOI: 10.1016/j.medcli.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 10/18/2022]
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van Kooten JP, Belderbos RA, von der Thüsen JH, Aarts MJ, Verhoef C, Burgers JA, Baas P, Aalbers AGJ, Maat APWM, Aerts JGJV, Cornelissen R, Madsen EVE. Incidence, treatment and survival of malignant pleural and peritoneal mesothelioma: a population-based study. Thorax 2022; 77:1260-1267. [PMID: 35149582 DOI: 10.1136/thoraxjnl-2021-217709] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 12/30/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Malignant mesothelioma (MM) is an aggressive cancer that primarily arises from the pleura (MPM) or peritoneum (MPeM), mostly due to asbestos exposure. This study reviewed the Dutch population-based incidence, treatment and survival since the national ban on asbestos in 1993. MATERIALS AND METHODS Patients with MPM or MPeM diagnosed from 1993 to 2018 were selected from the Dutch cancer registry. Annual percentage change (APC) was calculated for (age-specific and sex-specific) revised European standardised incidence rates (RESR). Treatment pattern and Kaplan-Meier overall survival analyses were performed. RESULTS In total, 12 168 patients were included in the study. For male patients younger than 80 years, the MM incidence significantly decreased in the last decade (APC ranging between -9.4% and -1.8%, p<0.01). Among both male and female patients aged over 80 years, the incidence significantly increased during the entire study period (APC 3.3% and 4.6%, respectively, p<0.01). From 2003 onwards, the use of systemic chemotherapy increased especially for MPM (from 9.3% to 39.4%). Overall, 62.2% of patients received no antitumour treatment. The most common reasons for not undergoing antitumour treatment were patient preference (42%) and performance status (25.6%). The median overall survival improved from 7.3 (1993-2003) to 8.9 (2004-2011) and 9.3 months from 2012 to 2018 (p<0.001). CONCLUSION The peak of MM incidence was reached around 2010 in the Netherlands, and currently the incidence is declining in most age groups. The use of systemic chemotherapy increased from 2003, which likely resulted in improved overall survival over time. The majority of patients do not receive treatment though and prognosis is still poor.
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Affiliation(s)
- Job P van Kooten
- Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Kanker Instituut, Rotterdam, The Netherlands
| | - Robert A Belderbos
- Pulmonary Medicine, Erasmus MC Kanker Instituut, Rotterdam, The Netherlands
| | | | - Mieke J Aarts
- Department of Research and Development, Dutch Association of Comprehensive Cancer Centers, Utrecht, The Netherlands
| | - Cornelis Verhoef
- Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Kanker Instituut, Rotterdam, The Netherlands
| | - Jacobus A Burgers
- Thoracic Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Paul Baas
- Thoracic Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Arend G J Aalbers
- Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | | | - Robin Cornelissen
- Pulmonary Medicine, Erasmus MC Kanker Instituut, Rotterdam, The Netherlands
| | - Eva V E Madsen
- Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Kanker Instituut, Rotterdam, The Netherlands
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de Rouw N, de Boer M, Boosman RJ, van den Heuvel MM, Burger DM, Lieverse JE, Derijks HJ, Frederix GWJ, Ter Heine R. The pharmacoeconomic benefits of pemetrexed dose individualization in lung cancer patients. Clin Pharmacol Ther 2022; 111:1103-1110. [PMID: 35048355 PMCID: PMC9304220 DOI: 10.1002/cpt.2529] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/05/2022] [Indexed: 11/06/2022]
Abstract
Neutropenia is a dose-related treatment-limiting and costly adverse event of pemetrexed. We postulate that individualized dosing reduces the incidence of neutropenia. The aims of this study were to 1) investigate the costs of pemetrexed-related neutropenia and 2) to determine the pharmacoeconomic benefits of individualized dosing of pemetrexed in terms of budget impact, yearly cost savings and reduction in severe neutropenia. Retrospective data on the treatment of ≥grade 3 neutropenia during pemetrexed-based chemotherapy were collected from three Dutch hospitals to determine the mean health care consumption during a neutropenic episode. Subsequently, Monte Carlo simulations were performed using a validated pharmacokinetic/pharmacodynamic (PK/PD) model to predict the neutropenia incidence during four cycles for standard dosing of pemetrexed and individualized dosing. The mean costs per neutropenia and the expected neutropenia incidence were combined to calculate the budget impact and cost savings. We found that the average costs per pemetrexed-associated neutropenic episode to be € 1,490. The neutropenia incidence for the standard and individualized pemetrexed dosing strategies were 12.7 and 9.9%, respectively. This resulted in total expected neutropenia-related costs of approximately € 3.0 million and €2.4 million, respectively. Taking the number of patients eligible for pemetrexed treatment into account, individualized dosing could result in saving €686,000 on a yearly basis in the Netherlands alone. Individualized dosing of pemetrexed can decrease the incidence of neutropenia and thus result in a significant decrease in neutropenia-related costs and decreased risk of hospitalization or even death while maintaining therapeutic exposure.
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Affiliation(s)
- Nikki de Rouw
- Department of Pharmacy, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.,Department of Pharmacy, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Merel de Boer
- Utrecht University, School of Pharmacy, Utrecht, The Netherlands
| | - René J Boosman
- Department of Pharmacy & Pharmacology, Antoni van Leeuwenhoek, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Michel M van den Heuvel
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Pulmonary Diseases, Nijmegen, The Netherlands
| | - David M Burger
- Department of Pharmacy, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Joris E Lieverse
- Department of Hospital Pharmacy, Haga Teaching Hospital, The Hague, the Netherlands
| | - Hieronymus J Derijks
- Department of Pharmacy, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.,Department of Pharmacy, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Geert W J Frederix
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Rob Ter Heine
- Department of Pharmacy, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
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Treatment patterns and outcomes for patients with malignant pleural mesothelioma in England in 2013-2017: A nationwide CAS registry analysis from the I-O Optimise initiative. Lung Cancer 2021; 162:185-193. [PMID: 34823894 DOI: 10.1016/j.lungcan.2021.11.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/30/2021] [Accepted: 11/02/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Malignant pleural mesothelioma (MPM) is a rare and aggressive cancer with a poor prognosis and limited treatment options. This study assessed the characteristics, treatment patterns, and outcomes for patients diagnosed with MPM in England. MATERIALS AND METHODS As part of I-O Optimise, this retrospective cohort study analyzed data recorded in the Cancer Analysis System in England for all adult patients newly diagnosed with MPM between 2013 and 2017, with follow-up to March 2018 or death, whichever occurred first. Overall survival (OS) was estimated using Kaplan-Meier methods. A Cox regression model was used to describe the impact of sociodemographic and clinical characteristics at diagnosis on OS. RESULTS 9458 patients diagnosed with MPM were analyzed. Median age at diagnosis was 75 years; 83.4% were male. Eastern Cooperative Oncology Group performance status (ECOG PS) was 0-1 for 44.5%; 2 for 11.5%; >2 for 9.1%; and missing for 34.9% of patients. TNM stage was missing for 60.4%. A majority of patients had epithelioid histology (36.4%) or not otherwise specified (NOS) MPM (43.3%). After diagnosis, 48.7% of all patients received best supportive care (BSC; no surgery, radiotherapy, SACT); 11.4% received palliative radiotherapy alone; 6.5% underwent surgery; 33.4% received systemic anticancer therapy (SACT) as initial treatment. Platinum plus pemetrexed was the main SACT regimen used in both first and second line. Median OS (8.3 months) varied by histopathology and ranged from 4.3 to 13.3 months for sarcomatoid and epithelioid MPM, respectively. After adjusting for age, sex, and ECOG PS, sarcomatoid, biphasic, and NOS MPM remained significantly associated with worse OS than epithelioid MPM (all p < 0.001). Median OS varied from 4.6 to 17.0 months for patients receiving BSC/palliative radiotherapy, and patients receiving surgery, respectively. CONCLUSION Outcomes for patients with MPM in England remain poor. Future studies will investigate the impact of newer therapies on the treatment patterns and survival of MPM patients.
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Dick IM, Lee YCG, Cheah HM, Miranda A, Robinson BWS, Creaney J. Profile of soluble factors in pleural effusions predict prognosis in mesothelioma. Cancer Biomark 2021; 33:159-169. [PMID: 34487023 PMCID: PMC8925107 DOI: 10.3233/cbm-210280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND: Pleural mesothelioma is a deadly asbestos induced cancer. Less than 10% of mesothelioma patients survive 5 years post diagnosis. However survival can range from a few months to a number of years. Accurate prediction of survival is important for patients to plan for their remaining life, and for clinicians to determine appropriate therapy. One unusual feature of mesothelioma is that patients frequently present with tumor-associated pleural effusions early in the course of the disease. OBJECTIVE: To study whether cells and molecules present in pleural effusions provide prognostic information for mesothelioma. METHODS: We profiled the cellular constituents and concentrations of 40 cytokines, chemokines and cellular factors (collectively “soluble factors”) involved in inflammatory and immune signalling pathways in pleural effusion samples from 50 mesothelioma patients. Associations with survival were evaluated by Cox proportional hazards regression methods. Results for the two soluble factors most significantly and independently associated with survival were validated in an independent set of samples (n= 51) using a separate assay system. RESULTS: Survival analysis revealed that IL8, IL2Ra (CD25) and PF4 were independent determinants of a more negative prognosis in mesothelioma patients, independent of other known prognostic factors. Lipocalin2 and IL4 were associated with better prognosis. CONCLUSIONS: This study demonstrates that pleural effusions rich in a range of soluble factors are associated with poor prognosis. These findings will enhance our ability to prognosticate outcomes in mesothelioma patients.
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Affiliation(s)
- I M Dick
- National Centre for Asbestos Related Disease, University of Western Australia, Nedlands, WA, Australia.,Faculty of Health and Medical Science, University of Western Australia, Nedlands, WA, Australia.,Institute of Respiratory Health, University of Western Australia, Nedlands, WA, Australia
| | - Y C G Lee
- Faculty of Health and Medical Science, University of Western Australia, Nedlands, WA, Australia.,Institute of Respiratory Health, University of Western Australia, Nedlands, WA, Australia.,Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - H M Cheah
- Institute of Respiratory Health, University of Western Australia, Nedlands, WA, Australia
| | - A Miranda
- National Centre for Asbestos Related Disease, University of Western Australia, Nedlands, WA, Australia
| | - B W S Robinson
- National Centre for Asbestos Related Disease, University of Western Australia, Nedlands, WA, Australia.,Faculty of Health and Medical Science, University of Western Australia, Nedlands, WA, Australia.,Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - J Creaney
- National Centre for Asbestos Related Disease, University of Western Australia, Nedlands, WA, Australia.,Faculty of Health and Medical Science, University of Western Australia, Nedlands, WA, Australia.,Institute of Respiratory Health, University of Western Australia, Nedlands, WA, Australia
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Schmid S, Zhan L, Dietrich K, Khan K, Chowdhury M, Herman M, Patel D, Zaeimi F, Leighl NB, Sacher A, Feld R, Shepherd FA, Donahoe L, de Perrot M, Cho BCJ, Liu G, Bradbury PA. Treatment Patterns and Outcomes of Patients With Advanced Pleural Mesothelioma at an Academic Referral Centre. Clin Lung Cancer 2021; 23:e43-e53. [PMID: 34531139 DOI: 10.1016/j.cllc.2021.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/21/2021] [Accepted: 08/05/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Overall survival (OS) for malignant pleural mesothelioma (MPM) in vulnerable subgroups remains poorly understood with scarce data available to guide treatment decisions. The study describes real-world detailed treatment patterns and outcomes of patients with advanced MPM overall and specifically in elderly and poor performance status (PS) patients. METHODS Retrospective chart review was performed for all patients with histologically confirmed MPM seen at University Health Network/Princess Margaret Cancer Centre (UHN-PM). RESULTS A total of 667 patients with MPM were identified and 304 advanced-disease MPM (aMPM) patients had continuing care at UHN-PM (UP-cohort). In the UP-cohort, 77% of patients received ≥ one line of systemic treatment. Systemic therapy trial participation was 39%. Patients not treated with systemic therapy (29%) were more likely to be ≥ 75 years and PS ≥ 2. Median OS was 15.3 months (95%CI 13.6-18.3), with longer survival in treated vs. untreated patients (17.4 vs. 10.6 months; P = .01). Longer survival with systemic treatment was seen in patients ≥75 years (12.7 vs. 6.6 months) and patients with poor PS (9.1 vs. 5.9 months). Median progression-free-survival (PFS) and OS for patients treated with second-line therapy was poor (3.0 and 8.9 months, respectively). DISCUSSION In our real-world analysis of patients with aMPM treated at an academic referral centre, systemic treatment was given to the majority of patients and benefit was seen even in the elderly and poor PS patients frequently underrepresented in clinical trials. Trial participation was potentially facilitated by the formation of a dedicated multidisciplinary MPM clinic.
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Affiliation(s)
- Sabine Schmid
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Medical Oncology and Haematology, Cantonal Hospital St.Gallen, Rorschacherstrasse 95, 9007 St.Gallen, Switzerland.
| | - Luna Zhan
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Kristen Dietrich
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Khaleeq Khan
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Maisha Chowdhury
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Michael Herman
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Oakville Trafalgar Memorial Hospital, Oakville, Canada
| | - Devalben Patel
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Fatemeh Zaeimi
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Natasha B Leighl
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Adrian Sacher
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Ronald Feld
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Frances A Shepherd
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Laura Donahoe
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Marc de Perrot
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | | | - Geoffrey Liu
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.
| | - Penelope A Bradbury
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.
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Dipper A, Maskell N, Bibby A. Ancillary Diagnostic Investigations in Malignant Pleural Mesothelioma. Cancers (Basel) 2021; 13:cancers13133291. [PMID: 34209209 PMCID: PMC8268996 DOI: 10.3390/cancers13133291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 06/18/2021] [Indexed: 12/13/2022] Open
Abstract
For a number of patients presenting with an undiagnosed pleural effusion, frailty, medical co-morbidity or personal choice may preclude the use of pleural biopsy, the gold standard investigation for diagnosis of malignant pleural mesothelioma (MPM). In this review article, we outline the most recent evidence on ancillary diagnostic tests which may be used to support a diagnosis of MPM where histological samples cannot be obtained or where results are non-diagnostic. Immunocytochemical markers, molecular techniques, diagnostic biomarkers and imaging techniques are discussed. No adjunctive test has a sensitivity and specificity profile to support use in isolation; however, correlation of pleural fluid cytology with relevant radiology and supplementary biomarkers can enable an MDT-consensus clinico-radiological-cytological diagnosis to be made where further invasive tests are not possible or not appropriate. Diagnostic challenges surrounding non-epithelioid MPM are recognised, and there is a critical need for reliable and non-invasive investigative tools in this population.
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Opitz I, Scherpereel A, Berghmans T, Psallidas I, Glatzer M, Rigau D, Astoul P, Bölükbas S, Boyd J, Coolen J, De Bondt C, De Ruysscher D, Durieux V, Faivre-Finn C, Fennell DA, Galateau-Salle F, Greillier L, Hoda MA, Klepetko W, Lacourt A, McElnay P, Maskell NA, Mutti L, Pairon JC, Van Schil P, van Meerbeeck JP, Waller D, Weder W, Putora PM, Cardillo G. ERS/ESTS/EACTS/ESTRO guidelines for the management of malignant pleural mesothelioma. Eur J Cardiothorac Surg 2021; 58:1-24. [PMID: 32448904 DOI: 10.1093/ejcts/ezaa158] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The European Respiratory Society (ERS)/European Society of Thoracic Surgeons (ESTS)/European Association for Cardio-Thoracic Surgery (EACTS)/European Society for Radiotherapy and Oncology (ESTRO) task force brought together experts to update previous 2009 ERS/ESTS guidelines on management of malignant pleural mesothelioma (MPM), a rare cancer with globally poor outcome, after a systematic review of the 2009-2018 literature. The evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluation approach. The evidence syntheses were discussed and recommendations formulated by this multidisciplinary group of experts. Diagnosis: pleural biopsies remain the gold standard to confirm the diagnosis, usually obtained by thoracoscopy but occasionally via image-guided percutaneous needle biopsy in cases of pleural symphysis or poor performance status. Pathology: standard staining procedures are insufficient in ∼10% of cases, justifying the use of specific markers, including BAP-1 and CDKN2A (p16) for the separation of atypical mesothelial proliferation from MPM. Staging: in the absence of a uniform, robust and validated staging system, we advise using the most recent 2016 8th TNM (tumour, node, metastasis) classification, with an algorithm for pretherapeutic assessment. Monitoring: patient's performance status, histological subtype and tumour volume are the main prognostic factors of clinical importance in routine MPM management. Other potential parameters should be recorded at baseline and reported in clinical trials. Treatment: (chemo)therapy has limited efficacy in MPM patients and only selected patients are candidates for radical surgery. New promising targeted therapies, immunotherapies and strategies have been reviewed. Because of limited data on the best combination treatment, we emphasize that patients who are considered candidates for a multimodal approach, including radical surgery, should be treated as part of clinical trials in MPM-dedicated centres.
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Affiliation(s)
- Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Arnaud Scherpereel
- Department of Pulmonary and Thoracic Oncology, French National Network of Clinical Expert Centers for Malignant Pleural Mesothelioma Management (Mesoclin), Lille, France.,Department of Pulmonary and Thoracic Oncology, University Lille, CHU Lille, INSERM U1189, OncoThAI, Lille, France
| | | | - Ioannis Psallidas
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Markus Glatzer
- Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - David Rigau
- Iberoamerican Cochrane Center, Barcelona, Spain
| | - Philippe Astoul
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Hôpital Nord, Aix-Marseille University, Marseille, France
| | - Servet Bölükbas
- Department of Thoracic Surgery, Evang, Kliniken Essen-Mitte, Essen, Germany
| | | | - Johan Coolen
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Charlotte De Bondt
- Department of Pulmonology and Thoracic Oncology, Antwerp University and Antwerp University Hospital, Antwerp, Belgium
| | - Dirk De Ruysscher
- Department of Radiation Oncology (Maastro Clinic), Maastricht University Medical Center+, GROW Research Institute, Maastricht, Netherlands
| | - Valerie Durieux
- Bibliothèque des Sciences de la Santé, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Corinne Faivre-Finn
- The Christie NHS Foundation Trust, The University of Manchester, Manchester, UK
| | - Dean A Fennell
- Leicester Cancer Research Centre, University of Leicester and University of Leicester Hospitals NHS Trust, Leicester, UK
| | - Francoise Galateau-Salle
- Department of Biopathology, National Reference Center for Pleural Malignant Mesothelioma and Rare Peritoneal Tumors MESOPATH, Centre Leon Berard, Lyon, France
| | - Laurent Greillier
- Department of Multidisciplinary Oncology and Therapeutic Innovations, Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Inserm UMR1068, CNRS UMR7258, Marseille, France
| | - Mir Ali Hoda
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Walter Klepetko
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Aude Lacourt
- University Bordeaux, INSERM, Bordeaux Population Health Research Center, Team EPICENE, UMR 1219, Bordeaux, France
| | | | - Nick A Maskell
- Academic Respiratory Unit, Bristol Medical School, University of Bristol, Bristol, UK
| | - Luciano Mutti
- Teaching Hospital Vercelli/Gruppo Italiano, Vercelli, Italy
| | - Jean-Claude Pairon
- INSERM U955, GEIC2O, Université Paris-Est Créteil, Service de Pathologies professionnelles et de l'Environnement, Institut Santé -Travail Paris-Est, CHI Créteil, Créteil, France
| | - Paul Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University and Antwerp University Hospital, Antwerp, Belgium
| | - Jan P van Meerbeeck
- Department of Pulmonology and Thoracic Oncology, Antwerp University and Antwerp University Hospital, Antwerp, Belgium
| | - David Waller
- Barts Thorax Centre, St Bartholomew's Hospital, London, UK
| | - Walter Weder
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Paul Martin Putora
- Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland.,Department of Radiation Oncology, University of Bern, Bern, Switzerland
| | - Giuseppe Cardillo
- Unit of Thoracic Surgery, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
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Switch-maintenance gemcitabine after first-line chemotherapy in patients with malignant mesothelioma (NVALT19): an investigator-initiated, randomised, open-label, phase 2 trial. THE LANCET RESPIRATORY MEDICINE 2021; 9:585-592. [PMID: 33515500 DOI: 10.1016/s2213-2600(20)30362-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 07/09/2020] [Accepted: 07/17/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Almost all patients with malignant mesothelioma eventually have disease progression after first-line therapy. Previous studies have investigated maintenance therapy, but none has shown a great effect. We aimed to assess the efficacy and safety of switch-maintenance gemcitabine in patients with malignant mesothelioma without disease progression after first-line chemotherapy. METHODS We did a randomised, open-label, phase 2 trial in 18 hospitals in the Netherlands (NVALT19). We recruited patients aged older than 18 years with unresectable malignant mesothelioma with no evidence of disease progression after at least four cycles of first-line chemotherapy (with platinum and pemetrexed), who had a WHO performance status of 0-2, adequate organ function, and measurable or evaluable disease. Exclusion criteria were active uncontrolled infection or severe cardiac dysfunction, serious disabling conditions, symptomatic CNS metastases, radiotherapy within 2 weeks before enrolment, and concomitant use of any other drugs under investigation. Patients were randomly assigned (1:1), using the minimisation method, to maintenance intravenous gemcitabine (1250 mg/m2 on days 1 and 8, in cycles of 21 days) plus supportive care, or to best supportive care alone, until disease progression, unacceptable toxicity, serious intercurrent illness, patient request for discontinuation, or need for any other anticancer agent, except for palliative radiotherapy. A CT scan of the thorax or abdomen (or both) and pulmonary function tests were done at baseline and repeated every 6 weeks. The primary outcome was progression-free survival in the intention-to-treat population. Safety was analysed in all participants who received one or more doses of the study drug or had at least one visit for supportive care. Recruitment is now closed; treatment and follow-up are ongoing. This study is registered with the Netherlands Trial Registry, NTR4132/NL3847. FINDINGS Between March 20, 2014, and Feb 27, 2019, 130 patients were enrolled and randomly assigned to gemcitabine plus supportive care (65 patients [50%]) or supportive care alone (65 patients [50%]). No patients were lost to follow-up; median follow-up was 36·5 months (95% CI 34·2 to not reached), and one patient in the supportive care group withdrew consent. Progression-free survival was significantly longer in the gemcitabine group (median 6·2 months [95% CI 4·6-8·7]) than in the supportive care group (3·2 months [2·8-4·1]; hazard ratio [HR] 0·48 [95% CI 0·33-0·71]; p=0·0002). The benefit was confirmed by masked independent central review (HR 0·49 [0·33-0·72]; p=0·0002). Grade 3-4 adverse events occurred in 33 (52%) of 64 patients in the gemcitabine group and in ten (16%) of 62 patients in the supportive care group. The most frequent adverse events were anaemia, neutropenia, fatigue or asthenia, pain, and infection in the gemcitabine group, and pain, infection, and cough or dyspnoea in the supportive care group. One patient (2%) in the gemcitabine group died, due to a treatment-related infection. INTERPRETATION Switch-maintenance gemcitabine, after first-line chemotherapy, significantly prolonged progression-free survival compared with best supportive care alone, among patients with malignant mesothelioma. This study confirms the activity of gemcitabine in treating malignant mesothelioma. FUNDING Dutch Cancer Society (Koningin Wilhelmina Fonds voor de Nederlandse Kankerbestrijding) and Stichting NVALT studies.
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Malignant pleural mesothelioma: Treatment patterns and outcomes from the Spanish Lung Cancer Group. Lung Cancer 2020; 147:83-90. [PMID: 32682189 DOI: 10.1016/j.lungcan.2020.06.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/13/2020] [Accepted: 06/26/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Malignant mesothelioma is a rare but aggressive tumor arising from the pleura, typically associated with exposure to asbestos. The purpose of this investigation was to describe mesothelioma patient characteristics, treatment patterns, and outcomes in Spain. MATERIAL AND METHODS Patients diagnosed with malignant mesothelioma of the pleura were recorded in an anonymous online database (BEMME, Epidemiologic Spanish Malignant Mesothelioma Database) from June 2008 through May 2013. Patient and tumor characteristics at time of diagnosis, as well as subsequent treatments (surgery, radiation, and chemotherapy), were collected. Among patients treated with chemotherapy, we explored type of chemotherapy regimen and outcomes by treatments. RESULTS A total of 560 malignant pleural mesothelioma (MPM) patients were recorded. The median age at diagnosis was 68 years, mainly with epithelioid histology (62 %), and any asbestos exposure was noted in 45 % of patients. Nearly two-thirds of patients (71 %) received chemotherapy, mainly platinum-pemetrexed combination, as part of their treatment. Surgery and radiotherapy were given in 36 % and 17 % of patients, respectively. The median overall survival (OS) in the whole cohort was 13.0 months (95 % confidence interval (CI), 11.1-14.8 months) with 1-year OS of 53.2 % (95 % CI, 48.7-57.7 %). In patients receiving first-line chemotherapy (N = 315), the median OS was 13.4 months (95 % CI, 10.8-16.0 months), reaching 20.2 months (95 % CI, 17.2-23.2 months) for those 68 patients receiving maintenance chemotherapy. Results of multivariate analyses showed significant association of ECOG-performance status, histology and treatment response with improved OS in MPM patients treated with palliative chemotherapy. CONCLUSIONS Despite multimodal therapeutic intervention, survival of patients with mesothelioma in Spain remains poor. Although it did not reach significance in the multivariate analysis, a meaningful additional survival benefit was observed among those patients receiving maintenance chemotherapy.
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Scherpereel A, Opitz I, Berghmans T, Psallidas I, Glatzer M, Rigau D, Astoul P, Bölükbas S, Boyd J, Coolen J, De Bondt C, De Ruysscher D, Durieux V, Faivre-Finn C, Fennell D, Galateau-Salle F, Greillier L, Hoda MA, Klepetko W, Lacourt A, McElnay P, Maskell NA, Mutti L, Pairon JC, Van Schil P, van Meerbeeck JP, Waller D, Weder W, Cardillo G, Putora PM. ERS/ESTS/EACTS/ESTRO guidelines for the management of malignant pleural mesothelioma. Eur Respir J 2020; 55:13993003.00953-2019. [PMID: 32451346 DOI: 10.1183/13993003.00953-2019] [Citation(s) in RCA: 128] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 10/17/2019] [Indexed: 12/23/2022]
Abstract
The European Respiratory Society (ERS)/European Society of Thoracic Surgeons (ESTS)/European Association for Cardio-Thoracic Surgery (EACTS)/European Society for Radiotherapy and Oncology (ESTRO) task force brought together experts to update previous 2009 ERS/ESTS guidelines on management of malignant pleural mesothelioma (MPM), a rare cancer with globally poor outcome, after a systematic review of the 2009-2018 literature. The evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluation approach. The evidence syntheses were discussed and recommendations formulated by this multidisciplinary group of experts. Diagnosis: pleural biopsies remain the gold standard to confirm the diagnosis, usually obtained by thoracoscopy but occasionally via image-guided percutaneous needle biopsy in cases of pleural symphysis or poor performance status. Pathology: standard staining procedures are insufficient in ∼10% of cases, justifying the use of specific markers, including BAP-1 and CDKN2A (p16) for the separation of atypical mesothelial proliferation from MPM. Staging: in the absence of a uniform, robust and validated staging system, we advise using the most recent 2016 8th TNM (tumour, node, metastasis) classification, with an algorithm for pre-therapeutic assessment. Monitoring: patient's performance status, histological subtype and tumour volume are the main prognostic factors of clinical importance in routine MPM management. Other potential parameters should be recorded at baseline and reported in clinical trials. Treatment: (chemo)therapy has limited efficacy in MPM patients and only selected patients are candidates for radical surgery. New promising targeted therapies, immunotherapies and strategies have been reviewed. Because of limited data on the best combination treatment, we emphasise that patients who are considered candidates for a multimodal approach, including radical surgery, should be treated as part of clinical trials in MPM-dedicated centres.
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Affiliation(s)
- Arnaud Scherpereel
- Pulmonary and Thoracic Oncology, Univ. Lille, CHU Lille, INSERM U1189, OncoThAI, Lille, France .,French National Network of Clinical Expert Centers for Malignant Pleural Mesothelioma Management (Mesoclin), Lille, France
| | - Isabelle Opitz
- Dept of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | | | - Ioannis Psallidas
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Markus Glatzer
- Dept of Radiation Oncology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - David Rigau
- Iberoamerican Cochrane Center, Barcelona, Spain
| | - Philippe Astoul
- Dept of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Hôpital Nord, Aix-Marseille University, Marseille, France
| | - Servet Bölükbas
- Dept of Thoracic Surgery, Evang, Kliniken Essen-Mitte, Essen, Germany
| | | | - Johan Coolen
- Dept of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Charlotte De Bondt
- Dept of Pulmonology and Thoracic Oncology, Antwerp University and Antwerp University Hospital, Antwerp, Belgium
| | - Dirk De Ruysscher
- Dept of Radiation Oncology (Maastro Clinic), Maastricht University Medical Center+, GROW Research Institute, Maastricht, The Netherlands
| | - Valerie Durieux
- Bibliothèque des Sciences de la Santé, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Corinne Faivre-Finn
- The Christie NHS Foundation Trust, The University of Manchester, Manchester, UK
| | - Dean Fennell
- Leicester Cancer Research Centre, University of Leicester and University of Leicester Hospitals NHS Trust, Leicester, UK
| | - Francoise Galateau-Salle
- National Reference Center for Pleural Malignant Mesothelioma and Rare Peritoneal Tumors MESOPATH, Dept of Biopathology, Centre Leon Berard, Lyon, France
| | - Laurent Greillier
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Inserm UMR1068, CNRS UMR7258, Dept of Multidisciplinary Oncology and Therapeutic Innovations, Marseille, France
| | - Mir Ali Hoda
- Dept of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Walter Klepetko
- Dept of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Aude Lacourt
- Univ. Bordeaux, INSERM, Bordeaux Population Health Research Center, team EPICENE, UMR 1219, Bordeaux, France
| | | | - Nick A Maskell
- Academic Respiratory Unit, Bristol Medical School, University of Bristol, Bristol, UK
| | - Luciano Mutti
- Teaching Hosp. Vercelli/Gruppo Italiano Mesotelioma, Italy
| | - Jean-Claude Pairon
- INSERM U955, Equipe 4, Université Paris-Est Créteil, and Service de Pathologies professionnelles et de l'Environnement, Institut Santé-Travail Paris-Est, CHI Créteil, Créteil, France
| | - Paul Van Schil
- Dept Thoracic and Vascular Surgery, Antwerp University and Antwerp University Hospital, Antwerp, Belgium
| | - Jan P van Meerbeeck
- Dept of Pulmonology and Thoracic Oncology, Antwerp University and Antwerp University Hospital, Antwerp, Belgium
| | - David Waller
- Barts Thorax Centre, St Bartholomew's Hospital, London, UK
| | - Walter Weder
- Dept of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Giuseppe Cardillo
- Unit of Thoracic Surgery, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - Paul Martin Putora
- Dept of Radiation Oncology, Kantonsspital St Gallen, St Gallen, Switzerland.,Dept of Radiation Oncology, University of Bern, Bern, Switzerland
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Brockwell NK, Alamgeer M, Kumar B, Rivalland G, John T, Parker BS. Preliminary study highlights the potential of immune checkpoint inhibitors in sarcomatoid mesothelioma. Transl Lung Cancer Res 2020; 9:639-645. [PMID: 32676326 PMCID: PMC7354134 DOI: 10.21037/tlcr-19-485] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Malignant pleural mesothelioma (MPM) is well known as an aggressive disease with poor survival. This has sparked trials of alternate immune-based therapies in MPM. While up to a quarter of MPM patients respond to immune checkpoint inhibitors (ICIs), predicting response remains challenging and PD-L1 expression alone has been deemed insufficient. Additionally, patients with sarcomatoid MPM are often excluded from trials utilizing ICIs due to their rapid progression. Here, we analyze the association of T lymphocytes with response to ICI-based immunotherapy to uncover predictive immune markers across subtypes. Methods Retrospective analysis of immunotherapy treated mesothelioma patient cohorts from two sites were pooled. Patient characteristics, including age, sex, subtype and previous treatment were captured. Multiplex immunohistochemistry was used to assess proportions of CD4, CD8, CD45RO and FOXP3 positive infiltrates in MPM and their association with progression free (PFS) and overall (OS) survival post immunotherapy. Results Samples derived from 22 patients were analyzed; 13 (59%) had epithelioid MPM, 6 (27%) sarcomatoid and 3 (14%) biphasic. The overall ICI response rate was 40%, with a median PFS (mPFS) and OS (mOS) of 3.8 and 11.17 months, respectively. Of the subtypes, sarcomatoid patients displayed the greatest median PFS and OS (>28 months) post ICI compared to the epithelioid subtype (3 and 11 months respectively), which correlated with higher proportions of infiltrating CD8+, CD45RO+ and CD8+CD45RO+ cells. Patients who received ICIs as first-line therapy had greater PFS than those who received it as second or third line post-chemotherapy. Conclusions High proportions of T lymphocytes and CD45RO+ cells were associated with prolonged mPFS and mOS in sarcomatoid patients treated with ICI immunotherapy. These data support the expansion of trials utilizing single and combination ICIs as first-line therapy in sarcomatoid MPM and warrants further studies testing the impact or detriment of chemotherapy pre-ICI.
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Affiliation(s)
- Natasha K Brockwell
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia.,Research Division, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Biochemistry and Genetics, La Trobe Institute for Molecular Science, La Trobe University, Melbourne, Victoria, Australia
| | - Muhammad Alamgeer
- Department of Medical Oncology, Monash Medical Centre, Monash University, Clayton, Victoria, Australia.,Monash Health, Clayton, Victoria, Australia
| | | | - Gareth Rivalland
- Olivia Newton-John Cancer Research Institute, Melbourne, Victoria, Australia
| | - Thomas John
- Olivia Newton-John Cancer Research Institute, Melbourne, Victoria, Australia
| | - Belinda S Parker
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia.,Research Division, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Biochemistry and Genetics, La Trobe Institute for Molecular Science, La Trobe University, Melbourne, Victoria, Australia
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14
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Billè A, Okiror L, Harling L, Pernazza F, Muzio A, Roveta A, Grosso F. Analysis of survival of patients with metastatic malignant pleural mesothelioma. TUMORI JOURNAL 2020; 107:110-118. [PMID: 32458750 DOI: 10.1177/0300891620926239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To report the outcomes and prognosis of patients with malignant pleural mesothelioma (MPM) who present with or develop metastases during treatment. METHODS This is a retrospective observational study of patients diagnosed with MPM over 7 years. Metastases at presentation or during follow-up were recorded. Multivariate Cox regression was used to evaluate the relationship of clinicopathologic variables and overall survival (OS). Logistic regression was used for propensity score matching of patients to assess chemotherapy treatment effect. RESULTS There were 367 patients included with a median age of 71 years (range, 29-91). A total of 69 patients (18%) had metastases: 14 at presentation and 55 during follow-up. Patients presenting with metastases had significantly worse median and 2-year OS compared to those developing metastases during follow-up: 13.3 months (95% confidence interval [CI], 2-24.6 months) and 0% versus 20.2 months (95% CI, 16.7-23.3 months) and 33%, respectively (p = 0.029). Female sex, age >70 years, nonepithelioid histology, and not receiving chemotherapy were independent poor prognostic factors. There was no difference in OS of patients with locally advanced (T4) disease compared to metastatic disease (M1): median OS 10.7 months (95% CI, 5.9-15.6) versus 13.3 months (95% CI, 2-24.6) (p = 0.18), respectively. Following propensity matching, sarcomatoid histology (hazard ratio, 7.86 [95% CI, 3.64-16.95]; p < 0.001) and multiple lines of chemotherapy (hazard ratio, 0.38 [95% CI, 0.19-0.84]; p = 0.015) were significant independent prognostic factors for OS. CONCLUSIONS T4 disease carries a similar OS as metastatic MPM. Female sex, advanced age, nonepithelioid histology, and not receiving chemotherapy were independent poor prognostic factors.
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Affiliation(s)
- Andrea Billè
- Department of Thoracic Surgery, Guy's and St Thomas' Hospitals, London, UK
| | - Lawrence Okiror
- Department of Thoracic Surgery, Guy's and St Thomas' Hospitals, London, UK
| | - Leanne Harling
- Department of Thoracic Surgery, Guy's and St Thomas' Hospitals, London, UK
| | - Fausto Pernazza
- Department of Thoracic Surgery, SS Antonio e Biagio General Hospital, Alessandria, Italy
| | - Alberto Muzio
- Department of Oncology, S Spirito Hospital, Casale Monferrato, Casale, Italy
| | - Annalisa Roveta
- Department of Oncology, SS Antonio e Biagio General Hospital, Alessandria, Italy
| | - Federica Grosso
- Department of Oncology, SS Antonio e Biagio General Hospital, Alessandria, Italy
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15
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Trama A, Proto C, Signorelli D, Garassino MC, Lo Russo G, Ganzinelli M, Prelaj A, Mensi C, Gangemi M, Gennaro V, Chellini E, Caldarella A, Angelillo IF, Ascoli V, Pascucci C, Tagliabue G, Cusimano R, Bella F, Falcini F, Merler E, Masanotti G, Ziino A, Michiara M, Gola G, Storchi C, Mangone L, Vitale MF, Cirilli C, Tumino R, Scuderi T, Fanetti AC, Piffer S, Tiseo M, Gatta G, Botta L. Treatment patterns among patients with malignant pleural mesothelioma: An Italian, population-based nationwide study. Thorac Cancer 2020; 11:1661-1669. [PMID: 32364316 PMCID: PMC7262944 DOI: 10.1111/1759-7714.13456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 02/29/2020] [Indexed: 12/01/2022] Open
Abstract
Background Malignant pleural mesothelioma (MPM) is a rare cancer with a poor prognosis. Centralization of rare cancer in dedicated centers is recommended to ensure expertise, multidisciplinarity and access to innovation. In Italy, expert centers for MPM have not been identified in all regions. We aimed to describe the treatment patterns among MPM patients across different Italian regions and to identify factors associated with the treatment patterns across the regions. Methods We performed an observational study on a random sample of 2026 MPM patients diagnosed in 2003–2008. We included 26 population‐based registries covering 70% of the Italian population. To identify factors associated with treatment patterns, across the different regions, we fitted a multinomial logistic regression model adjusted by age, sex, stage, histology and hospital with thoracic surgical department. Results MPM patients mostly received chemotherapy alone (41%) or no cancer‐directed therapy (36%) especially the older patients. The first course of treatment for MPM patients differed across regions. Patients from Piedmont, Liguria and Campania were more likely to receive no cancer‐directed therapy; those living in Tuscany and Sicily were more likely to get surgery; patients from Marche and Lazio were more likely to receive chemotherapy. These differences were not explained by age, sex, stage, histology and availability of a thoracic surgery department. Conclusions There is limited expertise available and lack of a network able to maximize the expertise available may contribute to explaining the results of our study. Our findings support the need to ensure the appropriate care of all MPM patients in reorganizing the health care services. Key points
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Affiliation(s)
- Annalisa Trama
- Research Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Claudia Proto
- Department of Medical Oncology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | - Diego Signorelli
- Department of Medical Oncology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | - Marina C Garassino
- Department of Medical Oncology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | - Giuseppe Lo Russo
- Department of Medical Oncology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | - Monica Ganzinelli
- Department of Medical Oncology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | - Arsela Prelaj
- Department of Medical Oncology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | - Carolina Mensi
- COR Lombardy, Epidemiology Unit,Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico and University of Milan, Milan, Italy
| | - Manuela Gangemi
- Unit of Cancer Epidemiology, University of Turin and CPO-Piemonte, Turin, Italy
| | - Valerio Gennaro
- COR Liguria, UO Epidemiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Elisabetta Chellini
- Unit of Occupational & Environmental Epidemiology, Tuscan Occupational Cancer Registry, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Adele Caldarella
- Tuscan Cancer Registry, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Italo F Angelillo
- Department of Experimental Medicine, COR Campania, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Valeria Ascoli
- Department of Radiological Sciences, Oncology and Anatomical Pathology, COR Lazio, University La Sapienza, Rome, Italy
| | - Cristiana Pascucci
- Mesothelioma Marche Registry - COR Marche, School of Medicinal and Health Products Sciences, University of Camerino, Camerino, Italy
| | - Giovanna Tagliabue
- Varese Cancer Registry, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Francesca Bella
- Integrated Cancer Registry of Catania-Messina-Siracusa-Enna, Azienda Ospedaliero-Universitaria Policlinico-Vittorio Emanuale, Catania, Italy
| | - Fabio Falcini
- Romagna Cancer Registry, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Forlì, Italy
| | - Enzo Merler
- COR Veneto, Occupational Health Unit, Department of Prevention, Padua, Italy
| | - Giuseppe Masanotti
- Sec. Public Health, Department of Experimental Medicine, COR Umbria, University of Perugia, Perugia, Italy
| | | | | | | | - Cinzia Storchi
- Servizio di Epidemiologia, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Lucia Mangone
- Servizio di Epidemiologia, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Maria F Vitale
- U.O.S.D. Napoli 3 South Cancer Registry, Piazza San Giovanni, Naples, Italy
| | | | - Rosario Tumino
- Cancer Registry and Histopathology Deaprtment, COR Sicily, 'Civic -M.P. Arezzo' Hospital, Ragusa, Italy
| | | | | | - Silvano Piffer
- Trento Cancer Registry, Servizio Epidemiologia Clinica e Valutativa, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Marcello Tiseo
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Gemma Gatta
- Research Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Laura Botta
- Research Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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- Research Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,Department of Medical Oncology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
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Xu D, Liang SQ, Yang H, Bruggmann R, Berezowska S, Yang Z, Marti TM, Hall SRR, Gao Y, Kocher GJ, Schmid RA, Peng RW. CRISPR Screening Identifies WEE1 as a Combination Target for Standard Chemotherapy in Malignant Pleural Mesothelioma. Mol Cancer Ther 2019; 19:661-672. [DOI: 10.1158/1535-7163.mct-19-0724] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/18/2019] [Accepted: 10/31/2019] [Indexed: 11/16/2022]
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17
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Zhu TC, Ong Y, Kim MM, Liang X, Finlay JC, Dimofte A, Simone CB, Friedberg JS, Busch TM, Glatstein E, Cengel KA. Evaluation of Light Fluence Distribution Using an IR Navigation System for HPPH-mediated Pleural Photodynamic Therapy (pPDT). Photochem Photobiol 2019; 96:310-319. [PMID: 31556122 DOI: 10.1111/php.13166] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 09/13/2019] [Indexed: 12/29/2022]
Abstract
Uniform light fluence distribution for patients undergoing photodynamic therapy (PDT) is critical to ensure predictable PDT outcomes. However, current practice when delivering intrapleural PDT uses a point source to deliver light that is monitored by seven isotropic detectors placed within the pleural cavity to assess its uniformity. We have developed a real-time infrared (IR) tracking camera to follow the movement of the light point source and the surface contour of the treatment area. The calculated light fluence rates were matched with isotropic detectors using a two-correction factor method and an empirical model that includes both direct and scattered light components. Our clinical trial demonstrated that we can successfully implement the IR navigation system in 75% (15/20) of the patients. Data were successfully analyzed in 80% (12/15) patients because detector locations were not available for three patients. We conclude that it is feasible to use an IR camera-based system to track the motion of the light source during PDT and demonstrate its use to quantify the uniformity of light distribution, which deviated by a standard deviation of 18% from the prescribed light dose. The navigation system will fail when insufficient percentage of light source positions is obtained (<30%) during PDT.
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Affiliation(s)
- Timothy C Zhu
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Yihong Ong
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Michele M Kim
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Xing Liang
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Jarod C Finlay
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Andreea Dimofte
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | | | | | - Theresa M Busch
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Eli Glatstein
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Keith A Cengel
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
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Friedberg JS, Simone CB, Culligan MJ, Putt ME, Barsky AR, Katz S, Cengel KA. Posterior Intercostal Lymph Nodes Double Recurrence and Death Risk in Malignant Pleural Mesothelioma. Ann Thorac Surg 2019; 110:241-250. [PMID: 31634442 DOI: 10.1016/j.athoracsur.2019.07.097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 06/14/2019] [Accepted: 07/09/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Posterior intercostal lymph nodes, previously undescribed for cancer staging, are part of the lymphatic drainage of the pleural space. This study assessed the impact of posterior intercostal lymph nodes on survival in patients undergoing extended pleurectomy/decortication for malignant pleural mesothelioma. METHODS As part of the thoracic lymphadenectomy, posterior intercostal lymph nodes were accessed by incising the endothoracic fascia at the level of the rib heads. These nodes were systematically harvested in 56 consecutive patients undergoing extended pleurectomy decortication in a clinical trial. The impact of these nodes on progression-free (PFS) and overall survival (OS) was analyzed by multiple statistical methods. RESULTS Median PFS and OS were 11.6 and 25.5 months, respectively. In 6 of 56 patients (11%), posterior intercostal lymph nodes were the only positive nodes, and overall, 48.2% had posterior intercostal lymph node metastases. Patients with N2 disease had significantly poorer prognosis if the posterior intercostal lymph nodes were involved: PFS (7.3 vs 14.9 months, P = .002) and OS (14.4 vs 26.1 months, P = .028). In the multivariable models, after adjustment for nodal stage and other prognostic factors, intercostal nodes remained associated with a 2.5-fold elevated risk of progression (P < .001) and a 2.3-fold elevated risk of death (P < .001). CONCLUSIONS Metastases to posterior intercostal lymph nodes independently more than doubled the risk of progression and death and were the only site of nodal metastases in 11% of patients. These nodes warrant further investigation, including nonoperative techniques to identify and factor them into treatment decision making.
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Affiliation(s)
- Joseph S Friedberg
- Division of Thoracic Surgery, University of Maryland School of Medicine, Baltimore, Maryland.
| | - Charles B Simone
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Melissa J Culligan
- Division of Thoracic Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Mary E Putt
- Department of Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andrew R Barsky
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sharyn Katz
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Keith A Cengel
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Ceresoli GL, Rossi A. Approved and emerging treatments of malignant pleural mesothelioma in elderly patients. Expert Rev Respir Med 2019; 13:1179-1188. [PMID: 31596154 DOI: 10.1080/17476348.2019.1678386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Introduction: Malignant pleural mesothelioma (MPM) is a rare neoplasm with asbestos exposure as the dominant etiologic agent. Owing to the long latent period following exposure, MPM is often diagnosed late in life. Despite this, elderly patients are under-represented in clinical trials. To date, data regarding the tolerability and efficacy of anticancer treatments for elderly patients affected by MPM are still lacking.Areas covered: The current state-of-the-art of approved treatments employed in the treatment of MPM elderly patients is reviewed and discussed, with a look to emerging therapies. A structured search of bibliographic databases for peer-reviewed research literature and of main meeting abstracts using a focused review question was undertaken.Expert opinion: Even though the median age of MPM patients enrolled in the most recent experimental trials is increasing, no specific analysis has been reported so far in the elderly. Moreover, no data are available for the 'oldest of the elderly' (>75 years). Treatment of elderly patients with MPM is one of the major challenges to the clinician. There is a clear need of large, well-conducted retrospective studies and above all of prospective investigations in this patient population, both in the first-and in the second-line setting.
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Affiliation(s)
- Giovanni Luca Ceresoli
- Division of Medical Oncology, Thoracic and Urologic Oncology Unit, Cliniche Humanitas Gavazzeni, Bergamo, Italy
| | - Antonio Rossi
- Division of Medical Oncology, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy
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20
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A Proposed System Toward Standardizing Surgical-Based Treatments for Malignant Pleural Mesothelioma, From the Joint National Cancer Institute–International Association for the Study of Lung Cancer–Mesothelioma Applied Research Foundation Taskforce. J Thorac Oncol 2019; 14:1343-1353. [DOI: 10.1016/j.jtho.2019.04.029] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 04/23/2019] [Accepted: 04/26/2019] [Indexed: 11/19/2022]
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21
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Ospina D, Villegas VE, Rodríguez-Leguizamón G, Rondón-Lagos M. Analyzing biological and molecular characteristics and genomic damage induced by exposure to asbestos. Cancer Manag Res 2019; 11:4997-5012. [PMID: 31239765 PMCID: PMC6556979 DOI: 10.2147/cmar.s205723] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 04/19/2019] [Indexed: 12/24/2022] Open
Abstract
Asbestos is one of the most important occupational carcinogens. Currently, about 125 million people worldwide are exposed to asbestos in the workplace. According to global estimates, at least 107,000 people die each year from lung cancer, mesothelioma, and asbestosis as a result of occupational exposure to asbestos. The high pathogenicity of this material is currently known, being associated with the development of pulmonary diseases, of which lung cancer is the main cause of death due to exposure to this mineral. Pulmonary diseases related to asbestos are a common clinical problem and a major health concern worldwide. Extensive research has identified many important pathogenic mechanisms; however, the precise molecular mechanisms involved, and the generated genomic damage that lead to the development of these diseases, are not completely understood. The modes of action that underlie this type of disease seem to differ depending on the type of fiber, lung clearance, and genetics. This evidences the need to increase our knowledge about these effects on human health. This review focuses on the characteristics of asbestos and the cellular and genomic damage generated in humans via exposure.
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Affiliation(s)
- Diana Ospina
- Biology Program, Faculty of Natural Sciences and Mathematics, Universidad del Rosario, Bogotá111221,Colombia
| | - Victoria Eugenia Villegas
- Biology Program, Faculty of Natural Sciences and Mathematics, Universidad del Rosario, Bogotá111221,Colombia
| | - Giovanni Rodríguez-Leguizamón
- Hospital Universitario Mayor Méderi – Universidad del Rosario. School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, 111221, Colombia
| | - Milena Rondón-Lagos
- School of Biological Sciences, Universidad Pedagógica y Tecnológica de Colombia, Tunja150003, Colombia
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22
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Verma V, Wegner RE, Ludmir EB, Hasan S, Colonias A, Grover S, Friedberg JS, Simone CB. Management of Malignant Pleural Mesothelioma in the Elderly Population. Ann Surg Oncol 2019; 26:2357-2366. [DOI: 10.1245/s10434-019-07351-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Indexed: 01/22/2023]
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23
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Patterns of care and survival of older patients with malignant pleural mesothelioma. J Geriatr Oncol 2019; 10:573-576. [PMID: 30917938 DOI: 10.1016/j.jgo.2019.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 12/14/2018] [Accepted: 02/21/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Malignant pleural mesothelioma (MPM) is a cancer that primarily affects older adults. However this patient population is frequently under-represented in clinical studies. Therefore, we studied the impact of advancing age on treatment utilisation and clinical outcomes in an extensive series of minimally selected MPM patients. MATERIALS AND METHODS Patients with MPM receiving compensation from the New South Wales (NSW) Dust Diseases Authority (2002-2009) were assessed. They were categorised by age (<70 years, 70-80 years or > 80 years) and chi-square testing was used to assess the relationship between clinical and demographic variables, age, treatment and overall survival (OS). RESULTS We identified 910 patients; 41% were aged <70 years, 40% were aged 70-80 years, and 19% were aged >80 years old. Median OS decreased with increasing age: 13.5 months in <70 years, 9.5 months in 70-80 years and 7.1 months in >80 years as did chemotherapy use (66%, 35% and 8% respectively). Radical surgical intervention, adjuvant, and palliative radiotherapy were less frequently used with advanced age. A Kaplan Meier analysis revealed that there was a significant survival advantage (p < .001) for patients <70 and 70-80 years receiving chemotherapy (16.8 vs 7.0 months; 13.9 vs 5.8 months respectively), but not for patients >80 years. CONCLUSION Advancing age group of NSW patients with MPM was associated with reduced treatment utilisation and a decline in OS. Prospective studies are warranted to verify if current treatment guidelines are relevant for the older adults with MPM.
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Yoshimura M, Kinoshita Y, Hamasaki M, Matsumoto S, Hida T, Oda Y, Iwasaki A, Nabeshima K. Highly expressed EZH2 in combination with BAP1 and MTAP loss, as detected by immunohistochemistry, is useful for differentiating malignant pleural mesothelioma from reactive mesothelial hyperplasia. Lung Cancer 2019; 130:187-193. [PMID: 30885343 DOI: 10.1016/j.lungcan.2019.02.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 01/28/2019] [Accepted: 02/03/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Malignant pleural mesothelioma (MPM) is an aggressive neoplasm with poor prognosis. Loss of BRCA-associated protein 1 (BAP1) protein expression as detected by immunohistochemistry (IHC) and homozygous deletion (HD) of the 9p21 locus as detected by fluorescence in situ hybridization (FISH) permits differentiation of MPM from reactive mesothelial hyperplasia (RMH). We have previously reported that detecting the loss of methylthioadenosine phosphorylase (MTAP) using IHC is a surrogate assay for 9p21 FISH. Furthermore, enhancer of zeste homolog 2 (EZH2), which encodes a component of polycomb repressor complex 2 (PRC-2), has been overexpressed in various tumors as well as MPM. In the current study, we investigated whether EZH2 IHC assay, alone or in combination with BAP1 and MTAP IHC, is useful for distinguishing MPM from RMH. MATERIALS AND METHODS We examined IHC expression of EZH2, BAP1, and MTAP, and 9p21 FISH in MPM (n = 38) and RMH (n = 29) and analyzed the sensitivity and specificity of each detection assay for distinguishing MPM from RMH. RESULTS AND CONCLUSION EZH2, BAP1, and MTAP IHC, and 9p21 FISH were characterized by a 100% specificity each and 44.7%, 52.6%, 47.4%, and 65.8% sensitivities, respectively. A combination of EZH2 and BAP1 IHC, and 9p21 FISH showed the greatest sensitivity (89.5%). Using IHC alone (EZH2, BAP1, and MTAP IHC) also yielded a good sensitivity of 86.9%; this level is high enough for routine diagnostics. There were no statistically significant associations between expression of EZH2 and that of other markers (BAP1 and MTAP IHC) or 9p21 HD. However, a high expression level of EZH2 was significantly associated with short survival (P = 0.025). In conclusion, adding a high expression level of EZH2 to a combination of BAP1 and MTAP loss, all detected by IHC, demonstrated useful for discriminating MPM from RMH.
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Affiliation(s)
- Masayo Yoshimura
- Department of Pathology, Fukuoka University School of Medicine and Hospital, Fukuoka, Japan
| | - Yoshiaki Kinoshita
- Department of Pathology, Fukuoka University School of Medicine and Hospital, Fukuoka, Japan
| | - Makoto Hamasaki
- Department of Pathology, Fukuoka University School of Medicine and Hospital, Fukuoka, Japan
| | - Shinji Matsumoto
- Department of Pathology, Fukuoka University School of Medicine and Hospital, Fukuoka, Japan
| | - Tomoyuki Hida
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akinori Iwasaki
- Department of Thoracic Surgery, Fukuoka University School of Medicine and Hospital, Fukuoka, Japan
| | - Kazuki Nabeshima
- Department of Pathology, Fukuoka University School of Medicine and Hospital, Fukuoka, Japan.
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25
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Warby A, Dhillon HM, Kao S, Vardy JL. Managing malignant pleural mesothelioma: experience and perceptions of health care professionals caring for people with mesothelioma. Support Care Cancer 2019; 27:3509-3519. [PMID: 30684047 DOI: 10.1007/s00520-019-4648-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 01/14/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Malignant pleural mesothelioma (MPM) has a poor prognosis and heavy symptom burden. Here, we investigate health professionals' attitudes to management and decision-making in people with MPM. METHODS Survey questions were based on previous interviews with health professionals, MPM patients, and caregivers. Surveys were sent to specialist doctors and nurses who treat MPM. RESULTS Surveys were completed by 107 doctors and 19 nurses from January-September 2014. Most doctors were respiratory physicians (50%) or medical oncologists (35%). Overall, 90% of doctors estimated > 10% of eligible MPM patients did not receive chemotherapy; 43% estimated the rate was > 20%. Doctors believed clinical barriers to chemotherapy were clinician nihilism (70%); non-referral to medical oncology (49%); and lack of specialists in rural/regional areas (44%). Nurses perceived barriers as follows: delayed diagnosis (74%); non-referral to medical oncology (63%); lack of clinician knowledge (58%). Patient-related barriers were negative perception of chemotherapy (83%) and belief survival benefit not worthwhile (63%). Doctors' preference in decision-making was for the patient to make the decision while strongly considering the doctor's opinion (33%); equally with the doctor (29%); and using knowledge gained (23%). Nurses described their roles as providing patient support (100%); information (95%); intermediary (74%); and link to palliative care (74%). Overall, 95% believed they enabled better resource allocation and provided patients with holistic care (95%); clearer communication (89%); more time (89%); additional information (89%); timely referrals (89%). CONCLUSIONS Caring for patients with MPM is challenging and complex. Health care professionals believe under-utilisation of chemotherapy is occurring, primarily due to clinician nihilism and lack of medical oncology referral.
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Affiliation(s)
- Anne Warby
- Centre for Medical Psychology and Evidence-Based Decision-Making, The University of Sydney, Sydney, NSW, 2006, Australia
- Asbestos Diseases Research Institute, Bernie Banton Centre, Gate 3, Hospital Rd., Concord, NSW, 2139, Australia
| | - Haryana M Dhillon
- Centre for Medical Psychology and Evidence-Based Decision-Making, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Steven Kao
- Asbestos Diseases Research Institute, Bernie Banton Centre, Gate 3, Hospital Rd., Concord, NSW, 2139, Australia
- Chris O'Brien Lifehouse, 119-143 Missenden Rd., Camperdown, NSW, 2050, Australia
- Sydney Medical School, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Janette L Vardy
- Centre for Medical Psychology and Evidence-Based Decision-Making, The University of Sydney, Sydney, NSW, 2006, Australia.
- Asbestos Diseases Research Institute, Bernie Banton Centre, Gate 3, Hospital Rd., Concord, NSW, 2139, Australia.
- Sydney Medical School, The University of Sydney, Sydney, NSW, 2006, Australia.
- Concord Cancer Centre, Concord Repatriation General Hospital, Hospital Rd, Concord, NSW, 2139, Australia.
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26
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Jackaman C, Gardner JK, Tomay F, Spowart J, Crabb H, Dye DE, Fox S, Proksch S, Metharom P, Dhaliwal SS, Nelson DJ. CD8 + cytotoxic T cell responses to dominant tumor-associated antigens are profoundly weakened by aging yet subdominant responses retain functionality and expand in response to chemotherapy. Oncoimmunology 2019; 8:e1564452. [PMID: 30906657 PMCID: PMC6422383 DOI: 10.1080/2162402x.2018.1564452] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 11/30/2018] [Accepted: 12/11/2018] [Indexed: 12/21/2022] Open
Abstract
Increasing life expectancy is associated with increased cancer incidence, yet the effect of cancer and anti-cancer treatment on elderly patients and their immune systems is not well understood. Declining T cell function with aging in response to infection and vaccination is well documented, however little is known about aged T cell responses to tumor antigens during cancer progression or how these responses are modulated by standard chemotherapy. We examined T cell responses to cancer in aged mice using AE17sOVA mesothelioma in which ovalbumin (OVA) becomes a 'spy' tumor antigen containing one dominant (SIINFEKL) and two subdominant (KVVRFDKL and NAIVFKGL) epitopes. Faster progressing tumors in elderly (22-24 months, cf. 60-70 human years) relative to young (2-3 months, human 15-18 years) mice were associated with increased pro-inflammatory cytokines and worsened cancer cachexia. Pentamer staining and an in-vivo cytotoxic T lymphocyte (CTL) assay showed that whilst elderly mice generated a greater number of CD8+ T cells recognizing all epitopes, they exhibited a profound loss of function in their ability to lyse targets expressing the dominant, but not subdominant, epitopes compared to young mice. Chemotherapy was less effective and more toxic in elderly mice however, similar to young mice, chemotherapy expanded CTLs recognizing at least one subdominant epitope in tumors and draining lymph nodes, yet treatment efficacy still required CD8+ T cells. Given the significant dysfunction associated with elderly CTLs recognizing dominant epitopes, our data suggest that responses to subdominant tumor epitopes may become important when elderly hosts with cancer are treated with chemotherapy.
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Affiliation(s)
- Connie Jackaman
- School of Pharmacy and Biomedical Sciences, Curtin University, Perth, Australia.,Curtin Health Innovation Research Institute, Curtin University, Perth, Australia
| | - Joanne K Gardner
- School of Pharmacy and Biomedical Sciences, Curtin University, Perth, Australia.,Curtin Health Innovation Research Institute, Curtin University, Perth, Australia
| | - Federica Tomay
- School of Pharmacy and Biomedical Sciences, Curtin University, Perth, Australia.,Curtin Health Innovation Research Institute, Curtin University, Perth, Australia
| | - Joshua Spowart
- School of Pharmacy and Biomedical Sciences, Curtin University, Perth, Australia.,Curtin Health Innovation Research Institute, Curtin University, Perth, Australia
| | - Hannah Crabb
- School of Pharmacy and Biomedical Sciences, Curtin University, Perth, Australia.,Curtin Health Innovation Research Institute, Curtin University, Perth, Australia
| | - Danielle E Dye
- School of Pharmacy and Biomedical Sciences, Curtin University, Perth, Australia.,Curtin Health Innovation Research Institute, Curtin University, Perth, Australia
| | - Simon Fox
- School of Pharmacy and Biomedical Sciences, Curtin University, Perth, Australia.,Curtin Health Innovation Research Institute, Curtin University, Perth, Australia
| | - Stephen Proksch
- School of Pharmacy and Biomedical Sciences, Curtin University, Perth, Australia.,Curtin Health Innovation Research Institute, Curtin University, Perth, Australia
| | - Pat Metharom
- Curtin Health Innovation Research Institute, Curtin University, Perth, Australia
| | - Satvinder S Dhaliwal
- Curtin Health Innovation Research Institute, Curtin University, Perth, Australia.,School of Public Health, Curtin University, Perth, Australia
| | - Delia J Nelson
- School of Pharmacy and Biomedical Sciences, Curtin University, Perth, Australia.,Curtin Health Innovation Research Institute, Curtin University, Perth, Australia
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Schwartz RM, Lieberman-Cribbin W, Wolf A, Flores RM, Taioli E. Systematic review of quality of life following pleurectomy decortication and extrapleural pneumonectomy for malignant pleural mesothelioma. BMC Cancer 2018; 18:1188. [PMID: 30497433 PMCID: PMC6267825 DOI: 10.1186/s12885-018-5064-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 11/07/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Few studies have focused on quality of life (QoL) after treatment of malignant pleural mesothelioma (MPM). There are still questions as to which surgical procedure, extrapleural pneumonectomy (EPP) or pleurectomy decortication (P/D) is most effective and results in better survival outcomes, involves fewer complications, and results in better QoL. Here we performed a literature review on MPM patients to assess and compare QoL changes after P/D and EPP. METHODS Research articles concerning QoL after mesothelioma surgery were identified through May 2018 in Medline. For inclusion, studies were 1) cohort or randomized controlled trials (RCT) design, 2) included standardized QoL instruments, 3) reported QoL measurement after surgery, 4) described the type of surgery performed (EPP or P/D), 5) were written in English. Measures of lung function (FEV1, FVC) and measures from the EORTC-C30 were compared 6 months following surgery with preoperative values. RESULTS QoL data was extracted from 17 articles (14 datasets), encompassing 659 patients (102 EPP, 432 P/D); the available evidence was of low quality. While two studies directly compared QoL between the two surgical procedures, additional data was available from one arm of two RCTs, as the RCTs were not comparing EPP and P/D. The remaining data was reported from observational studies. While QoL was still compromised 6 months following surgery, from the limited and low quality data available it would appear that P/D patients had better QoL than EPP patients across all measures. Physical function, social function and global health were better at follow-up for P/D than for EPP, while other indicators such as pain and cough were similar. Forced Expiratory Volume (FEV1) and Forced Vital Capacity (FVC) were reported in one study only, and were higher at follow-up for P/D compared to EPP. CONCLUSIONS Although the existing evidence is limited and of low quality, it suggests that P/D patients have better QoL than EPP patients following surgery. QoL outcomes should be factored into the choice of surgical procedure for MPM patients, and the possible effects on lung function and QoL should be discussed with patients when presenting surgical treatment options.
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Affiliation(s)
- Rebecca M Schwartz
- Department of Occupational Medicine, Epidemiology and Prevention, Northwell Health Physician Partners, Hofstra Northwell School of Medicine, Great Neck, NY, USA.,Institute for Translational Epidemiology and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1133, New York, NY, USA
| | - Wil Lieberman-Cribbin
- Institute for Translational Epidemiology and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Andrea Wolf
- Department of Thoracic Surgery, Mount Sinai Health System, Icahn School of Medicine, New York, NY, USA
| | - Raja M Flores
- Department of Thoracic Surgery, Mount Sinai Health System, Icahn School of Medicine, New York, NY, USA.,Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1133, New York, NY, USA
| | - Emanuela Taioli
- Institute for Translational Epidemiology and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA. .,Department of Thoracic Surgery, Mount Sinai Health System, Icahn School of Medicine, New York, NY, USA. .,Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1133, New York, NY, USA.
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28
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Harling L, Kolokotroni SM, Nair A, Smelt J, King J, Routledge T, Spicer J, Ng W, Bille A. Differential Survival Characteristics of Sarcomatoid Subtype in Biphasic Pleural Mesothelioma. Ann Thorac Surg 2018; 107:929-935. [PMID: 30389446 DOI: 10.1016/j.athoracsur.2018.09.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 08/23/2018] [Accepted: 09/10/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Biphasic pleural mesothelioma (BPM) accounts for approximately 10% of all pleural mesothelioma. Our aim was to assess the clinical, radiologic, and pathologic factors impacting survival in BPM and to better identify patients most likely to benefit from active treatment. METHODS A 10-year retrospective review was made of 214 biopsy-proven BPM cases with minimum 2-year follow-up. Patients with insufficient tissue for analysis were excluded (n = 96). Clinical and pathologic factors were evaluated along with radiologic assessment of pleural thickness. Survival was measured from time of diagnosis. Univariable and multivariable predictors of survival were evaluated. RESULTS In all, 118 patients were included; 28 underwent pleurectomy/decortication, with 27 receiving additional modalities. Ninety patients underwent chemotherapy (n = 18) or radiotherapy alone (n = 9), 63 received combination therapy, and 27 received best supportive care. Median overall survival was 11.2 months (range, 0.3 to 36.2). At univariable analysis, pleurectomy/decortication (p = 0.0061), radiotherapy (p < 0.0001), and chemotherapy (p < 0.0001) were associated with superior survival when compared with best supportive care alone. Pleurectomy/decortication demonstrated 40% survival improvement compared with no surgery (p = 0.122). In a multivariable model, necrosis was negatively prognostic (hazard ratio 2.1, SE 0.76). Furthermore, increased sarcomatoid component was associated with worse survival without radiotherapy. CONCLUSIONS BPM prognosis remains poor despite multimodality treatment. Anticancer treatment is associated with superior outcome in this nonrandomized retrospective series. Our findings suggest superior survival for patients with a lower proportion of sarcomatoid disease, with selective benefit of radiotherapy in higher proportions of sarcomatoid disease. When planning active treatment, the potential survival benefits require balancing against associated morbidity and recovery period.
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Affiliation(s)
- Leanne Harling
- Department of Thoracic Surgery, Guy's Hospital, London, United Kingdom; Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | | | - Arjun Nair
- Department of Radiology, Guy's Hospital, London, United Kingdom
| | - Jeremy Smelt
- Department of Thoracic Surgery, Guy's Hospital, London, United Kingdom
| | - Juliet King
- Department of Thoracic Surgery, Guy's Hospital, London, United Kingdom
| | - Tom Routledge
- Department of Thoracic Surgery, Guy's Hospital, London, United Kingdom
| | - James Spicer
- School of Cancer Studies, King's College London, Guy's Hospital, London, United Kingdom
| | - Wen Ng
- Department of Pathology, Guy's Hospital, London, United Kingdom
| | - Andrea Bille
- Department of Thoracic Surgery, Guy's Hospital, London, United Kingdom.
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Kinoshita Y, Hamasaki M, Yoshimura M, Matsumoto S, Sato A, Tsujimura T, Ueda H, Makihata S, Kato F, Iwasaki A, Nabeshima K. A combination of MTAP and BAP1 immunohistochemistry is effective for distinguishing sarcomatoid mesothelioma from fibrous pleuritis. Lung Cancer 2018; 125:198-204. [DOI: 10.1016/j.lungcan.2018.09.019] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 09/13/2018] [Accepted: 09/21/2018] [Indexed: 01/15/2023]
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30
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Rosskamp M, Macq G, Nackaerts K, Praet M, Van Eycken L, Van Meerbeeck JP, De Schutter H. Real-life treatment practice for malignant pleural mesothelioma in Belgium. Lung Cancer 2018; 125:258-264. [DOI: 10.1016/j.lungcan.2018.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 09/13/2018] [Accepted: 10/06/2018] [Indexed: 01/27/2023]
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de Goeje PL, Klaver Y, Kaijen-Lambers MEH, Langerak AW, Vroman H, Kunert A, Lamers CHJ, Aerts JGJV, Debets R, Hendriks RW. Autologous Dendritic Cell Therapy in Mesothelioma Patients Enhances Frequencies of Peripheral CD4 T Cells Expressing HLA-DR, PD-1, or ICOS. Front Immunol 2018; 9:2034. [PMID: 30245692 PMCID: PMC6137618 DOI: 10.3389/fimmu.2018.02034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 08/17/2018] [Indexed: 01/05/2023] Open
Abstract
Introduction: Malignant pleural mesothelioma (MPM) is a malignancy with a very poor prognosis for which new treatment options are urgently needed. We have previously shown that dendritic cell (DC) immunotherapy provides a clinically feasible treatment option. In the current study, we set out to assess the immunological changes induced by DC immunotherapy in peripheral blood of MPM patients. Methods: Peripheral blood was collected from nine patients enrolled in a phase I dose escalation study, before and after treatment with DCs that were pulsed with an allogeneic tumor lysate preparation consisting of a mixture of five cultured mesothelioma cell lines. We used immune profiling by multiplex flow cytometry to characterize different populations of immune cells. In particular, we determined frequencies of T cell subsets that showed single and combinatorial expression of multiple markers that signify T cell activation, maturation and inhibition. Therapy-induced T cell reactivity was assessed in peptide/MHC multimer stainings using mesothelin as a prototypic target antigen with confirmed expression in the clinical tumor lysate preparation. T cell receptor (TCR) diversity was evaluated by TCRB gene PCR assays. Results: We observed an increase in the numbers of B cells, CD4 and CD8 T cells, but not NK cells at 6 weeks post-treatment. The increases in B and T lymphocytes were not accompanied by major changes in T cell reactivity toward mesothelin nor in TCRB diversity. Notably, we did observe enhanced proportions of CD4 T cells expressing HLA-DR, PD-1 (at 2 weeks after onset of treatment) and ICOS (6 weeks) and a CD8 T cell population expressing LAG3 (2 weeks). Discussion: DC immunotherapy using allogeneic tumor lysate resulted in enhanced frequencies of B cells and T cells in blood. We did not detect a skewed antigen-reactivity of peripheral CD8 T cells. Interestingly, frequencies of CD4 T cells expressing activation markers and PD-1 were increased. These findings indicate a systemic activation of the adaptive immune response and may guide future immune monitoring studies of DC therapies.
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Affiliation(s)
- Pauline L de Goeje
- Department of Pulmonary Medicine, Erasmus MC, Rotterdam, Netherlands.,Erasmus MC Cancer Institute, Erasmus MC, Rotterdam, Netherlands
| | - Yarne Klaver
- Erasmus MC Cancer Institute, Erasmus MC, Rotterdam, Netherlands.,Department of Medical Oncology, Laboratory of Tumor Immunology, Erasmus MC, Rotterdam, Netherlands
| | - Margaretha E H Kaijen-Lambers
- Department of Pulmonary Medicine, Erasmus MC, Rotterdam, Netherlands.,Erasmus MC Cancer Institute, Erasmus MC, Rotterdam, Netherlands
| | - Anton W Langerak
- Department of Immunology, Laboratory Medical Immunology, Erasmus MC, Rotterdam, Netherlands
| | - Heleen Vroman
- Department of Pulmonary Medicine, Erasmus MC, Rotterdam, Netherlands.,Erasmus MC Cancer Institute, Erasmus MC, Rotterdam, Netherlands
| | - André Kunert
- Department of Pulmonary Medicine, Erasmus MC, Rotterdam, Netherlands.,Erasmus MC Cancer Institute, Erasmus MC, Rotterdam, Netherlands.,Department of Medical Oncology, Laboratory of Tumor Immunology, Erasmus MC, Rotterdam, Netherlands
| | - Cor H J Lamers
- Erasmus MC Cancer Institute, Erasmus MC, Rotterdam, Netherlands.,Department of Medical Oncology, Laboratory of Tumor Immunology, Erasmus MC, Rotterdam, Netherlands
| | - Joachim G J V Aerts
- Department of Pulmonary Medicine, Erasmus MC, Rotterdam, Netherlands.,Erasmus MC Cancer Institute, Erasmus MC, Rotterdam, Netherlands
| | - Reno Debets
- Erasmus MC Cancer Institute, Erasmus MC, Rotterdam, Netherlands.,Department of Medical Oncology, Laboratory of Tumor Immunology, Erasmus MC, Rotterdam, Netherlands
| | - Rudi W Hendriks
- Department of Pulmonary Medicine, Erasmus MC, Rotterdam, Netherlands
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Assessing the completeness and correctness of the registration of malignant mesothelioma in Belgium. Lung Cancer 2018; 122:38-43. [DOI: 10.1016/j.lungcan.2018.05.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 05/19/2018] [Accepted: 05/20/2018] [Indexed: 11/21/2022]
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Xu D, Liang SQ, Yang H, Lüthi U, Riether C, Berezowska S, Marti TM, Hall SRR, Bruggmann R, Kocher GJ, Schmid RA, Peng RW. Increased sensitivity to apoptosis upon endoplasmic reticulum stress-induced activation of the unfolded protein response in chemotherapy-resistant malignant pleural mesothelioma. Br J Cancer 2018; 119:65-75. [PMID: 29921948 PMCID: PMC6035279 DOI: 10.1038/s41416-018-0145-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 04/13/2018] [Accepted: 05/17/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Standard treatment for advanced malignant pleural mesothelioma (MPM) is a cisplatin/pemetrexed (MTA) regimen; however, this is confronted by drug resistance. Proteotoxic stress in the endoplasmic reticulum (ER) is a hallmark of cancer and some rely on this stress signalling in response to cytotoxic chemotherapeutics. We hypothesise that ER stress and the adaptive unfolded protein response (UPR) play a role in chemotherapy resistance of MPM. METHODS In vitro three-dimensional (3D) and ex vivo organotypic culture were used to enrich a chemotherapy-resistant population and recapitulate an in vivo MPM microenvironment, respectively. Markers of ER stress, the UPR and apoptosis were assessed at mRNA and protein levels. Cell viability was determined based on acid phosphatase activity. RESULTS MPM cells with de novo and/or acquired chemotherapy resistance displayed low ER stress, which rendered the cells hypersensitive to agents that induce ER stress and alter the UPR. Bortezomib, an FDA-approved proteasome inhibitor, selectively impairs chemotherapy-resistant MPM cells by activating the PERK/eIF2α/ATF4-mediated UPR and augmenting apoptosis. CONCLUSIONS We provide the first evidence for ER stress and the adaptive UPR signalling in chemotherapy resistance of MPM, which suggests that perturbation of the UPR by altering ER stress is a novel strategy to treat chemotherapy-refractory MPM.
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Affiliation(s)
- Duo Xu
- Division of General Thoracic Surgery, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Shun-Qing Liang
- Division of General Thoracic Surgery, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Haitang Yang
- Division of General Thoracic Surgery, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Ursina Lüthi
- Department of Medical Oncology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Carsten Riether
- Department of Medical Oncology, Inselspital, Bern University Hospital, Bern, Switzerland.,Department for BioMedical Research, University of Bern, Bern, Switzerland
| | | | - Thomas M Marti
- Division of General Thoracic Surgery, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Sean R R Hall
- Division of General Thoracic Surgery, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Rémy Bruggmann
- Interfaculty Bioinformatics Unit, University of Bern, Bern, Switzerland
| | - Gregor J Kocher
- Division of General Thoracic Surgery, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Ralph A Schmid
- Division of General Thoracic Surgery, Inselspital, Bern University Hospital, Bern, Switzerland. .,Department for BioMedical Research, University of Bern, Bern, Switzerland.
| | - Ren-Wang Peng
- Division of General Thoracic Surgery, Inselspital, Bern University Hospital, Bern, Switzerland. .,Department for BioMedical Research, University of Bern, Bern, Switzerland.
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Wu TH, Lee LJH, Yuan CT, Chen TWW, Yang JCH. Prognostic factors and treatment outcomes of malignant pleural mesothelioma in Eastern Asian patients - A Taiwanese study. J Formos Med Assoc 2018; 118:230-236. [PMID: 29709339 DOI: 10.1016/j.jfma.2018.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 03/27/2018] [Accepted: 04/03/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND/PURPOSE There are scarce reports on the prognostic factors and treatment outcomes of patients with malignant pleural mesothelioma (MPM) in Asia. This study aimed to address these matters in a real-world setting. METHODS Medical records of patients with histologically proven MPM diagnosed between 1977 and 2016 at the National Taiwan University Hospital were reviewed. Variables including age, gender, performance status, asbestos exposure, smoking history, histology subtype, staging, and treatment received were recorded. All patients were followed until death or March 1st, 2017. Survival and prognostic factors were analyzed by the Kaplan-Meir method and the Cox proportional hazard model. RESULTS A total of 93 patients was identified, including 65 men and 28 women. An increasing trend of MPM cases diagnosed was observed in the past 40 years. Stage I/II disease (HR 0.24, 95% CI 0.13-0.46) and epithelioid histology (HR 0.42, 95% CI 0.23-0.75) were associated with favorable prognosis, whereas age ≥70 years (HR 2.66, 95% CI 1.36-5.22) and ECOG ≥2 (HR 5.03, 95% CI 2.69-9.4) were poor prognostic factors. After adjustment for prognostic factors, surgery in stage I-III MPM (HR 0.36, 95% CI 0.15-0.83) and systemic therapy in stage III/IV disease (HR 0.42, 95% CI 0.19-0.94) conferred a survival benefit. CONCLUSION This is one of the largest case series of MPM reported in Asia outside of Japan. Prognostic factors in the study population included age, performance status, stage, and histology subtype. Surgery in potentially resectable disease and systemic therapy in advanced MPM confer a survival benefit in Asian patients.
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Affiliation(s)
- Ting-Hui Wu
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Lukas Jyuhn-Hsiarn Lee
- National Institute of Environmental Health Sciences, National Health Research Institutes, Zhunan, Miaoli, Taiwan; Department of Environmental and Occupational Medicine, National Taiwan University Hospital, Taipei, Taiwan; Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chang-Tsu Yuan
- Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan
| | - Tom Wei-Wu Chen
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan; National Taiwan University Cancer Center, Taipei, Taiwan; Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan.
| | - James Chih-Hsin Yang
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan; National Taiwan University Cancer Center, Taipei, Taiwan; Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan
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Damhuis RAM, van Meerbeeck JP. International trends in the clinical epidemiology of malignant pleural mesothelioma. J Thorac Dis 2018; 10:1147-1148. [PMID: 29708168 PMCID: PMC5906352 DOI: 10.21037/jtd.2018.03.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 02/14/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Ronald A. M. Damhuis
- Department of Research, Comprehensive Cancer Organization, DB Utrecht, The Netherlands
| | - Jan P. van Meerbeeck
- Department of Pulmonology & Thoracic Oncology, Antwerp University Hospital, Edegem, Belgium
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Lang-Lazdunski L. Malignant pleural mesothelioma: some progress, but still a long way from cure. J Thorac Dis 2018; 10:1172-1177. [PMID: 29708163 DOI: 10.21037/jtd.2018.01.152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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37
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Carioli G, Bonifazi M, Rossi M, Zambelli A, Franchi M, Zocchetti C, Gasparini S, Corrao G, La Vecchia C, Negri E. Management and Survival of Pleural Mesothelioma: A Record Linkage Study. Respiration 2018; 95:405-413. [PMID: 29421798 DOI: 10.1159/000486578] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 01/02/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Pleural mesothelioma (PM) is a rare, highly lethal tumor. A definite consensus on its management has yet to be established. OBJECTIVES To assess management, overall survival (OS), and their predictors in a cohort of patients from Lombardy, the largest Italian region (about 10 million inhabitants). METHODS Through a record linkage between Lombardy health care administrative databases, we identified patients diagnosed with PM in 2006-2011 without history of cancer, evaluating their management. OS from PM diagnosis was estimated using the Kaplan-Meier method. Predictors of OS and of treatment were assessed using Cox regression models with time-dependent covariates when appropriate. RESULTS Out of 1,326 patients, 754 (56.9%) received treatment for PM: 205 (15.5%) underwent surgery, and 696 (52.5%) used chemotherapy. Surgery was spread across several hospitals, and most patients diagnosed in nonspecialized centers (70%) underwent surgery in the same centers. Age at diagnosis was a strong inverse determinant of surgery. Determinants of receiving chemotherapy were younger age, a more recent first diagnosis, and first diagnosis in a specialized center. OS was 45.4% at 1 year, 24.8% at 2 years, and 9.6% at 5 years (median 11 months). OS decreased with age, and was higher for those who underwent surgery, but not for those treated with chemotherapy. CONCLUSIONS Management of PM varied widely in clinical practice, and significant predictors of treatment were younger age and recent diagnosis, though a high proportion of patients were not treated. Patients were treated in various hospitals, indicating the importance of concentrating serious rare neoplasms in Comprehensive Cancer Centers (as recognized by the Italian Health Ministry).
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Affiliation(s)
- Greta Carioli
- Department of Clinical Sciences and Community Health, Universitá degli Studi di Milano, Milan, Italy
| | - Martina Bonifazi
- Department of Biomedical Sciences and Public Health, Universitá Politecnica delle Marche, and Pulmonary Diseases Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria "Ospedali Riuniti", Ancona, Italy
| | - Marta Rossi
- Department of Clinical Sciences and Community Health, Universitá degli Studi di Milano, Milan, Italy
| | - Alberto Zambelli
- Department of Medical Oncology, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Matteo Franchi
- Laboratory of Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Carlo Zocchetti
- RESISS - Ricerche e Studi in Sanità e Salute, Gallarate, Italy
| | - Stefano Gasparini
- Department of Biomedical Sciences and Public Health, Universitá Politecnica delle Marche, and Pulmonary Diseases Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria "Ospedali Riuniti", Ancona, Italy
| | - Giovanni Corrao
- Laboratory of Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, Universitá degli Studi di Milano, Milan, Italy
| | - Eva Negri
- Department of Biomedical and Clinical Sciences, Universitá degli Studi di Milano, Milan, Italy
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Molecular and Histopathological Characterization of the Tumor Immune Microenvironment in Advanced Stage of Malignant Pleural Mesothelioma. J Thorac Oncol 2018; 13:124-133. [DOI: 10.1016/j.jtho.2017.09.1968] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 09/21/2017] [Accepted: 09/22/2017] [Indexed: 01/21/2023]
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Treatment Variation of Sequential versus Concurrent Chemoradiotherapy in Stage III Non-Small Cell Lung Cancer Patients in the Netherlands and Belgium. Clin Oncol (R Coll Radiol) 2017; 29:e177-e185. [DOI: 10.1016/j.clon.2017.07.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 06/28/2017] [Accepted: 07/12/2017] [Indexed: 11/19/2022]
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40
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Yoshimura M, Kinoshita Y, Hamasaki M, Matsumoto S, Hida T, Oda Y, Nabeshima K. Diagnostic application of BAP1 immunohistochemistry to differentiate pleural mesothelioma from metastatic pleural tumours. Histopathology 2017; 71:1011-1014. [DOI: 10.1111/his.13321] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 07/20/2017] [Accepted: 07/21/2017] [Indexed: 01/28/2023]
Affiliation(s)
- Masayo Yoshimura
- Department of Pathology; Fukuoka University School of Medicine and Hospital; Fukuoka Japan
| | - Yoshiaki Kinoshita
- Department of Pathology; Fukuoka University School of Medicine and Hospital; Fukuoka Japan
| | - Makoto Hamasaki
- Department of Pathology; Fukuoka University School of Medicine and Hospital; Fukuoka Japan
| | - Shinji Matsumoto
- Department of Pathology; Fukuoka University School of Medicine and Hospital; Fukuoka Japan
| | - Tomoyuki Hida
- Department of Anatomic Pathology; Graduate School of Medical Sciences, Kyushu University; Fukuoka Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology; Graduate School of Medical Sciences, Kyushu University; Fukuoka Japan
| | - Kazuki Nabeshima
- Department of Pathology; Fukuoka University School of Medicine and Hospital; Fukuoka Japan
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Otoshi T, Kataoka Y, Ikegaki S, Saito E, Matsumoto H, Kaku S, Shimada M, Hirabayashi M. Pleural effusion biomarkers and computed tomography findings in diagnosing malignant pleural mesothelioma: A retrospective study in a single center. PLoS One 2017; 12:e0185850. [PMID: 28968445 PMCID: PMC5624636 DOI: 10.1371/journal.pone.0185850] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 09/20/2017] [Indexed: 11/18/2022] Open
Abstract
In this study, we aimed to examine the clinical value of the pleural effusion (PE) biomarkers, soluble mesothelin-related peptide (SMRP), cytokeratin 19 fragment (CYFRA 21–1) and carcinoembryonic antigen (CEA), and the utility of combining chest computed tomography (CT) findings with these biomarkers, in diagnosing malignant pleural mesothelioma (MPM). We conducted a retrospective cohort study in a single center. Consecutive patients with undiagnosed pleural effusions who underwent PE analysis between September 2014 and August 2016 were reviewed. This study included 240 patients (32 with MPM and 208 non-MPM). SMRP and the CYFRA 21-1/CEA ratio had a sensitivity and specificity for diagnosing MPM of 56.3% and 86.5%, and 87.5% and 74.0%, respectively. Using receiver operating characteristics (ROC) curve analysis of the ability of these markers to distinguish MPM from all other PE causes, the area under the ROC curve (AUC) for SMRP and the CYFRA 21-1/CEA ratio was 0.804 and 0.874, respectively. The sensitivity and specificity of SMRP combined with the CYFRA 21-1/CEA ratio were 93.8% and 64.9%, respectively. The sensitivity of the combination of SMRP, the CYFRA 21-1/CEA ratio, and the presence of Leung’s criteria (a chest CT finding that is suggestive of malignant pleural disease) was 93.8%. In conclusion, the combined PE biomarkers had a high sensitivity for diagnosing MPM, although the addition of chest CT findings did not improve the sensitivity of SMRP combined with the CYFRA 21-1/CEA ratio. Combination of these biomarkers helped to rule out MPM effectively among patients at high risk of suffering MPM and would be valuable especially for old frail patients who have difficulty in undergoing invasive procedures such as thoracoscopy.
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Affiliation(s)
- Takehiro Otoshi
- Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
- * E-mail:
| | - Yuki Kataoka
- Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
| | - Shunkichi Ikegaki
- Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
| | - Emiko Saito
- Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
| | - Hirotaka Matsumoto
- Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
| | - Sawako Kaku
- Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
| | - Masatoshi Shimada
- Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
| | - Masataka Hirabayashi
- Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
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Friedberg JS, Simone CB, Culligan MJ, Barsky AR, Doucette A, McNulty S, Hahn SM, Alley E, Sterman DH, Glatstein E, Cengel KA. Extended Pleurectomy-Decortication-Based Treatment for Advanced Stage Epithelial Mesothelioma Yielding a Median Survival of Nearly Three Years. Ann Thorac Surg 2016; 103:912-919. [PMID: 27825687 DOI: 10.1016/j.athoracsur.2016.08.071] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 08/15/2016] [Accepted: 08/22/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND The purpose of this study was to assess survival for patients with malignant pleural mesothelioma (MPM), epithelial subtype, utilizing extended pleurectomy-decortication combined with intraoperative photodynamic therapy (PDT) and adjuvant pemetrexed-based chemotherapy. METHODS From 2005 to 2013, 90 patients underwent lung-sparing surgery and PDT for MPM. All patients had a preoperative diagnosis of epithelial subtype, of which 17 proved to be of mixed histology. The remaining 73 patients with pure epithelial subtype were analyzed. All patients received lung-sparing surgery and PDT; 92% also received chemotherapy. The median follow-up was 5.3 years for living patients. RESULTS Macroscopic complete resection was achieved in all 73 patients. Thirty-day mortality was 3% and 90-day mortality was 4%. For all 73 patients (89% American Joint Commission on Cancer stage III/IV, 69% N2 disease, median tumor volume 550 mL), the median overall and disease-free survivals were 3 years and 1.2 years, respectively. For the 19 patients without lymph node metastases (74% stage III/IV, median tumor volume 325 mL), the median overall and disease-free survivals were 7.3 years and 2.3 years, respectively. CONCLUSIONS This is a mature dataset for MPM that demonstrates the ability to safely execute a complex treatment plan that included a surgical technique that consistently permitted achieving a macroscopic complete resection while preserving the lung. The role for lung-sparing surgery is unclear but this series demonstrates that it is an option, even for advanced cases. The overall survival of 7.3 years for the node negative subset of patients, still of advanced stage, is encouraging. Of particular interest is the overall survival being approximately triple the disease-free survival, perhaps PDT related. The impact of PDT is unclear, but it is hoped that it will be established by an ongoing randomized trial.
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Affiliation(s)
- Joseph S Friedberg
- Division of Thoracic Surgery, University of Maryland Medical Center, Baltimore, Maryland.
| | - Charles B Simone
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Melissa J Culligan
- Division of Thoracic Surgery, University of Maryland Medical Center, Baltimore, Maryland
| | - Andrew R Barsky
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Abigail Doucette
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sally McNulty
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephen M Hahn
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Evan Alley
- Department of Hematology-Oncology, Penn-Presbyterian Medical Center, Philadelphia, Pennsylvania
| | - Daniel H Sterman
- Department of Pulmonary and Critical Care Medicine, New York University, New York, New York
| | - Eli Glatstein
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Keith A Cengel
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Hida T, Hamasaki M, Matsumoto S, Sato A, Tsujimura T, Kawahara K, Iwasaki A, Okamoto T, Oda Y, Honda H, Nabeshima K. BAP1 immunohistochemistry and p16 FISH results in combination provide higher confidence in malignant pleural mesothelioma diagnosis: ROC analysis of the two tests. Pathol Int 2016; 66:563-570. [PMID: 27614970 DOI: 10.1111/pin.12453] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 07/20/2016] [Accepted: 08/04/2016] [Indexed: 01/07/2023]
Abstract
Differentiation of malignant pleural mesothelioma (MPM) from benign mesothelial proliferation remains problematic. Loss of nuclear staining of BRCA1-associated protein 1 (BAP1; detected using immunohistochemistry (IHC)) and homozygous deletion (HD) of p16 (detected using fluorescence in situ hybridization (FISH)) are useful for differentiation of MPM from reactive mesothelial hyperplasia (RMH), but the correlation between BAP1 expression loss and p16 HD has not been fully described. We performed BAP1 IHC and p16-specific FISH for 40 MPM and 20 RMH cases, and measured proportions of cells showing BAP1 expression and p16 HD for each case. The diagnostic accuracy for MPM and the cut-off values of the two methods were assessed using receiver operating characteristic (ROC) analysis. BAP1 expression loss, p16 HD and coexistence of both were present in 27 (67.5 %), 27 (67.5 %) and 17 (42.5 %) MPM cases, respectively. Three MPM cases (7.5 %) and all 20 RMH cases had neither BAP1 loss nor p16 HD. There was no correlation between the results of the two methods. Their combination showed higher sensitivity (92.5 %, 37/40) and estimated probability than BAP1 IHC and p16-specific FISH used alone. BAP1 IHC and p16-specific FISH have independent diagnostic value, and have increased reliability when used in combination, for MPM diagnosis.
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Affiliation(s)
- Tomoyuki Hida
- Department of Pathology, Fukuoka University Hospital and School of Medicine, Fukuoka, Japan.,Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Makoto Hamasaki
- Department of Pathology, Fukuoka University Hospital and School of Medicine, Fukuoka, Japan
| | - Shinji Matsumoto
- Department of Pathology, Fukuoka University Hospital and School of Medicine, Fukuoka, Japan
| | - Ayuko Sato
- Department of Pathology, Hyogo College of Medicine, Hyogo, Japan
| | - Tohru Tsujimura
- Department of Pathology, Hyogo College of Medicine, Hyogo, Japan
| | - Kunimitsu Kawahara
- Department of Pathology, Osaka Prefectural Medical Center for Respiratory and Allergic Disease, Osaka, Japan
| | - Akinori Iwasaki
- Department of Thoracic Surgery, Fukuoka University Hospital and School of Medicine, Fukuoka, Japan
| | - Tatsuro Okamoto
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroshi Honda
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kazuki Nabeshima
- Department of Pathology, Fukuoka University Hospital and School of Medicine, Fukuoka, Japan.
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Management of malignant pleural mesothelioma - part 3 : Data from the Austrian Mesothelioma Interest Group (AMIG) database. Wien Klin Wochenschr 2016; 128:627-34. [PMID: 27457873 PMCID: PMC5033994 DOI: 10.1007/s00508-016-1037-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 06/09/2016] [Indexed: 12/29/2022]
Abstract
Background Malignant pleural mesothelioma (MPM) is a rare but aggressive tumor originating from the pleural cavity with a strong link to previous asbestos exposure. In order to determine the demographics, diagnostics, therapeutic strategies, and prognosis of MPM patients in Austria, the Austrian Mesothelioma Interest Group (AMIG) was founded in 2011. In this report the data from the AMIG MPM database collected to date are reported. Methods A prospective observational registry was initiated, including patients with histologically verified MPM diagnosed and treated at specialized centers in Austria. Patient inclusion started in January 2011 and follow-up was completed until September 2015. Results A total number of 210 patients were included. There were 167 male and 43 female patients with a mean age of 67.0 years (SD ± 11.3) at the time of diagnosis. Asbestos exposure was confirmed in 109 (69.4 %) patients. The histological subtype was epithelioid in 141 (67.2 %), sarcomatoid in 16 (7.6 %), biphasic in 28 (13.3 %), and MPM not otherwise specified in 25 (11.9 %) patients. Of the patients, 30 (14.3 %) received best supportive care (BSC) only, 71 (33.8 %) chemotherapy (CHT) alone, four (1.9 %) radiotherapy (RT) alone, 23 (11.9 %) CHT/RT, two (0.9 %) surgery alone, and 76 (36.2 %) curative surgery within a multimodality treatment (MMT), which was more frequently performed for patients younger than 65 years and with early-stage disease (I + II). Median overall survival (OS) was 19.1 months (95 % CI 14.7–23.5). The 1‑, 3‑, and 5‑year OS rates were 66 %, 30 %, and 23 %, respectively, and OS was significantly better in patients undergoing surgery within MMT (5-year survival 5 % vs. 40 %, p = 0.001). Conclusion Patients with earlier disease stages, younger age, good performance status, and epithelioid histology were more likely to undergo MMT including surgery, which resulted in a more favorable outcome.
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Righi L, Duregon E, Vatrano S, Izzo S, Giorcelli J, Rondón-Lagos M, Ascoli V, Ruffini E, Ventura L, Volante M, Papotti M, Scagliotti GV. BRCA1-Associated Protein 1 (BAP1) Immunohistochemical Expression as a Diagnostic Tool in Malignant Pleural Mesothelioma Classification: A Large Retrospective Study. J Thorac Oncol 2016; 11:2006-2017. [PMID: 27422796 DOI: 10.1016/j.jtho.2016.06.020] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 06/22/2016] [Accepted: 06/24/2016] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Malignant pleural mesothelioma (MPM) is a highly aggressive disease with limited therapeutic options. Histological subtype remains among the most reliable prognostic factors, because the epithelioid subtype associated with the best prognosis and the sarcomatoid subtype with the worst. The biphasic subtype has an intermediate prognosis, but its definitive histological diagnosis may be challenging owing to the difficulty of assessing the neoplastic nature of the stromal component. Recent data identified BRCA1-associated protein 1 gene (BAP1) as one of the most frequently mutated genes in MPM. Immunohistochemical testing for BRCA1-associated protein 1 (BAP1) has been proposed to be predictive for the detection of BAP1 mutation in neoplastic cells. The aim of the present study was to define the diagnostic usefulness of immunohistochemical determination of BAP1 in MPM, with clinicopathological correlation. METHODS A series of 143 MPMs were investigated for BAP1 protein expression in correlation with clinical and pathological data, including with a newly proposed nuclear grade. A pilot series of 20 selected cases were also investigated for BAP1 mutational status. RESULTS Negative nuclear staining for BAP1 occurred in 62% of MPMs (including 27% with a cytoplasmic pattern) and was significantly associated with the presence of BAP1 mutation, epithelioid subtype, and a better prognosis. In a subgroup of cases, the pattern of expression of BAP1 in stromal cells supported their distinction as reactive versus neoplastic, thus helping achieve the correct classification of biphasic histological subtype. CONCLUSIONS We showed that BAP1 protein determination is a diagnostic tool to correctly distinguish biphasic MPM from epithelial subtypes with an atypical/activated reactive stroma and an independent prognostic parameter in MPM.
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Affiliation(s)
- Luisella Righi
- Department of Oncology, University of Turin at San Luigi Hospital, Turin, Italy.
| | - Eleonora Duregon
- Department of Oncology, University of Turin at San Luigi Hospital, Turin, Italy
| | - Simona Vatrano
- Department of Oncology, University of Turin at San Luigi Hospital, Turin, Italy
| | - Stefania Izzo
- Department of Oncology, University of Turin at San Luigi Hospital, Turin, Italy
| | - Jessica Giorcelli
- Department of Oncology, University of Turin at San Luigi Hospital, Turin, Italy
| | | | - Valeria Ascoli
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
| | - Enrico Ruffini
- Department of Surgical Sciences, City of Health and Science Hospital, University of Turin, Turin, Italy
| | - Laura Ventura
- Department of Statistical Sciences, University of Padua, Padua, Italy
| | - Marco Volante
- Department of Oncology, University of Turin at San Luigi Hospital, Turin, Italy
| | - Mauro Papotti
- Department of Oncology, University of Turin at San Luigi Hospital, Turin, Italy; Pathology Unit, City of Health and Science Hospital, University of Turin, Turin, Italy
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