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Jia J, Tan X, Gao F, Shao Z, Zhang M. Primary Intrahepatic Mesothelioma: Case Series and Systematic Review of Literature. J Gastrointest Cancer 2024; 55:1520-1529. [PMID: 39141212 DOI: 10.1007/s12029-024-01075-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2024] [Indexed: 08/15/2024]
Abstract
BACKGROUND Primary intrahepatic mesothelioma (PIHMM) has been rarely reported. Its typical clinical presentation, radiological features and pathology have not been defined. Here, we aimed to summarize its diagnosis and treatment. METHODS We conducted a retrospective analysis of three cases of PIHMM in the First Affiliated Hospital of Zhejiang University School of Medicine and reviewed the current literature to investigate the clinical and pathological characteristics and prognosis of PIHMM. RESULTS Based on our case series and the literature, the mean age of PIHMM was 59.7 (41-83) years. Most patients present with nonspecific symptoms such as abdominal pain, fever, weight loss and weakness. On imaging, PIHMM usually presented as a solid, heterogeneous soft tissue mass with irregular margins and significant enhancement of the margins in the arterial phase. Immunohistochemical markers such as calretinin, cytokeratin (CK)5/6, D2-40, WT-1, mesothelin CK and vimentin may be useful for diagnosis. The 3-year relapse-free survival rate (RFS) was 51.85%, the 3-year overall survival (OS) rate was 83.33% and the 3-year postoperative overall survival rate was 100%. CONCLUSION PIHMM can only be diagnosed by careful postoperative pathology, because of its nonspecific clinical presentations, serological indicators or imaging features. Immunohistochemical staining is very useful to distinguish this tumor from other liver tumors. Surgery is the mainstay of treatment.
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Affiliation(s)
- Junjun Jia
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, Zhejiang Province, China
| | - Xinyue Tan
- College of Pediatrics, Capital Medical University, 100045, Beijing, China
| | - Feng Gao
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, Zhejiang Province, China
| | - Zhou Shao
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, Zhejiang Province, China
| | - Min Zhang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, Zhejiang Province, China.
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Occhipinti M, Brambilla M, Di Liello R, Ambrosini P, Lobianco L, Leporati R, Salvarezza M, Vitiello F, Marchesi S, Manglaviti S, Beninato T, Mazzeo L, Proto C, Prelaj A, Ferrara R, Della Corte CM, Lo Russo G, de Braud F, Ganzinelli M, Viscardi G. Unleashing precision: A review of targeted approaches in pleural mesothelioma. Crit Rev Oncol Hematol 2024; 203:104481. [PMID: 39159705 DOI: 10.1016/j.critrevonc.2024.104481] [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: 02/11/2024] [Revised: 08/12/2024] [Accepted: 08/13/2024] [Indexed: 08/21/2024] Open
Abstract
This review delves into the intricate landscape of pleural mesothelioma (PM), emphasizing the need for nuanced therapeutic strategies. While platinum-based chemotherapy remains a cornerstone, the advent of immune checkpoint inhibitors (ICIs), notably through the Checkmate 743 trial, has reshaped treatment paradigms. Challenges persist due to patient heterogeneity and a lack of specific biomarkers. Targeting genotypic and phenotypic alterations emerges as a promising avenue, demanding precision oncology in this rare disease. CDKN2A loss, prevalent in PM, may respond to CDK4/6 inhibitors. Defects in MMR and HR suggest tailored approaches with ICI or PARP inhibitors, respectively. Ongoing trials explore novel inhibitors and promising targets like mesothelin. Implementing these strategies requires overcoming challenges in patient selection, combination therapies, biomarker identification, and cost considerations. Collaboration is crucial for transforming these insights into impactful clinical interventions, heralding the era of personalized and precision medicine for PM.
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Affiliation(s)
- Mario Occhipinti
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Marta Brambilla
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
| | | | - Paolo Ambrosini
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Lorenzo Lobianco
- Medical Oncology, Precision Medicine Department, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Rita Leporati
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Maria Salvarezza
- Medical Oncology, Precision Medicine Department, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Fabiana Vitiello
- Medical Oncology Unit, Ospedale Monaldi, AORN Ospedali dei Colli, Naples, Italy
| | - Silvia Marchesi
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Sara Manglaviti
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Teresa Beninato
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Laura Mazzeo
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Claudia Proto
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Arsela Prelaj
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Department of Electronics, Information and Bioengineering, Polytechnic University of Milan, Milan, Italy
| | - Roberto Ferrara
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | | | - Giuseppe Lo Russo
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Filippo de Braud
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Monica Ganzinelli
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Giuseppe Viscardi
- Medical Oncology Unit, Ospedale Monaldi, AORN Ospedali dei Colli, Naples, Italy
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Khosla D, Singh PK, Chhabria BA, Kataria V, Singh N, Kapoor R. Malignant pleural mesothelioma: The disdained member of thoracic oncology! World J Exp Med 2024; 14:91739. [PMID: 39312698 PMCID: PMC11372740 DOI: 10.5493/wjem.v14.i3.91739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 07/17/2024] [Accepted: 07/30/2024] [Indexed: 08/29/2024] Open
Abstract
Pleural mesothelioma is a very aggressive malignancy that arises from the pleural mesothelial cell lining and is linked strongly to prior asbestos exposure. The ban on asbestos has helped to lower the incidence, but in developing countries like India, it is expected to rise. It has an extended latency period usually progressing over decades and presents with nonspecific symptoms. It has a median survival ranging between 10-22 months. The diagnosis of malignant pleural mesothelioma is challenging and is done using computed tomography (CT), magnetic resonance imaging, or positron emission tomography-CT, with the last two predicting the resectability of the tumor better than CT alone. A pleural biopsy along with an array of immunohistochemical markers, such as p16, BRCA1 associated protein 1, and claudin-4, are required for a definitive diagnosis. Several genetic alterations have prognostic significance as well. The current histological subtype identification is indispensable for decision making because of the new therapeutic avenues being explored. The combination of nivolumab and ipilimumab-based immunotherapy outperformed platinum and pemetrexed-based chemotherapy in terms of survival benefit and improved quality of life especially for non-epithelioid subtypes. However, the latter continues to be a robust treatment option for patients with the epithelioid subtype. Surgery is recommended for resectable cases with radiotherapy being indicated in neoadjuvant, adjuvant, and palliative settings along with systemic treatment. This review article provides an overview of epidemiology, etiology, clinical manifestations, diagnostic approaches (including immunohistochemical and genetic markers), staging, and multidisciplinary approaches to current treatment for malignant pleural mesothelioma using surgery, chemotherapy, immunotherapy, and radiotherapy. It also sheds light on some recent studies (EMPHACIS, CALGB30901, Checkmate-743, etc.) that have led to significant developments in recent years with clinically meaningful results.
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Affiliation(s)
- Divya Khosla
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Pawan Kumar Singh
- Department of Pulmonary and Critical Care Medicine, Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak 124001, India
| | - Bharath A Chhabria
- Department of Pulmonary and Critical Care Medicine, Ramaiah Memorial Hospital, Bengaluru 560054, India
| | - Vaishali Kataria
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Navneet Singh
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Rakesh Kapoor
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
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Haugaard AK, Saude Conde R, J Maria AR, Vithal Yergolkar A, Jørgensen KJ, Heleno B. Immunotherapy for advanced and recurrent malignant pleural mesothelioma. Cochrane Database Syst Rev 2024; 9:CD014720. [PMID: 39291744 PMCID: PMC11409431 DOI: 10.1002/14651858.cd014720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/19/2024]
Abstract
OBJECTIVES This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of immune checkpoint inhibitors (single-agent or combination therapy) in people with advanced malignant pleural mesothelioma in a first-line or salvage setting.
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Affiliation(s)
- Anna Karen Haugaard
- Department of Oncology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Rita Saude Conde
- Digestive Oncology Department, Institut Jules Bordet, Hôpital Universitaire de Bruxelles, Brussels, Belgium
| | - Ana Rita J Maria
- Comprehensive Health Research Centre, Nova Medical School | Faculdade de Ciências Médicas da Universidade NOVA de Lisboa, Lisbon, Portugal
| | | | - Karsten Juhl Jørgensen
- Cochrane Denmark and Centre for Evidence Based Medicine Odense, University of Southern Denmark, Odense, Denmark
| | - Bruno Heleno
- Comprehensive Health Research Centre, Nova Medical School | Faculdade de Ciências Médicas da Universidade NOVA de Lisboa, Lisbon, Portugal
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Fanizzi A, Catino A, Bove S, Comes MC, Montrone M, Sicolo A, Signorile R, Perrotti P, Pizzutilo P, Galetta D, Massafra R. Transfer learning approach in pre-treatment CT images to predict therapeutic response in advanced malignant pleural mesothelioma. Front Oncol 2024; 14:1432188. [PMID: 39351354 PMCID: PMC11439621 DOI: 10.3389/fonc.2024.1432188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 08/15/2024] [Indexed: 10/04/2024] Open
Abstract
Introduction Malignant pleural mesothelioma (MPM) is a poor-prognosis disease. Owing to the recent availability of new therapeutic options, there is a need to better assess prognosis. The initial clinical response could represent a useful parameter. Methods We proposed a transfer learning approach to predict an initial treatment response starting from baseline CT scans of patients with advanced/unresectable MPM undergoing first-line systemic therapy. The therapeutic response has been assessed according to the mRECIST criteria by CT scan at baseline and after two to three treatment cycles. We used three slices of baseline CT scan as input to the pre-trained convolutional neural network as a radiomic feature extractor. We identified a feature subset through a double feature selection procedure to train a binary SVM classifier to discriminate responders (partial response) from non-responders (stable or disease progression). Results The performance of the prediction classifiers was evaluated with an 80:20 hold-out validation scheme. We have evaluated how the developed model was robust to variations in the slices selected by the radiologist. In our dataset, 25 patients showed an initial partial response, whereas 13 patients showed progressive or stable disease. On the independent test, the proposed model achieved a median AUC and accuracy of 86.67% and 87.50%, respectively. Conclusions The proposed model has shown high performance even by varying the reference slices. Novel tools could help to improve the prognostic assessment of patients with MPM and to better identify subgroups of patients with different therapeutic responsiveness.
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Affiliation(s)
- Annarita Fanizzi
- Laboratorio di Biostatistica e Bioinformatica, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Tumori 'Giovanni Paolo II', Bari, Italy
| | - Annamaria Catino
- Struttura Semplice Dipartimentale di Oncologia Medica Toracica, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Tumori 'Giovanni Paolo II', Bari, Italy
| | - Samantha Bove
- Laboratorio di Biostatistica e Bioinformatica, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Tumori 'Giovanni Paolo II', Bari, Italy
| | - Maria Colomba Comes
- Laboratorio di Biostatistica e Bioinformatica, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Tumori 'Giovanni Paolo II', Bari, Italy
| | - Michele Montrone
- Struttura Semplice Dipartimentale di Oncologia Medica Toracica, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Tumori 'Giovanni Paolo II', Bari, Italy
| | - Angela Sicolo
- Struttura Semplice Dipartimentale di Oncologia Medica Toracica, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Tumori 'Giovanni Paolo II', Bari, Italy
| | - Rahel Signorile
- Laboratorio di Biostatistica e Bioinformatica, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Tumori 'Giovanni Paolo II', Bari, Italy
| | - Pia Perrotti
- Struttura Semplice Dipartimentale di Oncologia Medica Toracica, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Tumori 'Giovanni Paolo II', Bari, Italy
| | - Pamela Pizzutilo
- Struttura Semplice Dipartimentale di Oncologia Medica Toracica, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Tumori 'Giovanni Paolo II', Bari, Italy
| | - Domenico Galetta
- Struttura Semplice Dipartimentale di Oncologia Medica Toracica, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Tumori 'Giovanni Paolo II', Bari, Italy
| | - Raffaella Massafra
- Laboratorio di Biostatistica e Bioinformatica, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Tumori 'Giovanni Paolo II', Bari, Italy
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Bisceglia L, Morani F, Guerrieri L, Santoni-Rugiu E, Çakılkaya P, Scatena C, Scarpitta R, Engelholm LH, Behrendt N, Gemignani F, Landi S. BAG2, MAD2L1, and MDK are cancer-driver genes and candidate targets for novel therapies in malignant pleural mesothelioma. Cancer Gene Ther 2024:10.1038/s41417-024-00805-4. [PMID: 39300217 DOI: 10.1038/s41417-024-00805-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 06/22/2024] [Accepted: 07/02/2024] [Indexed: 09/22/2024]
Abstract
Malignant pleural mesothelioma (MPM) is an aggressive cancer with a poor prognosis and the identification of novel druggable targets is urgently needed. In previous work, we identified 15 deregulated genes highly expressed in MPM tissues and correlated with a poor prognosis. Here, we validated these findings on an independent dataset of 211 MPM patients (EGA, EGAD00001001915) and on a panel of MPM cell lines. Furthermore, we carried out in vitro gene silencing followed by proliferation, cytotoxicity, caspase, and migration assays to define whether these targets could be cancer-driver genes. We ended up with three novel candidates (i.e., BAG2, MAD2L1, and MDK), whose encoded proteins could be exploited as druggable targets. Moreover, of novelty, immunohistochemistry analysis on tissues revealed that the overexpression of BAG2 and MAD2L1 could differentiate MPM from RMP patients. Furthermore, when we tested Neratinib (an inhibitor of MAD2L1) and iMDK (an inhibitor of MDK) we found that they are effective on MPM cells, in part phenocopying the effects of MAD2L1 and MDK gene silencing. In summary, in the present work, we report that BAG2, MAD2L1, and MDK are bona fide cancer-driver genes for MPM worth of further studies.
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Affiliation(s)
| | | | | | - Eric Santoni-Rugiu
- Department of Pathology, Rigshospitalet, University of Copenhagen, 2100, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2200, Copenhagen N, Denmark
| | - Pınar Çakılkaya
- Finsen Laboratory, Rigshospitalet/Biotech Research & Innovation Centre (BRIC), University of Copenhagen, 2200, Copenhagen, Denmark
| | - Cristian Scatena
- Dipartimento di Ricerca Traslazionale e delle Nuove Tecnologie in Medicina e Chirurgia, Università di Pisa, Pisa, Italy
- UO Anatomia Patologica 1 Universitaria, DAI - Medicina di Laboratorio, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Rosa Scarpitta
- Dipartimento di Ricerca Traslazionale e delle Nuove Tecnologie in Medicina e Chirurgia, Università di Pisa, Pisa, Italy
- UO Anatomia Patologica 1 Universitaria, DAI - Medicina di Laboratorio, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Lars H Engelholm
- Finsen Laboratory, Rigshospitalet/Biotech Research & Innovation Centre (BRIC), University of Copenhagen, 2200, Copenhagen, Denmark
| | - Niels Behrendt
- Finsen Laboratory, Rigshospitalet/Biotech Research & Innovation Centre (BRIC), University of Copenhagen, 2200, Copenhagen, Denmark
| | | | - Stefano Landi
- Department of Biology, University of Pisa, Pisa, Italy.
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Fang Y, Xiang M, Jiang Z, Li H, Yuan G, Pei W, Li W, Sun Y. Survival prediction in peritoneal mesothelioma: a nomogram based on SEER data and a Chinese cohort. Front Endocrinol (Lausanne) 2024; 15:1432787. [PMID: 39309108 PMCID: PMC11412845 DOI: 10.3389/fendo.2024.1432787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 08/23/2024] [Indexed: 09/25/2024] Open
Abstract
Objective This study aimed to develop nomogram predicting overall survival (OS) of patients with peritoneal mesothelioma (PeM) using data from Surveillance, Epidemiology, and End Results (SEER) database and a Chinese institution. Methods 1,177 PeM patients from the SEER database were randomized into training and internal validation cohorts at a 7:3 ratio. An external validation cohort consisting of 109 patients was enrolled from a Chinese institution. Nomogram was constructed based on variables identified through multivariate Cox regression analysis and evaluated by consistency indices (C-index), calibration plots, and receiver operating characteristic (ROC) curves. Patients were stratified into different risk categories, and Kaplan-Meier survival analysis was used to assess OS differences among these groups. Results The nomogram, incorporating age, gender, histological type, T stage, M stage, and surgical status, demonstrated strong predictive capability with C-index values of 0.669 for the training cohort, 0.668 for the internal validation cohort, and 0.646 for the external validation cohort. The nomogram effectively stratified patients into high-risk and low-risk groups, with the high-risk group exhibiting significantly poorer OS (P < 0.05). Multivariate analysis confirmed gender, age, surgical intervention, and M stage as independent prognostic factors (P < 0.05). Specifically, male gender, older age, and unspecified M stage were linked to worse outcomes, while surgical intervention was associated with improved survival. Conclusion The nomogram provide a reliable tool for predicting the survival in PeM patients, facilitating more informed treatment decisions. Key independent prognostic factors include gender, age, surgical intervention, and M stage.
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Affiliation(s)
| | | | | | | | | | | | - Wenbin Li
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yongkun Sun
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Holtermann A, Gislon M, Angele M, Subklewe M, von Bergwelt-Baildon M, Lauber K, Kobold S. Prospects of Synergy: Local Interventions and CAR T Cell Therapy in Solid Tumors. BioDrugs 2024; 38:611-637. [PMID: 39080180 PMCID: PMC11358237 DOI: 10.1007/s40259-024-00669-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2024] [Indexed: 08/30/2024]
Abstract
Chimeric antigen receptor T cell therapy has been established in the treatment of various B cell malignancies. However, translating this therapeutic effect to treat solid tumors has been challenging because of their inter-tumoral as well as intratumoral heterogeneity and immunosuppressive microenvironment. Local interventions, such as surgery, radiotherapy, local ablation, and locoregional drug delivery, can enhance chimeric antigen receptor T cell therapy in solid tumors by improving tumor infiltration and reducing systemic toxicities. Additionally, ablation and radiotherapy have proven to (re-)activate systemic immune responses via abscopal effects and reprogram the tumor microenvironment on a physical, cellular, and chemical level. This review highlights the potential synergy of the combined approaches to overcome barriers of chimeric antigen receptor T cell therapy and summarizes recent studies that may pave the way for new treatment regimens.
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Affiliation(s)
- Anne Holtermann
- Division of Clinical Pharmacology, Department of Medicine IV, University Hospital, Ludwig Maximilian University (LMU) of Munich, Lindwurmstrasse 2a, 80336, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, a partnership between the DKFZ Heidelberg and the University Hospital of the LMU, Munich, Germany
| | - Mila Gislon
- Division of Clinical Pharmacology, Department of Medicine IV, University Hospital, Ludwig Maximilian University (LMU) of Munich, Lindwurmstrasse 2a, 80336, Munich, Germany
| | - Martin Angele
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Marion Subklewe
- Department of Medicine III, University Hospital, Ludwig Maximilian University (LMU) of Munich, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, a partnership between the DKFZ Heidelberg and the University Hospital of the LMU, Munich, Germany
| | - Michael von Bergwelt-Baildon
- Department of Medicine III, University Hospital, Ludwig Maximilian University (LMU) of Munich, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, a partnership between the DKFZ Heidelberg and the University Hospital of the LMU, Munich, Germany
| | - Kirsten Lauber
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Sebastian Kobold
- Division of Clinical Pharmacology, Department of Medicine IV, University Hospital, Ludwig Maximilian University (LMU) of Munich, Lindwurmstrasse 2a, 80336, Munich, Germany.
- German Cancer Consortium (DKTK), Partner Site Munich, a partnership between the DKFZ Heidelberg and the University Hospital of the LMU, Munich, Germany.
- Einheit für Klinische Pharmakologie (EKLiP), Helmholtz Zentrum München-German Research Center for Environmental Health Neuherberg, Munich, Germany.
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Bille A, Ripley RT, Giroux DJ, Gill RR, Kindler HL, Nowak AK, Opitz I, Pass HI, Wolf A, Rice D, Rusch VW. The International Association for the Study of Lung Cancer Mesothelioma Staging Project: Proposals for the "N" Descriptors in the Forthcoming Ninth Edition of the TNM Classification for Pleural Mesothelioma. J Thorac Oncol 2024; 19:1326-1338. [PMID: 38734073 PMCID: PMC11380593 DOI: 10.1016/j.jtho.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/29/2024] [Accepted: 05/03/2024] [Indexed: 05/13/2024]
Abstract
INTRODUCTION The International Association for the Study of Lung Cancer developed an international database to inform potential revisions in the ninth edition of the TNM classification of diffuse pleural mesothelioma (PM). This study analyzed the clinical and pathologic N categories to determine whether revisions were indicated relative to the eighth edition staging system. METHODS Of 7338 PM cases diagnosed from 2013 to 2022 and 3598 met all inclusion criteria for planned analyses. Data on 2836 patients without metastases were included in this study. Overall survival (OS) was measured from date of diagnosis. Patients were included regardless of whether they received neoadjuvant treatment. For the pathologic N analysis, patients who underwent resection (extrapleural pneumonectomy or pleurectomy/decortication) were included. N subgroups were analyzed and OS assessed by the Kaplan-Meier method. RESULTS The existing eighth edition N categories were performed adequately in the ninth edition data set. A median OS advantage was noted for clinical and pathologic N0 versus N1 patients: 23.2 versus 18.5 and 33.8 versus 25.0 months, respectively. Patients with resected pN0 had a 3-year OS of 48%. No difference in OS was noted for single- versus multiple-station nodal metastases. The number of nodal stations sampled at the time of resection was not associated with a difference in OS. CONCLUSIONS Data regarding clinical and pathologic N categories corroborate those used in the eighth edition. No changes in the N categories are recommended in the ninth edition of PM staging system.
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Affiliation(s)
- Andrea Bille
- Thoracic Surgery Department, Guy's Hospital, London, United Kingdom.
| | - R Taylor Ripley
- Department of Thoracic Surgery, Baylor College of Medicine, Houston, Texas
| | | | - Ritu R Gill
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Hedy L Kindler
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, Illinois
| | - Anna K Nowak
- National Centre for Asbestos-Related Diseases, Medical School, University of Western Australia, Crawley, Western Australia, Australia
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital, Zurich, Switzerland
| | - Harvey I Pass
- Department of Thoracic Surgery, NYU Langone Medical Center, New York, New York
| | - Andrea Wolf
- Department of Cardiothoracic Surgery, Icahn School of Medicine at Mt. Sinai, New York, New York
| | - David Rice
- Department of Thoracic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Valerie W Rusch
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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Pellicioli F, Sala L, Colonese F, Belloni E, Abbate MI, Canova S, D'Agostino A, Cortinovis DL. Newest therapeutic strategies impacting on rarest thoracic malignancies: The clinical case report of biphasic pleural mesothelioma. Heliyon 2024; 10:e36306. [PMID: 39253273 PMCID: PMC11382305 DOI: 10.1016/j.heliyon.2024.e36306] [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] [Received: 05/24/2024] [Revised: 08/05/2024] [Accepted: 08/13/2024] [Indexed: 09/11/2024] Open
Abstract
A caucasian 62-year-old woman, diagnosed with biphasic pleural mesothelioma (PM) of II stage and BAP1 loss, was treated with therapies included in clinical trial and Early Access Programmes (EAP). During her clinical history, radiological images presented an unusual representation of the disease, with a pseudo progression discussed many times by several specialists. The patient's overall survival improved as a result of the multidisciplinary team and the availability of medicines outside of clinical practice.
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Affiliation(s)
- F Pellicioli
- CS Medical Oncology, IRCCS San Gerardo Dei Tintori Foundation, Monza, Italy
- Department of Medical-Surgical Specialties, University of Brescia, Radiological Sciences and Public Health, Brescia, Italy
| | - L Sala
- CS Medical Oncology, IRCCS San Gerardo Dei Tintori Foundation, Monza, Italy
| | - F Colonese
- CS Medical Oncology, IRCCS San Gerardo Dei Tintori Foundation, Monza, Italy
| | - E Belloni
- CS Pathological Anatomy, IRCCS San Gerardo Dei Tintori Foundation, Monza, Italy
| | - M I Abbate
- CS Medical Oncology, IRCCS San Gerardo Dei Tintori Foundation, Monza, Italy
| | - S Canova
- CS Medical Oncology, IRCCS San Gerardo Dei Tintori Foundation, Monza, Italy
| | - A D'Agostino
- CS Medical Oncology, IRCCS San Gerardo Dei Tintori Foundation, Monza, Italy
| | - D L Cortinovis
- CS Medical Oncology, IRCCS San Gerardo Dei Tintori Foundation, Monza, Italy
- Medicine and Surgery Department, University of Milano Bicocca, Milan, Italy
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11
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Jurić Čuljak Ž, Tomić S, Šitum K, Boraska Jelavić T. Case report: complete response and long-term survival on third-line immunotherapy in patient with pleural mesothelioma. Front Oncol 2024; 14:1388829. [PMID: 39267830 PMCID: PMC11391104 DOI: 10.3389/fonc.2024.1388829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 08/13/2024] [Indexed: 09/15/2024] Open
Abstract
Introduction Pleural mesothelioma (PM) is a rare neoplasm with median survival time range from 8 to 14 months from diagnosis, and the 5-year survival rate less than 10%, indicating a poor prognosis. The standard treatment for unresectable PM for a long time has been polychemotherapy with pemetrexed and cisplatin for fit patients. Currently, the combination of the anti PD-1 inhibitor nivolumab and the anti-CTLA4 inhibitor ipilimumab has been recognized as the best possible frontline therapy (especially in the sarcomatoid or biphasic type) due to improved outcomes compared to the standard chemotherapy combination. There are still no established predictive biomarkers for any type of systemic therapy in this disease. Case presentation Patient who presented with cough and dyspnea has been diagnosed with advanced epithelioid type PM in May 2016. He was treated with three lines of therapy, including an antiangiogenic agent and immunotherapy with pembrolizumab in the third line. Immunotherapy with the PD-1 inhibitor pembrolizumab achieved a complete and prolonged response that transferred to long- term survival. Seven years from diagnosis, the patient is still alive. Histological findings showed an unusually immune-inflamed tumor microenvironment possibly leading to excellent response on immunotherapy. Conclusions The course of the disease in our patient points out that we need better predictive biomarkers to direct the treatment algorithm, as some of the patients, although chemorefractory to the best chemotherapy option, can sustain great benefit of second-line chemotherapy in combination with antiangiogenic agent, and especially immunotherapy, even in late lines of therapy.
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Affiliation(s)
- Željka Jurić Čuljak
- Department of Pulmonary Diseases, University Hospital of Split, Split, Croatia
| | - Snježana Tomić
- Department of Pathology, Forensic Medicine and Cytology, University Hospital of Split, School of Medicine, University of Split, Split, Croatia
| | - Kristina Šitum
- Department of Radiology, University Hospital of Split, Split, Croatia
| | - Tihana Boraska Jelavić
- Department of Oncology, General Hospital Dubrovnik, Dubrovnik, Croatia
- University Department for Health Studies, University of Split, Split, Croatia
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12
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Roca E, Aujayeb A, Astoul P. Diagnosis of Pleural Mesothelioma: Is Everything Solved at the Present Time? Curr Oncol 2024; 31:4968-4983. [PMID: 39329996 PMCID: PMC11430569 DOI: 10.3390/curroncol31090368] [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: 07/15/2024] [Revised: 08/22/2024] [Accepted: 08/24/2024] [Indexed: 09/28/2024] Open
Abstract
Ranked high in worldwide growing health issues, pleural diseases affect approximately one million people globally per year and are often correlated with a poor prognosis. Among these pleural diseases, malignant pleural mesothelioma (PM), a neoplastic disease mainly due to asbestos exposure, still remains a diagnostic challenge. Timely diagnosis is imperative to define the most suitable therapeutic approach for the patient, but the choice of diagnostic modalities depends on operator experience and local facilities while bearing in mind the yield of each diagnostic procedure. Since the analysis of pleural fluid cytology is not sufficient in differentiating historical features in PM, histopathological and morphological features obtained via tissue biopsies are fundamental. The quality of biopsy samples is crucial and often requires highly qualified expertise. Since adequate tissue biopsy is essential, medical or video-assisted thoracoscopy (MT or VATS) is proposed as the most suitable approach, with the former being a physician-led procedure. Indeed, MT is the diagnostic gold standard for malignant pleural pathologies. Moreover, this medical or surgical approach can allow diagnostic and therapeutic procedures: it provides the possibility of video-assisted biopsies, the drainage of high volumes of pleural fluid and the administration of sterile calibrated talcum powder under visual control in order to achieve pleurodesis, placement of indwelling pleural catheters if required and in a near future potential intrapleural therapy. In this context, dedicated diagnostic pathways remain a crucial need, especially to quickly and properly diagnose PM. Lastly, the interdisciplinary approach and multidisciplinary collaboration should always be implemented in order to direct the patient to the best customised diagnostic and therapeutic pathway. At the present time, the diagnosis of PM remains an unsolved problem despite MDT (multidisciplinary team) meetings, mainly because of the lack of standardised diagnostic work-up. This review aims to provide an overview of diagnostic procedures in order to propose a clear strategy.
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Affiliation(s)
- Elisa Roca
- Thoracic Oncology, Lung Unit, P. Pederzoli Hospital, Peschiera Del Garda, VR, Italy;
| | - Avinash Aujayeb
- Respiratory Department, Northumbria Health Care NHS Foundation Trust, Care of Gail Hewitt, Newcastle NE23 6NZ, UK;
| | - Philippe Astoul
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, North Hospital, Aix-Marseille University, Chemin des Bourrely, 13005 Marseille, France
- La Timone Campus, Aix-Marseille University, 13005 Marseille, France
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13
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Kindler HL, Rosenthal A, Giroux DJ, Nowak AK, Billè A, Gill RR, Pass H, Rice D, Ripley RT, Wolf A, Blyth KG, Cedres S, Rusch V. The International Association for the Study of Lung Cancer Mesothelioma Staging Project: Proposals for the M Descriptors in the Forthcoming Ninth Edition of the TNM Classification for Pleural Mesothelioma. J Thorac Oncol 2024:S1556-0864(24)00777-9. [PMID: 39181447 DOI: 10.1016/j.jtho.2024.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 08/01/2024] [Accepted: 08/18/2024] [Indexed: 08/27/2024]
Abstract
INTRODUCTION The International Association for the Study of Lung Cancer developed a global multicenter database to propose evidence-based revisions for the ninth edition of the TNM classification of pleural mesothelioma (PM). This study analyzes the M category to validate eighth edition M category recommendations. METHODS Cases were submitted electronically or by transfer of existing institutional databases for patients with histologically or cytologically confirmed PM. The presence and number of metastases (single versus multiple) in each of eight organ systems were reported for patients with M1 disease at diagnosis. Overall survival (OS) was calculated by the Kaplan-Meier method. Differences in OS were assessed by log-rank test. RESULTS Of 7338 submitted cases, 3598 were eligible and 3221 had sufficient data for clinical staging; 228 cases (7%) were M1. Median overall estimated survival was inferior for M1 compared with M0 patients: 10.5 months versus 21.5 months, respectively (p < 0.0001); estimated 1-year survival was 46% versus 71%, respectively. OS differences between M categories were preserved within histologic subgroups. Among 158 patients with organ-specific documentation of M1 disease, there was no statistically significant difference in OS between those with intrathoracic versus more distant metastatic disease (14.4 mo versus 10.9 mo, p = 0.64). No significant survival difference was detected between patients with metastatic disease in a single-organ system versus multiple-organ systems (12.6 mo versus 8.8 mo, p = 0.45). CONCLUSIONS This evidence-based analysis of the M category for PM conforms with the eighth edition M descriptors. No changes are proposed in the ninth edition of the mesothelioma M category.
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Affiliation(s)
- Hedy L Kindler
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, Illinois.
| | | | | | - Anna K Nowak
- National Centre for Asbestos Related Diseases, Medical School, University of Western Australia, Crawley, Australia
| | - Andrea Billè
- Thoracic Surgery, Guy's Hospital, London, United Kingdom
| | - Ritu R Gill
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Harvey Pass
- Thoracic Surgery, NYU Langone Medical Center, New York, New York
| | - David Rice
- Thoracic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Robert T Ripley
- Department of Thoracic Surgery, Baylor College of Medicine, Houston, Texas
| | - Andrea Wolf
- Department of Cardiothoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kevin G Blyth
- School of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Susanna Cedres
- Thoracic Tumors Unit, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Valerie Rusch
- Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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14
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Bylicki O, Guisier F, Scherpereel A, Daniel C, Swalduz A, Grolleau E, Bernardi M, Hominal S, Prevost JB, Pamart G, Marques MH, Cloarec N, Deshayes S, Raimbourg J, Veillon R, Oulkhouir Y, Audigier Valette C, Subtil F, Chouaïd C, Greillier L. Real-World efficacy and safety of combination nivolumab plus ipilimumab for Untreated, Unresectable, pleural Mesothelioma: The Meso-Immune (GFPC 04-2021) trial. Lung Cancer 2024; 194:107866. [PMID: 38972083 DOI: 10.1016/j.lungcan.2024.107866] [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: 04/15/2024] [Revised: 06/26/2024] [Accepted: 06/28/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND First-line standard-of-care for unresectable, pleural mesothelioma (PM) changed with the phase 3 CheckMate 743 study results, showing that nivolumab plus ipilimumab (Nivo + Ipi) significantly extended overall survival (OS) versus platinum + pemetrexed chemotherapy for PM (median OS 18.1 versus 14.1 months; hazard ratio: 0.74; p = 0.002). Efficacy and safety data in real-world (rw) settings are needed to confirm these results. METHODS This French multicenter, retrospective cohort study was undertaken to assess the outcomes of treatment-naïve PM patients given Nivo + Ipi via an early-access program (EAP). The primary objective was investigator-assessed real world -progression-free survival (PFS). The secondary objectives were the combination's -overall survival (OS) and safety. RESULTS From 1 April 2021 to 15 Feb 2022, the analysis included 201 of the 305 EAP-enrolled patients treated in 63 centers (79.6 % men; median age: 75 years; 91.8 % Eastern Cooperative Oncology Group performance status (ECOG-PS) 0/1; 74.5 % epithelioid histology). With median (95 % CI) follow-up for all patients of 18.4 (17.7-19.2) months, -PFS and OS were 6.3 (5.3-7.5) and 18.9 (17.6-not reached (NR)) months, with 1-year OS at 66.4 % (60.1-73.3 %). Median OS and 1-year survival rates were 21.0 (18.7-NR) and 70.8 % (63.9 %-780.6 %), and 14.1 (10.9-21.0) months and 54.9 % (42.8 %-70.4 %) for epithelioid and non-epithelioid PM subgroups, respectively. PFS was equal between the two subgroups. Grade 3-4 adverse events occurred in 23.3 % of patients and three deaths were treatment-related. CONCLUSIONS For this unselected PM population, efficacy and safety outcomes compared favorably with CheckMate 743 trial results.
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Affiliation(s)
- Olivier Bylicki
- Department of Pneumology, Hôpital d'Instruction des Armées Sainte-Anne, Toulon, France; Ecole du Val-de-Grâce, Paris, France.
| | - Florian Guisier
- Normandie Univ, UNIROUEN, LITIS Lab QuantIF team EA4108, CHU Rouen, Department of Pneumology and Inserm CIC-CRB 1404, F-76000 Rouen, France
| | - Arnaud Scherpereel
- Pulmonary and Thoracic Oncology, University of Lille, CHU de Lille, INSERM U1189, OncoThAI, Lille, France
| | - Catherine Daniel
- Department of Medical Oncology, Institut Curie Hospital, Paris, France
| | - Aurélie Swalduz
- Department of Medical Oncology, Léon-Bérard Cancer Center, Lyon, France
| | - Emmanuel Grolleau
- Acute Respiratory Disease and Thoracic Oncology Department, Lyon Sud Hospital, Hospices Civils de Lyon, 69310 Pierre-Bénite, France
| | - Marie Bernardi
- Pneumology Department, Aix-en-Provence Hospital, Aix-en-Provence, France
| | | | | | - Guillaume Pamart
- Pulmonology Department, Strasbourg University Hospital, Strasbourg, France
| | | | | | - Simon Deshayes
- Department of Pneumology and Thoracic Oncology, CHU de Caen, Caen, France
| | - Judith Raimbourg
- Institut de Cancérologie de l'Ouest, St-Herblain, France, CRCI2NA, INSERM, Université de Nantes, 44035 Nantes, France
| | - Rémi Veillon
- Department of Pneumology, CHU de Bordeaux, Bordeaux, France
| | | | | | - Fabien Subtil
- Service de Biostatistique, Hospices Civils de Lyon, Lyon France, Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Évolutive UMR 5558, Villeurbanne, France
| | - Christos Chouaïd
- Department of Pneumology, CH Intercommunal de Créteil, Créteil, France
| | - Laurent Greillier
- Aix Marseille Univ, APHM, INSERM, CNRS, CRCM, Hôpital Nord, Department of Multidisciplinary Oncology and Therapeutic Innovations, Marseille, France
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15
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Lippi L, de Sire A, Aprile V, Calafiore D, Folli A, Refati F, Balduit A, Mangogna A, Ivanova M, Venetis K, Fusco N, Invernizzi M. Rehabilitation for Functioning and Quality of Life in Patients with Malignant Pleural Mesothelioma: A Scoping Review. Curr Oncol 2024; 31:4318-4337. [PMID: 39195305 DOI: 10.3390/curroncol31080322] [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: 06/10/2024] [Revised: 07/26/2024] [Accepted: 07/29/2024] [Indexed: 08/29/2024] Open
Abstract
Malignant pleural mesothelioma (MPM) represents a significant clinical challenge due to limited therapeutic options and poor prognosis. Beyond mere survivorship, setting up an effective framework to improve functioning and quality of life is an urgent need in the comprehensive management of MPM patients. Therefore, this study aims to review the current understanding of MPM sequelae and the effectiveness of rehabilitative interventions in the holistic approach to MPM. A narrative review was conducted to summarize MPM sequelae and their impact on functioning, disability, and quality of life, focusing on rehabilitation interventions in MPM management and highlighting gaps in knowledge and areas for further investigation. Our findings showed that MPM patients experience debilitating symptoms, including fatigue, dyspnea, pain, and reduced exercise tolerance, decreasing quality of life. Supportive and rehabilitative interventions, including pulmonary rehabilitation, physical exercise improvement, psychological support, pain management, and nutritional supplementation, seem promising approaches in relieving symptoms and improving quality of life but require further research. These programs emphasize the pivotal synergy among patient-tailored plans, multidisciplinary team involvement, and disease-specific focus. Despite advancements in therapeutic management, MPM remains a challenging disease with limited effective interventions that should be adapted to disease progressions. Rehabilitative strategies are essential to mitigate symptoms and improve the quality of life in MPM patients. Further research is needed to establish evidence-based guidelines for rehabilitative interventions tailored to the unique needs of MPM patients.
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Affiliation(s)
- Lorenzo Lippi
- Department of Scientific Research, Off-Campus Semmelweis University of Budapest, Campus LUdeS Lugano (CH), 1085 Budapest, Hungary
| | - Alessandro de Sire
- Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", 88100 Catanzaro, Italy
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro Magna Graecia, 88100 Catanzaro, Italy
| | - Vittorio Aprile
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy
| | - Dario Calafiore
- Department of Neurosciences, ASST Carlo Poma, 46100 Mantova, Italy
| | - Arianna Folli
- Department of Health Sciences, University of Eastern Piedmont "A. Avogadro", 28100 Novara, Italy
| | - Fjorelo Refati
- Department of Health Sciences, University of Eastern Piedmont "A. Avogadro", 28100 Novara, Italy
| | - Andrea Balduit
- Institute for Maternal and Child Health, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Burlo Garofolo, 34100 Trieste, Italy
| | - Alessandro Mangogna
- Institute of Pathological Anatomy, Department of Medicine, University of Udine, 33100 Udine, Italy
| | - Mariia Ivanova
- Division of Pathology, European Institute of Oncology, IRCCS, 20141 Milan, Italy
| | - Konstantinos Venetis
- Division of Pathology, European Institute of Oncology, IRCCS, 20141 Milan, Italy
| | - Nicola Fusco
- Division of Pathology, European Institute of Oncology, IRCCS, 20141 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Marco Invernizzi
- Department of Health Sciences, University of Eastern Piedmont "A. Avogadro", 28100 Novara, Italy
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
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16
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Reveneau MF, Masliah-Planchon J, Fernandez M, Ouikene A, Dron B, Dadamessi I, Dayen C, Golmard L, Chauffert B. Major response of a peritoneal mesothelioma to nivolumab and ipilimumab: a case report, molecular analysis and review of literature. Front Oncol 2024; 14:1410322. [PMID: 39091916 PMCID: PMC11291227 DOI: 10.3389/fonc.2024.1410322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 07/05/2024] [Indexed: 08/04/2024] Open
Abstract
Malignant peritoneal mesothelioma (MPM) is a rare tumor associated with a poor prognosis and a lack of consensus regarding treatment strategies. While the Checkmate 743 trial demonstrated the superiority of first-line nivolumab and ipilimumab over chemotherapy in malignant pleural mesothelioma (MPlM), few studies have assessed the effectiveness of immunotherapy against MPM, due to its rarity. Here, we report a major and sustained 12-month response in a 74-year-old female patient who received the anti-PD-1 nivolumab and the anti-CTLA4 ipilimumab as first-line therapy for diffuse MPM. PD-L1 was expressed and BAP1 expression was lost, as shown by immunohistochemistry, however the BAP1 gene was not mutated. Our findings suggest a role for ICI in non-resectable diffuse MPM exhibiting PD-L1 overexpression and loss of BAP1 expression, and instill new hope in their treatment. To our knowledge, this is the second reported case of dual immunotherapy used as first-line in MPM with a major clinical response. To investigate the clinical outcome, we conducted additional molecular analyses of the MPM tumor and we reviewed the literature on immunotherapy in MPM to discuss the role of PD-L1 and BAP1.
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Affiliation(s)
- Marie-Florence Reveneau
- Department of Genetics, Institut Curie, Paris, France
- Department of Medical Oncology, Saint Quentin Hospital, Saint Quentin, France
| | | | - Manuel Fernandez
- Department of Radiology, Saint Quentin Hospital, Saint Quentin, France
| | - Abdenour Ouikene
- Department of Medical Oncology, Saint Quentin Hospital, Saint Quentin, France
| | - Bernard Dron
- Department of Digestive Surgery, Saint Quentin Hospital, Saint Quentin, France
| | - Innocenti Dadamessi
- Department of Digestive Surgery, Saint Quentin Hospital, Saint Quentin, France
| | - Charles Dayen
- Department of Pneumology, Saint Quentin Hospital, Saint Quentin, France
| | - Lisa Golmard
- Department of Genetics, Institut Curie, Paris, France
| | - Bruno Chauffert
- Department of Medical Oncology, Saint Quentin Hospital, Saint Quentin, France
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17
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Van den Bossche J, De Laere M, Deschepper K, Germonpré P, Valcke Y, Lamont J, Stein B, Van Camp K, Germonpré C, Nijs G, Roelant E, Anguille S, Lion E, Berneman Z. Integration of the PD-L1 inhibitor atezolizumab and WT1/DC vaccination into standard-of-care first-line treatment for patients with epithelioid malignant pleural mesothelioma-Protocol of the Immuno-MESODEC study. PLoS One 2024; 19:e0307204. [PMID: 39008481 PMCID: PMC11249236 DOI: 10.1371/journal.pone.0307204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 06/27/2024] [Indexed: 07/17/2024] Open
Abstract
Malignant pleural mesothelioma (MPM) is an aggressive cancer with a very poor prognosis. Recently, immune checkpoint inhibition (ICI) has taken center stage in the currently ongoing revolution that is changing standard-of-care treatment for several malignancies, including MPM. As multiple arguments and accumulating lines of evidence are in support of the existence of a therapeutic synergism between chemotherapy and immunotherapy, as well as between different classes of immunotherapeutics, we designed a multicenter, single-arm, phase I/II trial in which both programmed-death-ligand 1 (PD-L1) inhibition and dendritic cell (DC) vaccination are integrated in the first-line conventional platinum/pemetrexed-based treatment scheme for epithelioid MPM patients (Immuno-MESODEC, ClinicalTrials.gov identifier NCT05765084). Fifteen treatment-naïve patients with unresectable epithelioid subtype MPM will be treated with four 3-weekly (±3 days) chemo-immunotherapy cycles. Standard-of-care chemotherapy consisting of cisplatinum (75mg/m2) and pemetrexed (500mg/m2) will be supplemented with the anti-PD-L1 antibody atezolizumab (1200 mg) and autologous Wilms' tumor 1 mRNA-electroporated dendritic cell (WT1/DC) vaccination (8-10 x 106 cells/vaccination). Additional atezolizumab (1680 mg) doses and/or WT1/DC vaccinations (8-10 x 106 cells/vaccination) can be administered optionally following completion of the chemo-immunotherapy scheme. Follow-up of patients will last for up to 90 days after final atezolizumab administration and/or WT1/DC vaccination or 24 months after diagnosis, whichever occurs later. The trial's primary endpoints are safety and feasibility, secondary endpoints are clinical efficacy and immunogenicity. This phase I/II trial will evaluate whether addition of atezolizumab and WT1/DC vaccination to frontline standard-of-care chemotherapy for the treatment of epithelioid MPM is feasible and safe. If so, this novel combination strategy should be further investigated as a promising advanced treatment option for this hard-to-treat cancer.
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Affiliation(s)
- Jolien Van den Bossche
- Center for Cell Therapy and Regenerative Medicine (CCRG), Antwerp University Hospital (UZA), Edegem, Belgium
| | - Maxime De Laere
- Center for Cell Therapy and Regenerative Medicine (CCRG), Antwerp University Hospital (UZA), Edegem, Belgium
- Laboratory of Experimental Hematology, Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Koen Deschepper
- Division of Pulmonary and Infectious Diseases, VITAZ, Sint-Niklaas, Belgium
| | - Paul Germonpré
- Respiratory Oncology & Integrated Cancer Cancer Ghent, AZ Maria Middelares, Ghent, Belgium
| | - Yvan Valcke
- Division of Pulmonary and Infectious Diseases, VITAZ, Sint-Niklaas, Belgium
| | - Jan Lamont
- Respiratory Oncology & Integrated Cancer Cancer Ghent, AZ Maria Middelares, Ghent, Belgium
| | - Barbara Stein
- Center for Cell Therapy and Regenerative Medicine (CCRG), Antwerp University Hospital (UZA), Edegem, Belgium
| | - Kirsten Van Camp
- Division of Pulmonary and Infectious Diseases, VITAZ, Sint-Niklaas, Belgium
| | - Charlotte Germonpré
- Respiratory Oncology & Integrated Cancer Cancer Ghent, AZ Maria Middelares, Ghent, Belgium
| | - Griet Nijs
- Center for Cell Therapy and Regenerative Medicine (CCRG), Antwerp University Hospital (UZA), Edegem, Belgium
| | - Ella Roelant
- Clinical Trial Center (CTC), CRC Antwerp, Antwerp University Hospital (UZA), University of Antwerp, Edegem, Belgium
| | - Sébastien Anguille
- Center for Cell Therapy and Regenerative Medicine (CCRG), Antwerp University Hospital (UZA), Edegem, Belgium
- Laboratory of Experimental Hematology, Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Division of Hematology, Antwerp University Hospital (UZA), Edegem, Belgium
| | - Eva Lion
- Center for Cell Therapy and Regenerative Medicine (CCRG), Antwerp University Hospital (UZA), Edegem, Belgium
- Laboratory of Experimental Hematology, Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Zwi Berneman
- Center for Cell Therapy and Regenerative Medicine (CCRG), Antwerp University Hospital (UZA), Edegem, Belgium
- Laboratory of Experimental Hematology, Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Division of Hematology, Antwerp University Hospital (UZA), Edegem, Belgium
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18
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Cedres S, Calvete J, Taylor-Stokes G, Ayerza NÁ, Larena DV, Daumont M. Treatment patterns and humanistic burden of malignant pleural mesothelioma in Spain. Clin Transl Oncol 2024:10.1007/s12094-024-03591-5. [PMID: 38970770 DOI: 10.1007/s12094-024-03591-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 06/30/2024] [Indexed: 07/08/2024]
Abstract
PURPOSE Malignant pleural mesothelioma (MPM) is an aggressive cancer with long latency and poor prognosis. The real-world treatment patterns and humanistic burden of MPM in an international cohort of patients were recently published. Spanish data are currently lacking and are reported here. METHODS/PATIENTS Data were collected from three sources: physician-abstracted demographic, clinical and treatment characteristics of patients with MPM; patient-completed questionnaires on treatment satisfaction, symptoms, caregiver use, and impact of the disease; and caregiver-completed questionnaire reporting their activity and its impact on their daily life. RESULTS The 241 patients in Spain were primarily elderly (median age: 67 years), male, retired/unemployed/on long-term sick leave, and diagnosed at stage IV with unresectable disease. Exposure to asbestos was detected (54%, 101/188). First-line treatment (1L) consisted primarily of doublet chemotherapy (86%, 207/241). Of 102 patients who completed 1L at data abstraction, 67 were receiving maintenance therapy, most commonly singlet chemotherapy with pemetrexed. Best supportive care was given to 29 patients, primarily after 1L (86.2%, 25/29). Symptom burden was high and health-related quality of life was poor and declined with progression: mean (SD) EQ-5D score and EQ-5D visual analogue scale score were 0.615 (0.285) and 60.8 (17.1) in 1L and 0.497 (0.370) and 56.1 (19.5) in second line. Overall, 67% of patients (162/241) required daily assistance from their caregiver, who reported an impact on their psychological well-being. CONCLUSIONS Patients with MPM in Spain were overall treated according to treatment guidelines at the time. Nevertheless, a considerable burden of disease was reported by patients and caregivers.
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Affiliation(s)
- Susana Cedres
- Hospital Universitari de La Vall d'Hebron, Barcelona, Spain
| | | | - Gavin Taylor-Stokes
- Adelphi Real World, Adelphi Mill, Grimshaw Lane, Bollington, Macclesfield, Cheshire, UK
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19
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Kondo N, Hasegawa S. Optimal surgery for resectable malignant pleural mesothelioma in the setting of multimodality treatment. Surg Today 2024; 54:663-669. [PMID: 37474704 PMCID: PMC11189979 DOI: 10.1007/s00595-023-02723-8] [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: 08/22/2022] [Accepted: 06/18/2023] [Indexed: 07/22/2023]
Abstract
The surgical treatment of malignant pleural mesothelioma (MPM) involves procedures to achieve macroscopic complete resection, depending on the patient's condition. We reviewed the evolution of surgical approaches for resectable MPM. Since surgery is no more than a single step in the set of processes in multimodality treatment (MMT), we concluded that these procedures should give precedence to lung preservation and minimize resection whenever possible. Postoperative quality of life must be prioritized when the patient can receive appropriate adjuvant therapy.
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Affiliation(s)
- Nobuyuki Kondo
- Department of Thoracic Surgery, Hyogo Medical University, 1-1 Mukogawa-Cho, Nishinomiya, Hyogo, 663-8501, Japan.
| | - Seiki Hasegawa
- Department of Thoracic Surgery, Hyogo Medical University, 1-1 Mukogawa-Cho, Nishinomiya, Hyogo, 663-8501, Japan
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20
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Zhang X, Chang L, Ma Q, Zhang Q, Xu W, Li Q. Comparative efficacy of immune checkpoint inhibitors versus chemotherapy alone in diffuse pleural mesothelioma. Thorac Cancer 2024; 15:1590-1597. [PMID: 38837605 PMCID: PMC11246780 DOI: 10.1111/1759-7714.15386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/16/2024] [Accepted: 05/08/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND This study aimed to investigate the effects of immune checkpoint inhibitors (ICIs) versus chemotherapy on the prognosis of real-world diffuse pleural mesothelioma patients in China. METHODS Clinical data of 90 patients with diffuse pleural mesothelioma from 2019 to 2022 were collected from Harbin Medical University Cancer Hospital. Patients were divided into two groups: the ICIs-treated group (n = 46) and the chemotherapy-only group (n = 44). The efficacy and safety of immunotherapy relative to chemotherapy at different treatment stages were explored. RESULTS The median progression-free survival (PFS) was 10.0 and 7.0 months, and the median overall survival (OS) was 24.7 and 15.8 months in the ICIs-treated group and the chemotherapy group, respectively. The ICIs-treated group showed an 11% increase in objective response rate (ORR) (52.2% vs. 41.0%) and an 8.0% increase in disease control rate (DCR) (78.3% vs. 70.0%) compared to the chemotherapy group. The Kaplan-Meier curves demonstrated significant PFS (HR: 0.61; 95% CI: 0.38-0.98; p = 0.038) and OS (HR: 0.47; 95% CI: 0.26-0.86; p = 0.011) benefits of receiving immunotherapy over chemotherapy alone. Subgroup analysis according to treatment timing showed the same trend. CONCLUSION In patients with nonsurgical diffuse pleural mesothelioma, immunotherapy achieved better survival benefits compared to chemotherapy in both first- and second-/third-line treatments. The early addition of immunotherapy improved survival in patients with nonsurgical diffuse pleural mesothelioma.
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Affiliation(s)
- Xuemei Zhang
- Department of Radiation Oncology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, RD. Minjiang, Dist. Kecheng, Quzhou, Zhejiang, China
| | - Lele Chang
- Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Qian Ma
- Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Qian Zhang
- Department of Thoracic Radiotherapy, Harbin Medical University Cancer Hospital, Harbin, China
| | - Wansu Xu
- Department of Radiation Oncology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, RD. Minjiang, Dist. Kecheng, Quzhou, Zhejiang, China
| | - Qingwei Li
- Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China
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21
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Kitajima K, Kuribayashi K, Minami T, Yokoyama H, Nakamura A, Hashimoto M, Kijima T, Hasegawa S, Kaida H, Yamakado K. Comparison of FDG-PET/CT and CT for evaluation of tumor response to nivolumab plus ipilimumab combination therapy and prognosis prediction in patients with unresectable malignant pleural mesothelioma. Oncotarget 2024; 15:408-417. [PMID: 38900646 PMCID: PMC11197970 DOI: 10.18632/oncotarget.28594] [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: 03/09/2024] [Accepted: 06/05/2024] [Indexed: 06/22/2024] Open
Abstract
OBJECTIVES Results for malignant pleural mesothelioma (MPM) patients following first-line treatment with nivolumab plus ipilimumab obtained with immunotherapy-modified PERCIST (imPERCIST), shown by [18F]fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT), and modified RECIST (mRECIST), shown by CT, were compared for response evaluation and prognosis prediction. RESULTS imPERCIST indicated nine progressive metabolic disease (PMD), eight stable metabolic disease (SMD), four partial metabolic response (PMR), and five complete metabolic response (CMR) cases. mRECIST showed nine with progressive disease (PD), nine stable disease (SD), seven partial response (PR), and one complete response (CR). Although high concordance was noted (κ = 0.827), imPERCIST correctly judged a greater percentage with CMR (15.4%). Following a median 10.0 months, 15 patients showed progression and eight died from MPM. With both, progression-free survival (PFS) and overall survival (OS) were significantly longer in patients without progression (CMR/PMR/SMD, CR/PR/SD, respectively) as compared to PMD/PD patients (imPERCIST p < 0.0001 and p = 0.015, respectively; mRECIST p < 0.0001 and p = 0.015, respectively). METHODS Twenty-six patients (23 males, 3 females; median 73.5 years) with histologically proven MPM and no curative surgery received nivolumab plus ipilimumab combination therapy. FDG-PET/CT and diagnostic CT scanning at the baseline, and after 2-4 cycles (2 in three, 3 in 17, 4 in six patients) were performed. Therapeutic response findings evaluated using imPERCIST and mRECIST were compared. PFS and OS analyses were done using log-rank and Cox methods. CONCLUSION For unresectable MPM patient examinations, FDG-PET and CT provide accurate findings for evaluating tumor response and also prognosis prediction following first-line nivolumab plus ipilimumab immunotherapy (approximately three cycles).
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Affiliation(s)
- Kazuhiro Kitajima
- Department of Radiology, Hyogo Medical University, Nishinomiya, Hyogo, Japan
| | - Kozo Kuribayashi
- Division of Respiratory Medicine, Department of Internal Medicine, Hyogo Medical University, Nishinomiya, Hyogo, Japan
| | - Toshiyuki Minami
- Division of Respiratory Medicine, Department of Internal Medicine, Hyogo Medical University, Nishinomiya, Hyogo, Japan
| | - Hiroyuki Yokoyama
- Department of Radiology, Hyogo Medical University, Nishinomiya, Hyogo, Japan
| | - Akifumi Nakamura
- Department of Thoracic Surgery, Hyogo Medical University, Nishinomiya, Hyogo, Japan
| | - Masaki Hashimoto
- Department of Thoracic Surgery, Hyogo Medical University, Nishinomiya, Hyogo, Japan
| | - Takashi Kijima
- Division of Respiratory Medicine, Department of Internal Medicine, Hyogo Medical University, Nishinomiya, Hyogo, Japan
| | - Seiki Hasegawa
- Department of Thoracic Surgery, Hyogo Medical University, Nishinomiya, Hyogo, Japan
| | - Hayato Kaida
- Department of Radiology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Koichiro Yamakado
- Department of Radiology, Hyogo Medical University, Nishinomiya, Hyogo, Japan
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22
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Lim E, Waller D, Lau K, Steele J, Pope A, Ali C, Bilancia R, Keni M, Popat S, O'Brien M, Tokaca N, Maskell N, Stadon L, Fennell D, Nelson L, Edwards J, Tenconi S, Socci L, Rintoul RC, Wood K, Stone A, Muthukumar D, Ingle C, Taylor P, Cove-Smith L, Califano R, Summers Y, Tasigiannopoulos Z, Bille A, Shah R, Fuller E, Macnair A, Shamash J, Mansy T, Milton R, Koh P, Ionescu AA, Treece S, Roy A, Middleton G, Kirk A, Harris RA, Ashton K, Warnes B, Bridgeman E, Joyce K, Mills N, Elliott D, Farrar N, Stokes E, Hughes V, Nicholson AG, Rogers CA. Extended pleurectomy decortication and chemotherapy versus chemotherapy alone for pleural mesothelioma (MARS 2): a phase 3 randomised controlled trial. THE LANCET. RESPIRATORY MEDICINE 2024; 12:457-466. [PMID: 38740044 PMCID: PMC11136673 DOI: 10.1016/s2213-2600(24)00119-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 04/02/2024] [Accepted: 04/09/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Extended pleurectomy decortication for complete macroscopic resection for pleural mesothelioma has never been evaluated in a randomised trial. The aim of this study was to compare outcomes after extended pleurectomy decortication plus chemotherapy versus chemotherapy alone. METHODS MARS 2 was a phase 3, national, multicentre, open-label, parallel two-group, pragmatic, superiority randomised controlled trial conducted in the UK. The trial took place across 26 hospitals (21 recruiting only, one surgical only, and four recruiting and surgical). Following two cycles of chemotherapy, eligible participants with pleural mesothelioma were randomly assigned (1:1) to surgery and chemotherapy or chemotherapy alone using a secure web-based system. Individuals aged 16 years or older with resectable pleural mesothelioma and adequate organ and lung function were eligible for inclusion. Participants in the chemotherapy only group received two to four further cycles of chemotherapy, and participants in the surgery and chemotherapy group received pleurectomy decortication or extended pleurectomy decortication, followed by two to four further cycles of chemotherapy. It was not possible to mask allocation because the intervention was a major surgical procedure. The primary outcome was overall survival, defined as time from randomisation to death from any cause. Analyses were done on the intention-to-treat population for all outcomes, unless specified. This study is registered with ClinicalTrials.gov, NCT02040272, and is closed to new participants. FINDINGS Between June 19, 2015, and Jan 21, 2021, of 1030 assessed for eligibility, 335 participants were randomly assigned (169 to surgery and chemotherapy, and 166 to chemotherapy alone). 291 (87%) participants were men and 44 (13%) women, and 288 (86%) were diagnosed with epithelioid mesothelioma. At a median follow-up of 22·4 months (IQR 11·3-30·8), median survival was shorter in the surgery and chemotherapy group (19·3 months [IQR 10·0-33·7]) than in the chemotherapy alone group (24·8 months [IQR 12·6-37·4]), and the difference in restricted mean survival time at 2 years was -1·9 months (95% CI -3·4 to -0·3, p=0·019). There were 318 serious adverse events (grade ≥3) in the surgery group and 169 in the chemotherapy group (incidence rate ratio 3·6 [95% CI 2·3 to 5·5], p<0·0001), with increased incidence of cardiac (30 vs 12; 3·01 [1·13 to 8·02]) and respiratory (84 vs 34; 2·62 [1·58 to 4·33]) disorders, infection (124 vs 53; 2·13 [1·36 to 3·33]), and additional surgical or medical procedures (15 vs eight; 2·41 [1·04 to 5·57]) in the surgery group. INTERPRETATION Extended pleurectomy decortication was associated with worse survival to 2 years, and more serious adverse events for individuals with resectable pleural mesothelioma, compared with chemotherapy alone. FUNDING National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (15/188/31), Cancer Research UK Feasibility Studies Project Grant (A15895).
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Affiliation(s)
- Eric Lim
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK; Imperial College London, London, UK.
| | | | | | | | | | - Clinton Ali
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | | | | | - Sanjay Popat
- The Royal Marsden Hospital and the Institute of Cancer Research, London, UK
| | - Mary O'Brien
- The Royal Marsden Hospital and the Institute of Cancer Research, London, UK
| | - Nadza Tokaca
- The Royal Marsden Hospital and the Institute of Cancer Research, London, UK
| | | | | | | | | | - John Edwards
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Sara Tenconi
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Laura Socci
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Robert C Rintoul
- Papworth Trials Unit Collaboration, Royal Papworth Hospital, Cambridge, UK
| | - Kelly Wood
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Amanda Stone
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | | | - Charlotte Ingle
- East Sussex and North Essex NHS Foundation Trust, Colchester, UK
| | - Paul Taylor
- Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Raffaele Califano
- The Christie NHS Foundation Trust and Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Yvonne Summers
- Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Andrea Bille
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Riyaz Shah
- Maidstone and Tunbridge Wells NHS Trust, Maidstone, UK
| | - Elizabeth Fuller
- South Tyneside and Sunderland NHS Foundation Trust, South Shields, UK
| | - Andrew Macnair
- South Tyneside and Sunderland NHS Foundation Trust, South Shields, UK
| | - Jonathan Shamash
- Queen's Hospital, Barking Havering and Redbridge NHS Trust, Barking, UK
| | - Talal Mansy
- South Tees Hospital NHS Foundation Trust, Middlesbrough, UK
| | | | - Pek Koh
- Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | | | - Sarah Treece
- North West Anglia NHS Foundation Trust, Peterborough, UK
| | - Amy Roy
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | | | - Alan Kirk
- Golden Jubilee National Hospital, Clydebank, UK
| | - Rosie A Harris
- Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - Kate Ashton
- Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - Barbara Warnes
- Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emma Bridgeman
- Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - Katherine Joyce
- Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nicola Mills
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Daisy Elliott
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Nicola Farrar
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Elizabeth Stokes
- University of Oxford Health Economics Research Centre, Oxford, UK
| | - Vikki Hughes
- Papworth Trials Unit Collaboration, Royal Papworth Hospital, Cambridge, UK
| | - Andrew G Nicholson
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK; Imperial College London, London, UK
| | - Chris A Rogers
- Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
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Neilly MD, Pearson J, Thu AW, MacRae C, Blyth KG. Contemporary management of mesothelioma. Breathe (Sheff) 2024; 20:230175. [PMID: 39015660 PMCID: PMC11250169 DOI: 10.1183/20734735.0175-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 05/12/2024] [Indexed: 07/18/2024] Open
Abstract
Pleural mesothelioma (PM) is an aggressive asbestos-associated thoracic malignancy with a median survival of 12-18 months. Due to continued asbestos use in many nations, global incidence is rising. Causes due to non-occupational, environmental exposure are also rising in many countries despite utilisation bans. For many years, platinum--pemetrexed chemotherapy was the solitary licensed therapy, but first-line combination immune checkpoint blockade has recently demonstrated improved outcomes, with both regimes tested in predominantly late-stage cohorts. In the second-line setting, single-agent nivolumab has been shown to extend survival and is now available for routine use in some regions, while second-line chemotherapy has no proven role and opportunities for clinical trials should be maximised in relapsed disease. Surgery for "technically resectable" disease has been offered for decades in many expert centres, but the recent results from the phase III MARS2 trial have challenged this approach. There remains no robustly proven standard of care for early-stage PM. The clinical trial landscape for PM is complex and increasingly diverse, making further development of specialist PM multidisciplinary teams an important priority in all countries. The observation of improving outcomes in centres that have adopted this service model emphasises the importance of high-quality diagnostics and equitable access to therapies and trials. Novel therapies targeting a range of aberrations are being evaluated; however, a better understanding of the molecular drivers and their associated vulnerabilities is required to identify and prioritise treatment targets.
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Affiliation(s)
- Mark D.J. Neilly
- Glasgow Pleural Disease Unit, Queen Elizabeth University Hospital, Glasgow, UK
- School of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Jennifer Pearson
- Glasgow Pleural Disease Unit, Queen Elizabeth University Hospital, Glasgow, UK
- School of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Akari Win Thu
- Glasgow Pleural Disease Unit, Queen Elizabeth University Hospital, Glasgow, UK
- School of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Carolyn MacRae
- Glasgow Pleural Disease Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Kevin G. Blyth
- Glasgow Pleural Disease Unit, Queen Elizabeth University Hospital, Glasgow, UK
- School of Cancer Sciences, University of Glasgow, Glasgow, UK
- Cancer Research UK Scotland Institute, Glasgow, UK
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24
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Zhuang W, Liu L, Sun B, Bai H, Wang Z, Duan J, Wan R, Ma Z, Zhong J, Wang J. Evaluation of first-line and salvage therapies for unresectable malignant mesothelioma: A systematic review and network meta-analysis. Crit Rev Oncol Hematol 2024; 198:104372. [PMID: 38677356 DOI: 10.1016/j.critrevonc.2024.104372] [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: 03/01/2024] [Revised: 04/20/2024] [Accepted: 04/23/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Randomized controlled trials (RCTs) of systemic therapies for unresectable malignant mesothelioma have reported conflicting results. It is crucial and urgent to find optimal treatment options for this malignancy, which currently has a poor prognosis. METHODS Databases PubMed, EMBASE, Cochrane Library, ClinicalTrials.gov, and major international conferences were searched until February 29, 2024. The main outcomes of interest were overall survival (OS), progression-free survival (PFS), overall response rate (ORR), and grade ≥3 treatment-related adverse events (TRAEs). RESULTS We analyzed 16 RCTs with a total of 5018 patients. Among first-line therapies, nivolumab and ipilimumab significantly increased OS and resulted in fewer grade ≥3 TRAEs. Bevacizumab plus chemotherapy significantly increased PFS. Among salvage therapies, ramucirumab and chemotherapy was associated with the best OS and PFS, but resulted in more grade ≥3 TRAEs. Subgroup analysis by histologic types suggested that in first-line settings, bevacizumab and chemotherapy increase OS the most for epithelioid type, while the nivolumab plus ipilimumab treatment increases OS the most for non-epithelioid type. In salvage therapies, ramucirumab and chemotherapy increase OS for both epithelioid and non-epithelioid types. CONCLUSION Nivolumab plus ipilimumab was associated with the best OS among first-line treatments. Ramucirumab and chemotherapy was associated with the best clinical outcomes in salvage settings. Treatment for malignant mesothelioma should be tailored based on different clinicopathological characteristics.
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Affiliation(s)
- Wei Zhuang
- CAMS Key Laboratory of Translational Research on Lung Cancer, State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Lihui Liu
- CAMS Key Laboratory of Translational Research on Lung Cancer, State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Boyang Sun
- CAMS Key Laboratory of Translational Research on Lung Cancer, State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Hua Bai
- CAMS Key Laboratory of Translational Research on Lung Cancer, State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Zhijie Wang
- CAMS Key Laboratory of Translational Research on Lung Cancer, State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Jianchun Duan
- CAMS Key Laboratory of Translational Research on Lung Cancer, State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Rui Wan
- CAMS Key Laboratory of Translational Research on Lung Cancer, State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Zixiao Ma
- CAMS Key Laboratory of Translational Research on Lung Cancer, State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Jia Zhong
- CAMS Key Laboratory of Translational Research on Lung Cancer, State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
| | - Jie Wang
- CAMS Key Laboratory of Translational Research on Lung Cancer, State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
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25
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Bertoli E, De Carlo E, Bortolot M, Stanzione B, Del Conte A, Spina M, Bearz A. Targeted Therapy in Mesotheliomas: Uphill All the Way. Cancers (Basel) 2024; 16:1971. [PMID: 38893092 PMCID: PMC11171080 DOI: 10.3390/cancers16111971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 05/16/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024] Open
Abstract
Mesothelioma (MM) is an aggressive and lethal disease with few therapeutic opportunities. Platinum-pemetrexed chemotherapy is the backbone of first-line treatment for MM. The introduction of immunotherapy (IO) has been the only novelty of the last decades, allowing an increase in survival compared to standard chemotherapy (CT). However, IO is not approved for epithelioid histology in many countries. Therefore, therapy for relapsed MM remains an unmet clinical need, and the prognosis of MM remains poor, with an average survival of only 18 months. Increasing evidence reveals MM complexity and heterogeneity, of which histological classification fails to explain. Thus, scientific focus on possibly new molecular markers or cellular targets is increasing, together with the search for target therapies directed towards them. The molecular landscape of MM is characterized by inactivating tumor suppressor alterations, the most common of which is found in CDKN2A, BAP1, MTAP, and NF2. In addition, cellular targets such as mesothelin or metabolic enzymes such as ASS1 could be potentially amenable to specific therapies. This review examines the major targets and relative attempts of therapeutic approaches to provide an overview of the potential prospects for treating this rare neoplasm.
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Affiliation(s)
- Elisa Bertoli
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy; (E.B.); (E.D.C.); (M.B.); (B.S.); (A.D.C.); (M.S.)
| | - Elisa De Carlo
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy; (E.B.); (E.D.C.); (M.B.); (B.S.); (A.D.C.); (M.S.)
| | - Martina Bortolot
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy; (E.B.); (E.D.C.); (M.B.); (B.S.); (A.D.C.); (M.S.)
- Department of Medicine, University of Udine, 33100 Udine, Italy
| | - Brigida Stanzione
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy; (E.B.); (E.D.C.); (M.B.); (B.S.); (A.D.C.); (M.S.)
| | - Alessandro Del Conte
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy; (E.B.); (E.D.C.); (M.B.); (B.S.); (A.D.C.); (M.S.)
| | - Michele Spina
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy; (E.B.); (E.D.C.); (M.B.); (B.S.); (A.D.C.); (M.S.)
| | - Alessandra Bearz
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy; (E.B.); (E.D.C.); (M.B.); (B.S.); (A.D.C.); (M.S.)
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Lapidot M, Sattler M. The Role of Surgery in Pleural Mesothelioma. Cancers (Basel) 2024; 16:1719. [PMID: 38730667 PMCID: PMC11083222 DOI: 10.3390/cancers16091719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
Surgery plays a central role in the diagnosis, staging, and management of pleural mesothelioma. Achieving an accurate diagnosis through surgical intervention and identifying the specific histologic subtype is crucial for determining the appropriate course of treatment. The histologic subtype guides decisions regarding the use of chemotherapy, immunotherapy, or multimodality treatment. The goal of surgery as part of multimodality treatment is to accomplish macroscopic complete resection with the eradication of grossly visible and palpable disease. Over the past two decades, many medical centers worldwide have shifted from performing extra-pleural pneumonectomy (EPP) to pleurectomy decortication (PD). This transition is motivated by the lower rates of short-term mortality and morbidity associated with PD and similar or even better long-term survival outcomes, compared to EPP. This review aims to outline the role of surgery in diagnosing, staging, and treating patients with pleural mesothelioma.
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Affiliation(s)
- Moshe Lapidot
- Division of Thoracic Surgery, Lung Center and International Mesothelioma Program, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA
- Department of Thoracic Surgery, Galilee Medical Center, Nahariya 2210001, Israel
| | - Martin Sattler
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA;
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Schmid S, Zhan L, Garcia M, 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. Immediate Versus Deferred Systemic Therapy in Patients With Mesothelioma. Clin Lung Cancer 2024:S1525-7304(24)00066-4. [PMID: 38825405 DOI: 10.1016/j.cllc.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/02/2024] [Accepted: 04/17/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND The 2018 ASCO pleural mesothelioma (PM) treatment guideline states that "a trial of expectant observation may be offered" in patients with asymptomatic inoperable epithelioid mesothelioma with low disease burden. The aim of our analysis was to evaluate clinical characteristics and outcomes in PM-patients managed with initial observation and deferred treatment initiation. METHODS We retrospectively collected clinicodemograhic and outcome data of patients with inoperable PM. Patients were assigned to 2 treatment decision groups: decision to start immediate systemic treatment (Immediate Treatment Group) versus observation and deferring treatment (Deferred Treatment group). RESULTS Of 222 patients with advanced PM, systemic treatment was started immediately in the majority of patients (189, 85%; immediate group); treatment was deferred in 33 (15%) patients (deferred group); systemic therapy was chemotherapy-based in 91% and 79% respectively. Patients in the deferred group were older (70 vs 67 years, p = .05), less likely to have stage IV disease (28% vs. 51%, p = .08) and more often had epithelioid histology (90% vs. 70%, p = .03). Nineteen patients (58%) in the deferred group eventually received treatment. With a median follow-up time of 10.9 months median overall survival (OS) in the entire cohort was 12.4 months and was significantly longer in the deferred group (20.6 months vs. 11.5 months, p = .02). No difference in median progression-free survival (PFS) in first-line treatment between groups was seen (5.4 and 5.3 months). CONCLUSION This real-world analysis suggests that deferral of systemic therapy and close observation may not impact OS or physician-assessed PFS in selected PM-patients.
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Affiliation(s)
- Sabine Schmid
- University Health Network, Princess Margaret Cancer Centre, Toronto, ON, Canada; Department of Medical Oncology, Inselspital, Bern University Hospital, Switzerland
| | - Luna Zhan
- University Health Network, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Miguel Garcia
- University Health Network, Princess Margaret Cancer Centre, Toronto, ON, Canada; Ramon y Cajal University Hospital, Madrid, Spain
| | - Kristen Dietrich
- University Health Network, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Khaleeq Khan
- University Health Network, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Maisha Chowdhury
- University Health Network, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Michael Herman
- University Health Network, Princess Margaret Cancer Centre, Toronto, ON, Canada; Oakville Trafalgar Memorial Hospital, Oakville, Canada
| | - Devalben Patel
- University Health Network, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Fatemeh Zaeimi
- University Health Network, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Natasha B Leighl
- University Health Network, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Adrian Sacher
- University Health Network, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Ronald Feld
- University Health Network, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Frances A Shepherd
- University Health Network, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Laura Donahoe
- University Health Network, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Marc de Perrot
- University Health Network, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - B C John Cho
- University Health Network, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Geoffrey Liu
- University Health Network, Princess Margaret Cancer Centre, Toronto, ON, Canada.
| | - Penelope A Bradbury
- University Health Network, Princess Margaret Cancer Centre, Toronto, ON, Canada.
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van der Linde LIS, Hantzsch-Kuhn B, Ellebrecht D, Stellmacher F, Welker L. [Interdisciplinary diagnostics and therapy of malignant mesothelioma]. Pneumologie 2024; 78:262-268. [PMID: 38176439 DOI: 10.1055/a-2202-5445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
The asbestos-related malignant mesothelioma (MM) is one of the common occupational cancers in Germany with approximately 1000 new cases per year. Provided that the appropriate diagnostic criteria are fulfilled, MM can be diagnosed with high specificity from both histological and cytological specimens. However, many MM are detected cyto-/histologically only at advanced stages. Clinical/radiological aspects complement each other and enable interdisciplinary assessment of tumor stage and individualized decisions on the best possible therapeutic options. Diagnostically, video-assisted thoracoscopy (VATS) has the highest priority. Therapy planning is based on the MM subtype, tumor spread and stage, and the patient's clinical condition. MM has generally a very unfavorable prognosis. Accordingly, the standard therapy aims at a macroscopic radical tumor resection in terms of cytoreduction within the framework of a suitable multimodal therapy concept (chemotherapy, radiotherapy, psychooncology). The aim of palliative measures should be primarily symptom control. Overall, interdisciplinary diagnosis and therapy of MM is crucial for the best possible care of MM patients.
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Affiliation(s)
| | | | - David Ellebrecht
- Onkologie, LungenClinic Grosshansdorf GmbH, Grosshansdorf, Deutschland
| | | | - Lutz Welker
- Zytopathologie, Institut für Pathologie Universität Hamburg, Hamburg, Deutschland
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29
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Rigon M, Mutti L, Campanella M. Pleural mesothelioma (PMe): The evolving molecular knowledge of a rare and aggressive cancer. Mol Oncol 2024; 18:797-814. [PMID: 38459714 PMCID: PMC10994233 DOI: 10.1002/1878-0261.13591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/22/2023] [Accepted: 01/15/2024] [Indexed: 03/10/2024] Open
Abstract
Mesothelioma is a type of late-onset cancer that develops in cells covering the outer surface of organs. Although it can affect the peritoneum, heart, or testicles, it mainly targets the lining of the lungs, making pleural mesothelioma (PMe) the most common and widely studied mesothelioma type. PMe is caused by exposure to fibres of asbestos, which when inhaled leads to inflammation and scarring of the pleura. Despite the ban on asbestos by most Western countries, the incidence of PMe is on the rise, also facilitated by a lack of specific symptomatology and diagnostic methods. Therapeutic options are also limited to mainly palliative care, making this disease untreatable. Here we present an overview of biological aspects underlying PMe by listing genetic and molecular mechanisms behind its onset, aggressive nature, and fast-paced progression. To this end, we report on the role of deubiquitinase BRCA1-associated protein-1 (BAP1), a tumour suppressor gene with a widely acknowledged role in the corrupted signalling and metabolism of PMe. This review aims to enhance our understanding of this devastating malignancy and propel efforts for its investigation.
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Affiliation(s)
- Manuel Rigon
- Centre for Clinical Pharmacology and Precision Medicine William Harvey Research InstituteQueen Mary University of LondonUK
- Department of BiologyUniversity of Rome Tor VergataRomeItaly
| | - Luciano Mutti
- Department of Biotechnological and Applied Clinical SciencesDISCAB, L'Aquila UniversityL'AquilaItaly
- Temple University Sbarro Institute for Cancer Research and Molecular MedicinePhiladelphiaPAUSA
| | - Michelangelo Campanella
- Centre for Clinical Pharmacology and Precision Medicine William Harvey Research InstituteQueen Mary University of LondonUK
- Department of Biomedical SciencesUniversity of PaduaPaduaItaly
- Institute Gustave RoussyVillejuifFrance
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30
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McNamee N, Harvey C, Gray L, Khoo T, Lingam L, Zhang B, Nindra U, Yip PY, Pal A, Clay T, Arulananda S, Itchins M, Pavlakis N, Kao S, Bowyer S, Chin V, Warburton L, Pires da Silva I, John T, Solomon B, Alexander M, Nagrial A. Brief Report: Real-World Toxicity and Survival of Combination Immunotherapy in Pleural Mesothelioma-RIOMeso. J Thorac Oncol 2024; 19:636-642. [PMID: 38036250 DOI: 10.1016/j.jtho.2023.11.014] [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: 09/28/2023] [Revised: 11/03/2023] [Accepted: 11/09/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Australia has one of the highest rates of asbestos-associated diseases. Mesothelioma remains an area of unmet need with a 5-year overall survival of 10%. First-line immunotherapy with ipilimumab and nivolumab is now a standard of care for unresectable pleural mesothelioma following the CheckMate 743 trial, with supportive data from the later line single-arm MAPS2 trial. RIOMeso evaluates survival and toxicity of this regimen in real-world practice. METHODS Demographic and clinicopathologic data of Australian patients treated with ipilimumab and nivolumab in first- and subsequent-line settings for pleural mesothelioma were collected retrospectively. Survival was reported using the Kaplan-Meier method and compared between subgroups with the log-rank test. Toxicity was investigator assessed using Common Terminology Criteria for Adverse Events version 5.0. RESULTS A total of 119 patients were identified from 11 centers. The median age was 72 years, 83% were male, 92% had Eastern Cooperative Oncology Group less than or equal to 1, 50% were past or current smokers, and 78% had known asbestos exposure. In addition, 50% were epithelioid, 19% sarcomatoid, 14% biphasic, and 17% unavailable. Ipilimumab and nivolumab were used first line in 75% of patients. Median overall survival (mOS) was 14.5 months (95% confidence interval [CI]: 13.0-not reached [NR]) for the entire cohort. For patients treated first line, mOS was 14.5 months (95% CI: 12.5-NR) and in second- or later-line patients was 15.4 months (95% CI: 11.2-NR). There was no statistically significant difference in mOS for epithelioid patients compared with nonepithelioid (19.1 mo [95% CI: 15.4-NR] versus 13.0 mo [95% CI: 9.7-NR], respectively, p = 0.064). Furthermore, 24% of the patients had a Common Terminology Criteria for Adverse Events grade greater than or equal to 3 adverse events, including three treatment-related deaths. Colitis was the most frequent adverse event. CONCLUSIONS Combination immunotherapy in real-world practice has poorer survival outcomes and seems more toxic compared with clinical trial data. This is the first detailed report of real-world survival and toxicity outcomes using ipilimumab and nivolumab treatment of pleural mesothelioma.
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Affiliation(s)
- Nicholas McNamee
- The Kinghorn Cancer Centre, St. Vincent's Hospital, Sydney, Australia; Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, Australia; Garvan Institute of Medical Research, Sydney, Australia.
| | - Catriona Harvey
- Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, Australia
| | - Lauren Gray
- Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, Australia
| | - Trisha Khoo
- Sir Charles Gairdner Hospital, Perth, Australia
| | | | | | | | - Po Yee Yip
- Campbelltown Hospital, Sydney, Australia
| | | | - Timothy Clay
- St. John of God Subiaco Hospital, Perth, Australia; Edith Cowan University, Perth, Australia
| | - Surein Arulananda
- Monash Health, Melbourne, Australia; Monash University, Melbourne, Australia
| | - Malinda Itchins
- Royal North Shore Hospital, Sydney, Australia; University of Sydney, Sydney, Australia
| | - Nick Pavlakis
- Royal North Shore Hospital, Sydney, Australia; University of Sydney, Sydney, Australia
| | - Steven Kao
- Chris O'Brien Lifehouse, Sydney, Australia; University of Sydney, Sydney, Australia
| | - Samantha Bowyer
- Sir Charles Gairdner Hospital, Perth, Australia; University of Western Australia, Perth, Australia
| | - Venessa Chin
- The Kinghorn Cancer Centre, St. Vincent's Hospital, Sydney, Australia; Garvan Institute of Medical Research, Sydney, Australia; University of New South Wales, Sydney, Australia
| | - Lydia Warburton
- Fiona Stanley Hospital, Perth, Australia; Edith Cowan University, Perth, Australia
| | - Inês Pires da Silva
- University of Sydney, Sydney, Australia; Blacktown Hospital, Sydney, Australia
| | - Thomas John
- Peter MacCallum Cancer Centre, Melbourne, Australia; University of Melbourne, Melbourne, Australia
| | - Benjamin Solomon
- Peter MacCallum Cancer Centre, Melbourne, Australia; University of Melbourne, Melbourne, Australia
| | - Marliese Alexander
- Peter MacCallum Cancer Centre, Melbourne, Australia; University of Melbourne, Melbourne, Australia
| | - Adnan Nagrial
- Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, Australia; University of Sydney, Sydney, Australia; Blacktown Hospital, Sydney, Australia
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31
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Henschke P, Guglielmetti LC, Hillinger S, Monsch GM, Schneiter D, Opitz I, Lauk O. Risk factors influencing postoperative pleural empyema in patients with pleural mesothelioma: a retrospective single-centre analysis. Eur J Cardiothorac Surg 2024; 65:ezae137. [PMID: 38637940 PMCID: PMC11055398 DOI: 10.1093/ejcts/ezae137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 03/14/2024] [Accepted: 04/17/2024] [Indexed: 04/20/2024] Open
Abstract
OBJECTIVES Postoperative empyema is a severe, potentially lethal complication also present, but poorly studied in patients undergoing surgery for pleural mesothelioma. We aimed to analyse which perioperative characteristics might be associated with an increased risk for postoperative empyema. METHODS From September 1999 to February 2023 a retrospective analysis of consecutive patients undergoing surgery for pleural mesothelioma at the University Hospital of Zurich was performed. Uni- and multivariable logistic regression was used to identify associated risk factors of postoperative empyema after surgery. RESULTS A total of 400 PM patients were included in the analysis, of which n = 50 patients developed empyema after surgery (12.5%). Baseline demographics were comparable between patients with (Eyes) and without empyema (Eno). 39% (n = 156) patients underwent extrapleural pneumonectomy (EPP), of whom 22% (n = 35) developed postoperative pleural empyema; 6% (n = 15) of the remaining 244 patients undergoing pleurectomy and decortication (n = 46), extended pleurectomy and decortication (n = 114), partial pleurectomy (n = 54) or explorative thoracotomy (n = 30) resulted in postoperative empyema. In multivariable logistic regression analysis, EPP (odds ratio 2.8, 95% confidence interval 1.5-5.4, P = 0.002) emerged as the only risk factor associated with postoperative empyema when controlled for smoking status. Median overall survival was significantly worse for Eyes (16 months, interquartile range 5-27 months) than for Eno (18 months, interquartile range 8-35 months). CONCLUSIONS Patients undergoing EPP had a significantly higher risk of developing postoperative pleural empyema compared to patients undergoing other surgery types. Survival of patients with empyema was significantly shorter.
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Affiliation(s)
- Peter Henschke
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | | | - Sven Hillinger
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Gian-Marco Monsch
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Didier Schneiter
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Olivia Lauk
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
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32
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Tagliamento M, Morfouace M, Loizides C, Oliveira J, Greillier L, Raimbourg J, Toffart AC, Chatellier T, Cloarec N, Sullivan I, Brasiuniene B, Duruisseaux M, Oselin K, Robert MS, Fernandes C, Poncin A, Blay JY, Besse B, Girard N. EORTC-SPECTA Arcagen study, comprehensive genomic profiling and treatment adaptation of rare thoracic cancers. NPJ Precis Oncol 2024; 8:37. [PMID: 38366021 PMCID: PMC10873296 DOI: 10.1038/s41698-024-00518-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 01/15/2024] [Indexed: 02/18/2024] Open
Abstract
Arcagen (NCT02834884) is a European prospective study aiming at defining the molecular landscape of rare cancers for treatment guidance. We present data from the cohort of rare thoracic tumors. Patients with advanced pleural mesothelioma (PM) or thymic epithelial tumors (TET) underwent genomic profiling with large targeted assay [>300 genes, tumor mutational burden (TMB), microsatellite instability (MSI) status] on formalin-fixed paraffin-embedded (FFPE) or plasma samples. EORTC molecular tumor board (MTB) advised for biomarker-guided treatments. 102 patients recruited from 8 countries between July 2019 and May 2022 were evaluable: 56 with PM, 46 with TET (23 thymomas, 23 thymic carcinomas). Molecular profiling was performed on 70 FFPE samples (42 PM, 28 TET), and 32 cases on ctDNA (14 PM, 18 TET), within a median turnaround time of 8 days from sample reception. We detected relevant molecular alterations in 66 out of 102 patients (65%; 79% PM, 48% TET), 51 of 70 FFPE samples (73%; 90% PM, 46% TET), and 15 of 32 plasma samples (47%; 43% PM, 50% TET). The most frequently altered genes were CDKN2A/B, BAP1, MTAP in PM and TP53, CDKN2A/B, SETD2 in TET. The TMB was low (mean 3.2 Muts/MB), 2 PM had MSI-high status. MTB advised molecular-guided treatment options in 32 situations, for 17 PM and 15 TET patients (75% clinical trial option, 22% off-label drug or compassionate use, 3% early access program). Molecular testing and MTB discussion were feasible for patients with rare thoracic cancers and allowed the broadening of treatment options for 30% of the cases.
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Affiliation(s)
- Marco Tagliamento
- Department of Cancer Medicine, Gustave Roussy, Villejuif, France.
- Department of Internal Medicine and Medical Specialties, University of Genova, Genova, Italy.
| | | | | | - Julio Oliveira
- Medical Oncology Department, Instituto Portugues de Oncologia do Porto Francisco Gentil, Porto, Portugal
| | - Laurent Greillier
- Aix Marseille University, APHM, INSERM, CNRS, CRCM, Hôpital Nord, Multidisciplinary Oncology and Therapeutic Innovations Department, Marseille, France
| | - Judith Raimbourg
- Department of Medical Oncology, Nantes Université, Institut de Cancerologie de l'Ouest, Saint-Herblain, France
| | | | - Thierry Chatellier
- Clinique Mutualiste de l'Estuaire - Centre d'Oncologie, Saint Nazaire, France
| | - Nicolas Cloarec
- Service d'Oncologie Médicale et Hématologie Clinique, Centre Hospitalier d'Avignon, Avignon, France
| | - Ivana Sullivan
- Medical Oncology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Birute Brasiuniene
- Department of Medical Oncology of National Cancer Institute, Faculty of Medicine of Vilnius University, Vilnius, Lithuania
| | - Michael Duruisseaux
- Department of Medical Oncology, CHU de Lyon - Hôpital Lyon Sud, Lyon, France
| | - Kersti Oselin
- Department of Chemotherapy, Clinic of Oncology and Hematology, North Estonia Medical Centre, Tallinn, Estonia
| | | | | | | | - Jean-Yves Blay
- Department of Medicine, Centre Léon Bérard, Lyon, France
| | - Benjamin Besse
- Paris-Saclay University, Department of Cancer Medicine, Gustave Roussy, Villejuif, France
| | - Nicolas Girard
- Institut du Thorax Curie Montsouris, Institut Curie, Paris, France
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Khan AMH, Anwer SH, Sayed S, Mansha MA, Kamran YB, Khursheed A, Haroon F, Soomro NH, Idrees R, Abbasi AN. Comprehensive clinical overview of malignant pleural mesothelioma. Respir Med 2024; 222:107511. [PMID: 38163522 DOI: 10.1016/j.rmed.2023.107511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 11/19/2023] [Accepted: 12/21/2023] [Indexed: 01/03/2024]
Affiliation(s)
| | - Shaikh Hasan Anwer
- Department of Medical Oncology, The Aga Khan University Hospital, Karachi, Pakistan
| | - Samad Sayed
- Department of Medical Oncology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Muhammad Atif Mansha
- Department of Radiation Oncology, Dow University of Health Sciences, Karachi, Pakistan
| | - Yazdan Bin Kamran
- Department of Medicine, Bahria University of Health Sciences, Karachi, Pakistan
| | - Afrah Khursheed
- Department of Radiology, King Khalid Hospital,Tabuk, Saudi Arabia
| | - Fahd Haroon
- Diagnostic Radiology, Karachi X-Rays, Karachi, Pakistan
| | - Niaz Hussain Soomro
- Department of Thoracic Surgery, Dow University of Health Sciences, Karachi, Pakistan
| | - Romana Idrees
- Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital, Karachi, Pakistan
| | - Ahmed Nadeem Abbasi
- Department of Radiation Oncology, The Aga Khan University Hospital, Karachi, Pakistan
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34
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Febres-Aldana CA, Fanaroff R, Offin M, Zauderer MG, Sauter JL, Yang SR, Ladanyi M. Diffuse Pleural Mesothelioma: Advances in Molecular Pathogenesis, Diagnosis, and Treatment. ANNUAL REVIEW OF PATHOLOGY 2024; 19:11-42. [PMID: 37722697 DOI: 10.1146/annurev-pathol-042420-092719] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
Diffuse pleural mesothelioma (DPM) is a highly aggressive malignant neoplasm arising from the mesothelial cells lining the pleural surfaces. While DPM is a well-recognized disease linked to asbestos exposure, recent advances have expanded our understanding of molecular pathogenesis and transformed our clinical practice. This comprehensive review explores the current concepts and emerging trends in DPM, including risk factors, pathobiology, histologic subtyping, and therapeutic management, with an emphasis on a multidisciplinary approach to this complex disease.
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Affiliation(s)
- Christopher A Febres-Aldana
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA; ,
| | - Rachel Fanaroff
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA; ,
| | - Michael Offin
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Marjorie G Zauderer
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jennifer L Sauter
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA; ,
| | - Soo-Ryum Yang
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA; ,
| | - Marc Ladanyi
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA; ,
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Sato S. Adipo-oncology: adipocyte-derived factors govern engraftment, survival, and progression of metastatic cancers. Cell Commun Signal 2024; 22:52. [PMID: 38238841 PMCID: PMC10797898 DOI: 10.1186/s12964-024-01474-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/03/2024] [Indexed: 01/22/2024] Open
Abstract
Conventional therapies for metastatic cancers have limited efficacy. Recently, cancer therapies targeting noncancerous cells in tumor microenvironments have shown improved clinical outcomes in patients. However, further advances in our understanding of the metastatic tumor microenvironment are required to improve treatment outcomes. Adipocytes are distributed throughout the body, and as a part of the metastatic tumor microenvironment, they interact with cancer cells in almost all organs. Adipocytes secrete various factors that are reported to exert clinical effects on cancer progression, including engraftment, survival, and expansion at the metastatic sites. However, only a few studies have comprehensively examined their impact on cancer cells. In this review, we examined the impact of adipocytes on cancer by describing the adipocyte-secreted factors that are involved in controlling metastatic cancer, focusing on adipokines, such as adiponectin, leptin, visfatin, chemerin, resistin, apelin, and omentin. Adipocyte-secreted factors promote cancer metastasis and contribute to various biological functions of cancer cells, including migration, invasion, proliferation, immune evasion, and drug resistance at the metastatic sites. We propose the establishment and expansion of "adipo-oncology" as a research field to enhance the comprehensive understanding of the role of adipocytes in metastatic cancers and the development of more robust metastatic cancer treatments.
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Affiliation(s)
- Shinya Sato
- Morphological Analysis Laboratory, Kanagawa Cancer Center Research Institute, 2-3-2, Asahi-Ku, Yokohama, Kanagawa, 241-8515, Japan.
- Molecular Pathology and Genetics Division, Kanagawa Cancer Center Research Institute, 2-3-2, Asahi-Ku, Yokohama, Kanagawa, 241-8515, Japan.
- Department of Pathology, Kanagawa Cancer Center Hospital, 2-3-2, Asahi-Ku, Yokohama, Kanagawa, 241-8515, Japan.
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36
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Calabrò L, Bronte G, Grosso F, Cerbone L, Delmonte A, Nicolini F, Mazza M, Di Giacomo AM, Covre A, Lofiego MF, Crinò L, Maio M. Immunotherapy of mesothelioma: the evolving change of a long-standing therapeutic dream. Front Immunol 2024; 14:1333661. [PMID: 38259475 PMCID: PMC10800748 DOI: 10.3389/fimmu.2023.1333661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 12/19/2023] [Indexed: 01/24/2024] Open
Abstract
Pleural mesothelioma (PM) is an aggressive and rare disease, characterized by a very poor prognosis. For almost two decades, the world standard treatment regimen for unresectable PM has consisted of a platinum-based drug plus pemetrexed, leading to an overall survival of approximately 12 months. The dramatic therapeutic scenario of PM has recently changed with the entry into the clinic of immune checkpoint inhibition, which has proven to be an effective approach to improve the survival of PM patients. The aim of the present review is to provide a comprehensive overview of the most promising immunotherapeutic-based strategies currently under investigation for advanced PM.
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Affiliation(s)
- Luana Calabrò
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- Department of Oncology, University Hospital of Ferrara, Ferrara, Italy
| | - Giuseppe Bronte
- Department of Clinical and Molecular Sciences (DISCLIMO), Università Politecnica Delle Marche, Ancona, Italy
- Clinic of Laboratory and Precision Medicine, National Institute of Health and Sciences On Ageing (IRCCS INRCA), Ancona, Italy
| | - Federica Grosso
- Mesothelioma, Melanoma and Sarcoma Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Luigi Cerbone
- Mesothelioma, Melanoma and Sarcoma Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Angelo Delmonte
- Department of Medical Oncology, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Fabio Nicolini
- IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Massimiliano Mazza
- IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Anna Maria Di Giacomo
- Center for Immuno-Oncology, Medical Oncology and Immunotherapy, Department of Oncology, University Hospital of Siena, Siena, Italy
- Center for Immuno-Oncology, University of Siena, Siena, Italy
| | - Alessia Covre
- Center for Immuno-Oncology, Medical Oncology and Immunotherapy, Department of Oncology, University Hospital of Siena, Siena, Italy
- Center for Immuno-Oncology, University of Siena, Siena, Italy
- EPigenetic Immune-Oncology Consortium Airc (EPICA), Siena, Italy
| | - Maria Fortunata Lofiego
- Center for Immuno-Oncology, Medical Oncology and Immunotherapy, Department of Oncology, University Hospital of Siena, Siena, Italy
- Center for Immuno-Oncology, University of Siena, Siena, Italy
- EPigenetic Immune-Oncology Consortium Airc (EPICA), Siena, Italy
| | - Lucio Crinò
- Department of Medical Oncology, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Michele Maio
- Center for Immuno-Oncology, Medical Oncology and Immunotherapy, Department of Oncology, University Hospital of Siena, Siena, Italy
- Center for Immuno-Oncology, University of Siena, Siena, Italy
- EPigenetic Immune-Oncology Consortium Airc (EPICA), Siena, Italy
- Fondazione Network Italiano per la Bioterapia dei Tumori (NIBIT) Onlus, Siena, Italy
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Tagliamento M, Di Maio M, Remon J, Bironzo P, Genova C, Facchinetti F, Aldea M, Le Péchoux C, Novello S, Barlesi F, Besse B, Planchard D. Meta-Analysis on the Combination of Chemotherapy With Programmed Death-Ligand 1 and Programmed Cell Death Protein 1 Blockade as First-Line Treatment for Unresectable Pleural Mesothelioma. J Thorac Oncol 2024; 19:166-172. [PMID: 37567387 DOI: 10.1016/j.jtho.2023.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 07/11/2023] [Accepted: 08/01/2023] [Indexed: 08/13/2023]
Abstract
INTRODUCTION Dual immune checkpoint blockers regimen represents a standard first-line therapy in unresectable pleural mesothelioma (PM). Novel combination strategies, including immune checkpoint blockers and antiangiogenic drugs, are currently under investigation in this setting. We aimed to assess the efficacy of the chemoimmunotherapy combination by reference to literature evidence. METHODS A systematic review and meta-analysis of trials with first-line platinum-based chemotherapy associated with programmed death-ligand 1 and programmed cell death protein 1 agent in unresectable PM. We estimated the weighted summary proportion of disease response, along with the landmark probability of survival outcomes. RESULTS A total of 349 patients with unresectable PM from four trials (DREAM, PrE0505, JME-001, and IND.227) were included, 79% (n = 274) with epithelioid and 21% (n = 75) with nonepithelioid histologic type. In aggregate, the objective response rate was 59.2% (95% confidence interval [CI]: 50.3%-67.9%) and disease control rate was 92.2% (95% CI: 89.2%-94.8%). Comparing epithelioid versus nonepithelioid tumors, the objective response rate was 64.5% versus 46.4%, (p < 0.001) and the disease control rate was 92.3% versus 80.0%, (p = 0.043), with an OR of 2.56 (95% CI: 1.51-4.32) for disease response and of 3.37 (95% CI: 0.99-11.47) for disease control. The aggregated estimated probability of progression-free survival was 63% (95% CI: 53%-71%) at 6 months and 25% (95% CI: 21%-31%) at 12 months, whereas the 6-, 12- and 24-month overall survival rates were 88% (95% CI: 81%-93%), 71% (95% CI: 61%-79%) and 39% (95% CI: 34%-45%), respectively. CONCLUSIONS According to our analysis, first-line chemoimmunotherapy holds promise as a new treatment approach for PM, exhibiting encouraging survival outcomes and an enhanced response rate, including for the epithelioid subtype. Ongoing studies are necessary to establish its precise placement within the treatment algorithm.
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Affiliation(s)
- Marco Tagliamento
- Department of Cancer Medicine, Gustave Roussy, Villejuif, France; Department of Internal Medicine and Medical Specialties, University of Genova, Genova, Italy
| | - Massimo Di Maio
- Medical Oncology, Ordine Mauriziano Hospital, Turin, Italy; Department of Oncology, University of Turin, Turin, Italy
| | - Jordi Remon
- Department of Cancer Medicine, Gustave Roussy, Villejuif, France
| | - Paolo Bironzo
- Department of Oncology, University of Turin, Turin, Italy; Thoracic Oncology, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Carlo Genova
- Department of Internal Medicine and Medical Specialties, University of Genova, Genova, Italy; UO Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Francesco Facchinetti
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Mihaela Aldea
- Department of Cancer Medicine, Gustave Roussy, Villejuif, France; School of Medicine, Paris-Saclay University, Kremlin-Bicêtre, France
| | | | - Silvia Novello
- Department of Oncology, University of Turin, Turin, Italy; Thoracic Oncology, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Fabrice Barlesi
- Department of Cancer Medicine, Gustave Roussy, Villejuif, France; School of Medicine, Paris-Saclay University, Kremlin-Bicêtre, France
| | - Benjamin Besse
- Department of Cancer Medicine, Gustave Roussy, Villejuif, France; School of Medicine, Paris-Saclay University, Kremlin-Bicêtre, France
| | - David Planchard
- Department of Cancer Medicine, Gustave Roussy, Villejuif, France; School of Medicine, Paris-Saclay University, Kremlin-Bicêtre, France.
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Dumoulin DW, Douma LH, Hofman MM, van der Noort V, Cornelissen R, de Gooijer CJ, Burgers JA, Aerts JGJV. Nivolumab and ipilimumab in the real-world setting in patients with mesothelioma. Lung Cancer 2024; 187:107440. [PMID: 38104353 DOI: 10.1016/j.lungcan.2023.107440] [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: 09/14/2023] [Revised: 12/05/2023] [Accepted: 12/08/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVES Nivolumab (anti-PD-1) plus ipilimumab (anti-CTLA-4) is a new first-line treatment combination for patients with pleural mesothelioma. Nivolumab-ipilimumab improved the survival, however, 30.3% of the patients suffered from grade 3-4 treatment related adverse events (TRAE's) and TRAE's led to discontinuation in 23.0% of all patients. Here, we present the first real-world data of nivolumab plus ipilimumab in patients with malignant mesothelioma treated in two mesothelioma expert centers. METHODS Clinical data of patients with mesothelioma treated with nivolumab and ipilimumab were prospectively collected. Clinical parameters were obtained every visit, CT scans were evaluated every 12 weeks and adverse events were assessed continuously during the treatment. Data on grade 2-5 TRAE's and activity (overall response rate (ORR), duration of response (DOR), disease control rate (DCR), median progression-free survival (mPFS) and median overall survival (mOS) were reported. RESULTS Between January 2021 and August 2022, 184 patients were treated with nivolumab plus ipilimumab. The median follow-up was 12.1 months (95 %CI 11.1 - 13.1). Grade 3-4 TRAEs were seen in 27.7 % of the patients and 25.0 % discontinued immunotherapy treatment early because of TRAE's. ORR was 21.7 % (95 % CI 15.7-27.7), median DOR was 5.7 months (IQR 3.2-8.7) and DCR at 12 weeks 56.0 % (95 % CI 48.8-63.2). The mPFS was 5.5 months (95 %CI 4.1-6.9), mOS was 14.1 months (95 % CI 11.1-18.2). CONCLUSIONS Nivolumab plus ipilimumab had an equal efficacy in a real-world comparable population but also a high risk of TRAE's, leading to discontinuation of treatment in 25% of the patients.
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Affiliation(s)
- D W Dumoulin
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, University Medical Center Rotterdam, the Netherlands.
| | - L H Douma
- Department of Thoracic Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - M M Hofman
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, University Medical Center Rotterdam, the Netherlands; Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, the Netherlands
| | - V van der Noort
- Department of Biometrics, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - R Cornelissen
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, University Medical Center Rotterdam, the Netherlands
| | - C J de Gooijer
- Department of Thoracic Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - J A Burgers
- Department of Thoracic Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - J G J V Aerts
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, University Medical Center Rotterdam, the Netherlands
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Tian W, Guo Q, Fu D, Ma X, Wang R. Efficacy and safety profile of combining antiangiogenic agents with chemotherapy in patients with advanced malignant pleural mesothelioma: A systematic review and meta-analysis of randomized controlled trials. PLoS One 2023; 18:e0295745. [PMID: 38127857 PMCID: PMC10735007 DOI: 10.1371/journal.pone.0295745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVES Several prospective trials had been reported on chemotherapy with or without antiangiogenic agents in patients with advanced malignant pleural mesothelioma (MPM), with diverse results. We performed this systematic review and meta-analysis to evaluate the efficacy and safety of the combination regimen. METHODS We systematically identified trials in several databases, including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, ASCO Abstracts and ESMO Abstracts. All the randomized controlled trials (RCTs) about chemotherapy combined with antiangiogenic agents in advanced MPM were identified. Overall survival (OS) was the primary outcome, while progression-free survival (PFS), overall response rate (ORR) and serious toxicities were the secondary outcomes. Review Manager 5.3 was used to perform the statistical analyses. Stata 12.0 was used to assess the publication bias of egger's test. RESULTS 5 randomized controlled trials containing 1250 patients were finally included in this analysis. Statistical analyses showed that the addition of antiangiogenic agents to chemotherapy could prolong OS [HR 0.79 (0.71-0.89), p<0.0001] and PFS [HR 0.75 (0.68-0.84), p<0.00001] in advanced MPM, especially in the epithelioid subgroup, with a tolerable toxicity profile. No significant difference was found in the analysis of ORR [HR 1.13 (0.95-1.35), p = 0.18]. Heterogeneity was found in the analyses of PFS and ORR, which might be caused by the limitation in uniform evaluation of tumor response. CONCLUSIONS The combination of antiangiogenic agents with chemotherapy showed superior over chemotherapy alone in patients with advanced MPM. More prospective trials should be warranted to identify patients who would most likely benefit from the combination regimen.
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Affiliation(s)
- Wei Tian
- Department of Oncology, Zibo Central Hospital, Shandong University, Zibo, Shandong, Peoples’ Republic of China
| | - Qian Guo
- Day Care Unit, Zibo Central Hospital, Shandong University, Zibo, Shandong, Peoples’ Republic of China
| | - Daidi Fu
- Department of Oncology, Zibo Central Hospital, Shandong University, Zibo, Shandong, Peoples’ Republic of China
| | - Xiao Ma
- Department of Internal Medicine, Zhangqiu People’s Hospital, Zhangqiu, Shandong, People’ Republic of China
| | - Rui Wang
- Department of Oncology, Zibo Central Hospital, Shandong University, Zibo, Shandong, Peoples’ Republic of China
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Lee YCG. Pembrolizumab plus chemotherapy for pleural mesothelioma. Lancet 2023; 402:2266-2267. [PMID: 37931626 DOI: 10.1016/s0140-6736(23)01883-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 09/04/2023] [Indexed: 11/08/2023]
Affiliation(s)
- Y C Gary Lee
- Pleural Medicine Unit, Institute for Respiratory Health, Perth, WA 6009, Australia; School of Medicine, University of Western Australia, Perth, WA, Australia; Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia.
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Chu Q, Perrone F, Greillier L, Tu W, Piccirillo MC, Grosso F, Lo Russo G, Florescu M, Mencoboni M, Morabito A, Cecere FL, Ceresoli GL, Dawe DE, Zucali PA, Pagano M, Goffin JR, Sanchez ML, Gridelli C, Zalcman G, Quantin X, Westeel V, Gargiulo P, Delfanti S, Tu D, Lee CW, Leighl N, Sederias J, Brown-Walker P, Luo Y, Lantuejoul S, Tsao MS, Scherpereel A, Bradbury P, Laurie SA, Seymour L. Pembrolizumab plus chemotherapy versus chemotherapy in untreated advanced pleural mesothelioma in Canada, Italy, and France: a phase 3, open-label, randomised controlled trial. Lancet 2023; 402:2295-2306. [PMID: 37931632 DOI: 10.1016/s0140-6736(23)01613-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/29/2023] [Accepted: 08/01/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Pleural mesothelioma usually presents at an advanced, incurable stage. Chemotherapy with platinum-pemetrexed is a standard treatment. We hypothesised that the addition of pembrolizumab to platinum-pemetrexed would improve overall survival in patients with pleural mesothelioma. METHODS We did this open-label, international, randomised phase 3 trial at 51 hospitals in Canada, Italy, and France. Eligible participants were aged 18 years or older, with previously untreated advanced pleural mesothelioma, with an Eastern Cooperative Oncology Group performance status score of 0 or 1. Patients were randomly assigned (1:1) to intravenous chemotherapy (cisplatin [75 mg/m2] or carboplatin [area under the concentration-time curve 5-6 mg/mL per min] with pemetrexed 500 mg/m2, every 3 weeks for up to 6 cycles), with or without intravenous pembrolizumab 200 mg every 3 weeks (up to 2 years). The primary endpoint was overall survival in all randomly assigned patients; safety was assessed in all randomly assigned patients who received at least one dose of study therapy. This trial is registered with ClinicalTrials.gov, NCT02784171, and is closed to accrual. FINDINGS Between Jan 31, 2017, and Sept 4, 2020, 440 patients were enrolled and randomly assigned to chemotherapy alone (n=218) or chemotherapy with pembrolizumab (n=222). 333 (76 %) of patients were male, 347 (79%) were White, and median age was 71 years (IQR 66-75). At final analysis (database lock Dec 15, 2022), with a median follow-up of 16·2 months (IQR 8·3-27·8), overall survival was significantly longer with pembrolizumab (median overall survival 17·3 months [95% CI 14·4-21·3] with pembrolizumab vs 16·1 months [13·1-18·2] with chemotherapy alone, hazard ratio for death 0·79; 95% CI 0·64-0·98, two-sided p=0·0324). 3-year overall survival rate was 25% (95% CI 20-33%) with pembrolizumab and 17% (13-24%) with chemotherapy alone. Adverse events related to study treatment of grade 3 or 4 occurred in 60 (27%) of 222 patients in the pembrolizumab group and 32 (15%) of 211 patients in the chemotherapy alone group. Hospital admissions for serious adverse events related to one or more study drugs were reported in 40 (18%) of 222 patients in the pembrolizumab group and 12 (6%) of 211 patients in the chemotherapy alone group. Grade 5 adverse events related to one or more drugs occurred in two patients on the pembrolizumab group and one patient in the chemotherapy alone group. INTERPRETATION In patients with advanced pleural mesothelioma, the addition of pembrolizumab to standard platinum-pemetrexed chemotherapy was tolerable and resulted in a significant improvement in overall survival. This regimen is a new treatment option for previously untreated advanced pleural mesothelioma. FUNDING The Canadian Cancer Society and Merck & Co.
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Affiliation(s)
- Quincy Chu
- Cross Cancer Institute, Edmonton, AB, Canada
| | - Francesco Perrone
- Istituto Nazionale Tumori Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione G Pascale, Napoli, Italy
| | - Laurent Greillier
- Aix Marseille Univ, Marseille, France; Assistance publique - Hôpitaux de Marseille, Marseille, France; L'Institut National de la Santé et de la Recherche Médicale, Marseille, France; Centre National de la Recherche Scientifique, Marseille, France; Cancer Research Centre of Marseille, Marseille, France; Hôpital Nord, Multidisciplinary Oncology and Therapeutic Innovations, Marseille, France
| | - Wei Tu
- Canadian Cancer Trials Group, Queen's University, Kingston, ON, Canada
| | - Maria Carmela Piccirillo
- Istituto Nazionale Tumori Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione G Pascale, Napoli, Italy
| | - Federica Grosso
- Mesothelioma and Rare Cancer Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | | | - Marie Florescu
- Centre Hospitalier de l'Université de Montreal, Montreal, QC, Canada
| | - Manlio Mencoboni
- Unit di Oncologia Ospedale Villa Scassi, Genova Sampierdarena, Italy
| | - Alessandro Morabito
- Oncologia Clinica e Sperimentale Toraco-polmonare, Istituto Nazionale Tumori IRCCS Fondazione G Pascale, Napoli, Italy
| | | | | | | | - Paolo Andrea Zucali
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Department of Oncology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Maria Pagano
- Oncologia Medica IRCCS Arcispedale Maria Nuova Reggio Emilia, Reggio Emilia, Italy
| | - John R Goffin
- Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON, Canada
| | | | - Cesare Gridelli
- Azienda Ospedaliera San Giuseppe Moscati Dipartimento di Oncologia Medica, Avellino, Italy
| | - Gerard Zalcman
- Université Paris Cité, Hôpital Bichat-Claude Bernard, Thoracic Oncology Department, Assistance publique-Hôpitaux de Paris Nord, Paris, France
| | - Xavier Quantin
- Montpellier Cancer Institute and Montpellier Cancer Research Institute, INSERM U1194, University of Montpellier, Montpellier, France
| | | | - Piera Gargiulo
- Istituto Nazionale Tumori Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione G Pascale, Napoli, Italy
| | - Sara Delfanti
- Mesothelioma and Rare Cancer Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Dongsheng Tu
- Canadian Cancer Trials Group, Queen's University, Kingston, ON, Canada
| | | | - Natasha Leighl
- Princess Margaret Cancer Centre, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada
| | - Joana Sederias
- Canadian Cancer Trials Group, Queen's University, Kingston, ON, Canada
| | | | | | - Sylvie Lantuejoul
- Grenoble Alpes University and Department of Biopathology, Centre Léon Bérard and Netmeso Mesopath Network, Lyon, France
| | - Ming-Sound Tsao
- Princess Margaret Cancer Centre, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada
| | | | - Penelope Bradbury
- Princess Margaret Cancer Centre, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada
| | - Scott A Laurie
- Ottawa Hospital Research Institute, Ottawa, ON, Canada; University of Ottawa, Ottawa, ON, Canada
| | - Lesley Seymour
- Canadian Cancer Trials Group, Queen's University, Kingston, ON, Canada.
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Bertin B, Zugman M, Schvartsman G. The Current Treatment Landscape of Malignant Pleural Mesothelioma and Future Directions. Cancers (Basel) 2023; 15:5808. [PMID: 38136353 PMCID: PMC10741667 DOI: 10.3390/cancers15245808] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 11/29/2023] [Accepted: 12/01/2023] [Indexed: 12/24/2023] Open
Abstract
The incidence of malignant pleural mesothelioma is expected to increase globally. New treatment options for this malignancy are eagerly awaited to improve the survival and quality of life of patients. The present article highlights the results of recent advances in this field, analyzing data from several relevant trials. The heterogeneous tumor microenvironment and biology, together with the low mutational burden, pose a challenge for treating such tumors. So far, no single biomarker has been soundly correlated with targeted therapy development; thus, combination strategies are often required to improve outcomes. Locally applied vaccines, the expansion of genetically engineered immune cell populations such as T cells, the blockage of immune checkpoints that inhibit anti-tumorigenic responses and chemoimmunotherapy are among the most promising options expected to change the mesothelioma treatment landscape.
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Affiliation(s)
- Beatriz Bertin
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo 05651-901, Brazil;
| | - Miguel Zugman
- Department of Medical Oncology, Hospital Israelita Albert Einstein, São Paulo 05651-901, Brazil;
| | - Gustavo Schvartsman
- Department of Medical Oncology, Hospital Israelita Albert Einstein, São Paulo 05651-901, Brazil;
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Cedres S, Valdivia A, Iranzo P, Callejo A, Pardo N, Navarro A, Martinez-Marti A, Assaf-Pastrana JD, Felip E, Garrido P. Current State-of-the-Art Therapy for Malignant Pleural Mesothelioma and Future Options Centered on Immunotherapy. Cancers (Basel) 2023; 15:5787. [PMID: 38136333 PMCID: PMC10741743 DOI: 10.3390/cancers15245787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
Malignant pleural mesothelioma (MPM) is a locally aggressive disease related to asbestos exposure with a median survival for untreated patients of 4-8 months. The combination of chemotherapy based on platinum and antifolate is the standard treatment, and the addition of bevacizumab adds two months to median survival. Recently, in first-line treatment, immunotherapy combining nivolumab with ipilimumab has been shown to be superior to chemotherapy in the CheckMate-743 study in terms of overall survival (18.1 months), leading to its approval by the FDA and EMA. The positive results of this study represent a new standard of treatment for patients with MPM; however, not all patients will benefit from immunotherapy treatment. In an effort to improve the selection of patient candidates for immunotherapy for different tumors, biomarkers that have been associated with a greater possibility of response to treatment have been described. MPM is a type of tumor with low mutational load and neo-antigens, making it a relatively non-immunogenic tumor for T cells and possibly less susceptible to responding to immunotherapy. Different retrospective studies have shown that PD-L1 expression occurs in 20-40% of patients and is associated with a poor prognosis; however, the predictive value of PD-L1 in response to immunotherapy has not been confirmed. The purpose of this work is to review the state of the art of MPM treatment in the year 2023, focusing on the efficacy results of first-line or subsequent immunotherapy studies on patients with MPM and possible chemo-immunotherapy combination strategies. Additionally, potential biomarkers of response to immunotherapy will be reviewed, such as histology, PD-L1, lymphocyte populations, and TMB.
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Affiliation(s)
- Susana Cedres
- Medical Oncology Department, Vall d´Hebron Institute of Oncology (VHIO), Vall d’Hebron Hospital Universitari, 08035 Barcelona, Spain; (A.V.); (P.I.); (A.C.); (N.P.); (A.N.); (A.M.-M.); (J.D.A.-P.); (E.F.)
| | - Augusto Valdivia
- Medical Oncology Department, Vall d´Hebron Institute of Oncology (VHIO), Vall d’Hebron Hospital Universitari, 08035 Barcelona, Spain; (A.V.); (P.I.); (A.C.); (N.P.); (A.N.); (A.M.-M.); (J.D.A.-P.); (E.F.)
| | - Patricia Iranzo
- Medical Oncology Department, Vall d´Hebron Institute of Oncology (VHIO), Vall d’Hebron Hospital Universitari, 08035 Barcelona, Spain; (A.V.); (P.I.); (A.C.); (N.P.); (A.N.); (A.M.-M.); (J.D.A.-P.); (E.F.)
| | - Ana Callejo
- Medical Oncology Department, Vall d´Hebron Institute of Oncology (VHIO), Vall d’Hebron Hospital Universitari, 08035 Barcelona, Spain; (A.V.); (P.I.); (A.C.); (N.P.); (A.N.); (A.M.-M.); (J.D.A.-P.); (E.F.)
| | - Nuria Pardo
- Medical Oncology Department, Vall d´Hebron Institute of Oncology (VHIO), Vall d’Hebron Hospital Universitari, 08035 Barcelona, Spain; (A.V.); (P.I.); (A.C.); (N.P.); (A.N.); (A.M.-M.); (J.D.A.-P.); (E.F.)
| | - Alejandro Navarro
- Medical Oncology Department, Vall d´Hebron Institute of Oncology (VHIO), Vall d’Hebron Hospital Universitari, 08035 Barcelona, Spain; (A.V.); (P.I.); (A.C.); (N.P.); (A.N.); (A.M.-M.); (J.D.A.-P.); (E.F.)
| | - Alex Martinez-Marti
- Medical Oncology Department, Vall d´Hebron Institute of Oncology (VHIO), Vall d’Hebron Hospital Universitari, 08035 Barcelona, Spain; (A.V.); (P.I.); (A.C.); (N.P.); (A.N.); (A.M.-M.); (J.D.A.-P.); (E.F.)
| | - Juan David Assaf-Pastrana
- Medical Oncology Department, Vall d´Hebron Institute of Oncology (VHIO), Vall d’Hebron Hospital Universitari, 08035 Barcelona, Spain; (A.V.); (P.I.); (A.C.); (N.P.); (A.N.); (A.M.-M.); (J.D.A.-P.); (E.F.)
| | - Enriqueta Felip
- Medical Oncology Department, Vall d´Hebron Institute of Oncology (VHIO), Vall d’Hebron Hospital Universitari, 08035 Barcelona, Spain; (A.V.); (P.I.); (A.C.); (N.P.); (A.N.); (A.M.-M.); (J.D.A.-P.); (E.F.)
- Thoracic Cancers Translational Genomics Unit, Medical Oncology Department, Vall d´Hebron Institute of Oncology (VHIO), Vall d´Hebron Hospital Universitari, 08035 Barcelona, Spain
| | - Pilar Garrido
- Medical Oncology Department, Ramón y Cajal University Hospital, 28034 Madrid, Spain;
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Cerbone L, Orecchia S, Bertino P, Delfanti S, de Angelis AM, Grosso F. Clinical Next Generation Sequencing Application in Mesothelioma: Finding a Golden Needle in the Haystack. Cancers (Basel) 2023; 15:5716. [PMID: 38136262 PMCID: PMC10741845 DOI: 10.3390/cancers15245716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/25/2023] [Accepted: 12/04/2023] [Indexed: 12/24/2023] Open
Abstract
Mesothelioma comprises a group of rare cancers arising from the mesothelium of the pleura, peritoneum, tunica vaginalis testis and pericardium. Mesothelioma is generally associated with asbestos exposure and has a dismal prognosis, with few therapeutic options. Several next generation sequencing (NGS) experiments have been performed on mesothelioma arising at different sites. These studies highlight a genomic landscape mainly characterized by a high prevalence (>20%) of genomic aberrations leading to functional losses in oncosuppressor genes such as BAP1, CDKN2A, NF2, SETD2 and TP53. Nevertheless, to date, evidence of the effect of targeting these alterations with specific drugs is lacking. Conversely, 1-2% of mesothelioma might harbor activating mutations in oncogenes with specifically approved drugs. The goal of this review is to summarize NGS applications in mesothelioma and to provide insights into target therapy of mesothelioma guided by NGS.
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Affiliation(s)
- Luigi Cerbone
- Mesothelioma Unit, SS Antonio e and Biagio Hospital, 15121 Alessandria, Italy; (L.C.); (P.B.); (S.D.); (A.M.d.A.)
| | - Sara Orecchia
- Molecular Pathology Unit, SS Antonio e and Biagio Hospital, 15121 Alessandria, Italy;
| | - Pietro Bertino
- Mesothelioma Unit, SS Antonio e and Biagio Hospital, 15121 Alessandria, Italy; (L.C.); (P.B.); (S.D.); (A.M.d.A.)
| | - Sara Delfanti
- Mesothelioma Unit, SS Antonio e and Biagio Hospital, 15121 Alessandria, Italy; (L.C.); (P.B.); (S.D.); (A.M.d.A.)
| | - Antonina Maria de Angelis
- Mesothelioma Unit, SS Antonio e and Biagio Hospital, 15121 Alessandria, Italy; (L.C.); (P.B.); (S.D.); (A.M.d.A.)
| | - Federica Grosso
- Mesothelioma Unit, SS Antonio e and Biagio Hospital, 15121 Alessandria, Italy; (L.C.); (P.B.); (S.D.); (A.M.d.A.)
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Bertuccio FR, Agustoni F, Galli G, Bortolotto C, Saddi J, Baietto G, Baio N, Montini S, Putignano P, D’Ambrosio G, Corsico AG, Pedrazzoli P, Stella GM. Pleural Mesothelioma: Treatable Traits of a Heterogeneous Disease. Cancers (Basel) 2023; 15:5731. [PMID: 38136277 PMCID: PMC10741585 DOI: 10.3390/cancers15245731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 11/23/2023] [Accepted: 12/02/2023] [Indexed: 12/24/2023] Open
Abstract
Pleural mesothelioma is an aggressive disease with diffuse nature, low median survival, and prolonged latency presenting difficulty in prognosis, diagnosis, and treatment. Here, we review all these aspects to underline the progress being made in its investigation and to emphasize how much work remains to be carried out to improve prognosis and treatment.
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Affiliation(s)
- Francesco Rocco Bertuccio
- Department of Internal Medicine and Medical Therapeutics, University of Pavia Medical School, 27100 Pavia, Italy; (F.R.B.); (F.A.); (G.G.); (N.B.); (S.M.); (P.P.); (A.G.C.); (P.P.)
- Cardiothoracic and Vascular Department, Unit of Respiratory Diseases, IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Francesco Agustoni
- Department of Internal Medicine and Medical Therapeutics, University of Pavia Medical School, 27100 Pavia, Italy; (F.R.B.); (F.A.); (G.G.); (N.B.); (S.M.); (P.P.); (A.G.C.); (P.P.)
- Department of Medical Oncology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Giulia Galli
- Department of Internal Medicine and Medical Therapeutics, University of Pavia Medical School, 27100 Pavia, Italy; (F.R.B.); (F.A.); (G.G.); (N.B.); (S.M.); (P.P.); (A.G.C.); (P.P.)
- Department of Medical Oncology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Chandra Bortolotto
- Diagnostic Imaging and Radiotherapy Unit, Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy;
- Radiology Institute, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Jessica Saddi
- Department of Oncology, Clinical-Surgical, Unit of Radiation Therapy, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy;
- Department of Radiation Oncology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Guido Baietto
- Cardiothoracic and Vascular Department, Unit of Thoracic Surgery, IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Nicola Baio
- Department of Internal Medicine and Medical Therapeutics, University of Pavia Medical School, 27100 Pavia, Italy; (F.R.B.); (F.A.); (G.G.); (N.B.); (S.M.); (P.P.); (A.G.C.); (P.P.)
- Cardiothoracic and Vascular Department, Unit of Respiratory Diseases, IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Simone Montini
- Department of Internal Medicine and Medical Therapeutics, University of Pavia Medical School, 27100 Pavia, Italy; (F.R.B.); (F.A.); (G.G.); (N.B.); (S.M.); (P.P.); (A.G.C.); (P.P.)
- Cardiothoracic and Vascular Department, Unit of Respiratory Diseases, IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Paola Putignano
- Department of Internal Medicine and Medical Therapeutics, University of Pavia Medical School, 27100 Pavia, Italy; (F.R.B.); (F.A.); (G.G.); (N.B.); (S.M.); (P.P.); (A.G.C.); (P.P.)
- Cardiothoracic and Vascular Department, Unit of Respiratory Diseases, IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Gioacchino D’Ambrosio
- Pathology Unit, Department of Diagnostical Services and Imaging, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Angelo G. Corsico
- Department of Internal Medicine and Medical Therapeutics, University of Pavia Medical School, 27100 Pavia, Italy; (F.R.B.); (F.A.); (G.G.); (N.B.); (S.M.); (P.P.); (A.G.C.); (P.P.)
- Cardiothoracic and Vascular Department, Unit of Respiratory Diseases, IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Paolo Pedrazzoli
- Department of Internal Medicine and Medical Therapeutics, University of Pavia Medical School, 27100 Pavia, Italy; (F.R.B.); (F.A.); (G.G.); (N.B.); (S.M.); (P.P.); (A.G.C.); (P.P.)
- Department of Medical Oncology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Giulia Maria Stella
- Department of Internal Medicine and Medical Therapeutics, University of Pavia Medical School, 27100 Pavia, Italy; (F.R.B.); (F.A.); (G.G.); (N.B.); (S.M.); (P.P.); (A.G.C.); (P.P.)
- Cardiothoracic and Vascular Department, Unit of Respiratory Diseases, IRCCS Policlinico San Matteo, 27100 Pavia, Italy
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John A, O'Sullivan H, Popat S. Updates in Management of Malignant Pleural Mesothelioma. Curr Treat Options Oncol 2023; 24:1758-1789. [PMID: 37975977 DOI: 10.1007/s11864-023-01148-2] [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] [Accepted: 10/19/2023] [Indexed: 11/19/2023]
Abstract
OPINION STATEMENT Malignant pleural mesothelioma (MPM) is an aggressive asbestos-associated thoracic malignancy that is usually incurable. As demonstrated in the landmark MARS2 trial, surgical resection does not improve survival outcomes and its role in managing MPM is limited. Whilst platinum-pemetrexed chemotherapy in combination with bevacizumab was the standard first-line approach for unresectable disease, landmark phase 3 trials have now established the role of immune checkpoint inhibitors (CPIs) in the upfront management of unresectable disease: either nivolumab-ipilimumab or carboplatin-pemetrexed-pembrolizumab. Patient selection for optimal strategy remains an ongoing question. For relapsed disease novel genomic-based therapies targeting a range of aberrations including losses of the tumour suppressor genes BAP1, CDKN2A and NF2, are being evaluated. Nonetheless, the future of MPM therapeutics holds promise. Here we overview current treatment strategies in the management of MPM.
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Affiliation(s)
- Alexius John
- The Lung Unit, The Royal Marsden Hospital, London, UK.
| | - Hazel O'Sullivan
- The Lung Unit, The Royal Marsden Hospital, London, UK
- Department of Medical Oncology, Cork University Hospital, Cork, Ireland
| | - Sanjay Popat
- The Lung Unit, The Royal Marsden Hospital, London, UK
- The Institute of Cancer Research, London, UK
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Zhang C, Sun Q, Zhao J, Jiang N, Hao Y, Luo J, Karim S, Wu L, de Perrot M, Peng C, Zhao X. JSI-124 inhibits cell proliferation and tumor growth by inducing autophagy and apoptosis in murine malignant mesothelioma. Mol Carcinog 2023; 62:1888-1901. [PMID: 37642305 DOI: 10.1002/mc.23623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/11/2023] [Accepted: 08/17/2023] [Indexed: 08/31/2023]
Abstract
Malignant pleural mesothelioma (MPM), mainly caused by asbestos exposure, has a poor prognosis and lacks effective treatment compared with other cancer types. The intracellular transcription factor signal transducer and activator of transcription 3 (STAT3) is overexpressed and hyperactivated in most human cancers. In this study, the role of STAT3 in murine MPM was examined. Inhibition of the Janus kinase 2 (JAK2)/STAT3 pathway with the selective inhibitor JSI-124 has an antitumor effect in murine MPM. Specifically, we demonstrated that JSI-124 inhibits murine MPM cell growth and induces apoptotic and autophagic cell death. Exposure of RN5 and AB12 cells to JSI-124 resulted in apoptosis via the Bcl-2 family of proteins. JSI-124 triggered autophagosome formation, accumulation, and conversion of LC3I to LC3II. Autophagy inhibitors, Chloroquine (CQ) and Bafilomycin A1 (Baf-A1), inhibited autophagy and sensitized RN5 and AB12 cells to JSI-124-induced apoptosis. Our data indicate that JSI-124 is a promising therapeutic agent for MPM treatment.
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Affiliation(s)
- Chengke Zhang
- Department of Thoracic Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China
- Key Laboratory of Thoracic Cancer, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China
| | - Qifeng Sun
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China
| | - Jiangfeng Zhao
- Department of Thoracic Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China
- Key Laboratory of Thoracic Cancer, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China
| | - Ning Jiang
- Department of Thoracic Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China
- Key Laboratory of Thoracic Cancer, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China
| | - Yingtao Hao
- Department of Thoracic Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China
- Key Laboratory of Thoracic Cancer, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China
| | - Junwen Luo
- Department of Thoracic Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China
- Key Laboratory of Thoracic Cancer, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China
| | - Saraf Karim
- Latner Thoracic Surgery Research Laboratories and Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Licun Wu
- Key Laboratory of Thoracic Cancer, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China
- Latner Thoracic Surgery Research Laboratories and Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Marc de Perrot
- Latner Thoracic Surgery Research Laboratories and Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Department Immunology, University of Toronto, Toronto, Ontario, Canada
| | - Chuanliang Peng
- Department of Thoracic Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China
- Key Laboratory of Thoracic Cancer, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China
| | - Xiaogang Zhao
- Department of Thoracic Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China
- Key Laboratory of Thoracic Cancer, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China
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Dudek AZ, Xi MX, Scilla KA, Mamdani H, Creelan BC, Saltos A, Tanvetyanon T, Chiappori A. Phase 2 Trial of Nivolumab and Ramucirumab for Relapsed Mesothelioma: HCRN-LUN15-299. JTO Clin Res Rep 2023; 4:100584. [PMID: 38046376 PMCID: PMC10689266 DOI: 10.1016/j.jtocrr.2023.100584] [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] [Received: 06/30/2023] [Revised: 09/28/2023] [Accepted: 10/09/2023] [Indexed: 12/05/2023] Open
Abstract
Introduction We hypothesized that ramucirumab could increase previously reported objective response rate (ORR) of 11% of single-agent nivolumab in the second-line therapy of unresectable mesothelioma. Methods This was a cooperative group, single-arm, phase 2 trial enrolling patients with unresectable mesothelioma after progression on more than or equal to one pemetrexed-containing regimen. Ramucirumab and nivolumab were given intravenously every 14 days for up to 24 months. The primary end point was ORR; secondary end points were progression-free survival (PFS) rate at 24 weeks and overall survival (OS). Results Between April 2018 and October 2021, 34 patients were recruited. Median age was 72 (range: 40-89) years, 12% were women, and 79% of tumors had epithelial histology. Median follow-up was 10.2 months (interquartile range 19.6 mo [4.3-23.8]). ORR was 22.6% (95% confidence interval [CI]: 9.6%-41.1%) in all population and 43% (95% CI: 10%-82%) in patients with nonepithelioid histology. Of all patients, 45.2% (95% CI: 27.3%-64.0%) had stable disease. PFS rate at 24 weeks was 32% (95% CI: 17%-51%). Median PFS was 4.2 months (95% CI: 1.9-6.4 mo). Median OS was 12.5 months (95% CI: 6.3-23.5 mo). There was no grade greater than or equal to four toxicity. Programmed death-ligand 1 expression in the tumor did not correlate with benefit from treatment. Activation of tumor-infiltrating lymphocytes in response to treatment was associated with a trend toward improvement in PFS. Conclusions Nivolumab and ramucirumab combination was safe and generated PFS and OS rates and ORR that compare favorably with single-agent nivolumab in a similar patient population. The primary end point of 40% ORR was not reached. Further investigation of this regimen in mesothelioma with nonepithelioid histology may be warranted. Clinical Trial Information: NCT03502746.
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Affiliation(s)
- Arkadiusz Z. Dudek
- HealthPartners Institute, Minneapolis, Minnesota
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota
| | - Min X. Xi
- HealthPartners Institute, Minneapolis, Minnesota
| | - Katherine A. Scilla
- Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, Maryland
| | - Hirva Mamdani
- Karmanos Cancer Center, Wayne State University, Detroit, Michigan
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Wolf AS, Rosenthal A, Giroux DJ, Nowak AK, Bille A, de Perrot M, Kindler HL, Rice D, Opitz I, Rusch VW, Pass HI. The International Association for the Study of Lung Cancer Pleural Mesothelioma Staging Project: Updated Modeling of Prognostic Factors in Pleural Mesothelioma. J Thorac Oncol 2023; 18:1689-1702. [PMID: 37567386 PMCID: PMC11168491 DOI: 10.1016/j.jtho.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 08/13/2023]
Abstract
INTRODUCTION The International Association for the Study of Lung Cancer developed an international pleural mesothelioma database to improve staging. Data entered from 1995 to 2009 (training data set) were analyzed previously to evaluate supplemental prognostic factors. We evaluated these factors with new clinical data to determine whether the previous models could be improved. METHODS Patients entered into the database from 2009 to 2019 (validation cohort) were assessed for the association between previous prognosticators and overall survival using Cox proportional hazards regression with bidirectional stepwise selection. Additional variables were analyzed and models were compared using Harrell's C-index. RESULTS The training data set included 3101 patients and the validation cohort, 1733 patients. For the multivariable pathologic staging model applied to the training cohort, C-index was 0.68 (95% confidence interval [CI]: 0.656-0.705). For the validation data set (n = 497), C-index was 0.650 (95% CI: 0.614-0.685), and pathologic stage, histologic diagnosis, sex, adjuvant therapy, and platelet count were independently associated with survival. Adding anemia to the model increased the C-index to 0.652 (95% CI: 0.618-0.686). A basic presentation model including all parameters before staging yielded a C-index of 0.668 (95% CI: 0.641-0.695). In comparison, the European Organization for Research and Treatment of Cancer model yielded C-indices of 0.550 (95% CI: 0.511-0.589) and 0.577 (95% CI: 0.550-0.604) for pathologic staging and presentation models, respectively. CONCLUSIONS Although significant predictors differed slightly, the International Association for the Study of Lung Cancer training model performed well in the validation set and better than the model of the European Organization for Research and Treatment of Cancer. International collaboration is critical to improve outcomes in this rare disease.
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Affiliation(s)
- Andrea S Wolf
- Department of Thoracic Surgery, The Icahn School of Medicine at Mount Sinai, New York, New York.
| | | | | | - Anna K Nowak
- Medical School of the University of Western Australia, Crawley, Western Australia, Australia
| | - Andrea Bille
- Department of Thoracic Surgery, Guy's Hospital, London, United Kingdom
| | - Marc de Perrot
- Division of Thoracic Surgery, Toronto General Hospital, Ontario, Canada
| | - Hedy L Kindler
- Section of Hematology/Oncology, University of Chicago, Chicago, Illinois
| | - David Rice
- Department of Thoracic and Cardiovascular Surgery, MD Anderson Cancer Center, Houston, Texas
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Valerie W Rusch
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Harvey I Pass
- Department of Cardiothoracic Surgery, New York University (NYU) Langone Medical Center, New York, New York
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Medina CG, Xu Y, Ripley RT. International Prognostic Modeling: A Platform for Collaborative Approach for Patients With Mesothelioma. J Thorac Oncol 2023; 18:1618-1620. [PMID: 37993213 DOI: 10.1016/j.jtho.2023.09.1441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 09/13/2023] [Indexed: 11/24/2023]
Affiliation(s)
- Cristian G Medina
- David J. Sugarbaker Division of General Thoracic Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Yuan Xu
- David J. Sugarbaker Division of General Thoracic Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - R Taylor Ripley
- David J. Sugarbaker Division of General Thoracic Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
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