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Ji JH, Jung HI, Park JJ. Well-Differentiated Papillary Mesothelioma of the Peritoneum. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2023. [DOI: 10.4166/kjg.2023.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Affiliation(s)
- Jung Hyun Ji
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hoe In Jung
- Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Jun Park
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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2
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Nief CA, No HJ, Louie CY, Vitzthum L, Das M. Regression of Malignant Pleural Mesothelioma in Absence of Chemotherapy or Surgery: A Case Series. Clin Lung Cancer 2023; 24:76-81. [PMID: 36323592 DOI: 10.1016/j.cllc.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/07/2022] [Indexed: 02/03/2023]
Affiliation(s)
- Corrine A Nief
- Stanford Medical School, Stanford University, Stanford, CA.
| | | | - Christine Y Louie
- Department of Pathology, VA Palo Alto Health Care System, Palo Alto, CA
| | - Lucas Vitzthum
- Department of Radiation Oncology, Stanford University, Stanford, CA; Department of Medicine, VA Palo Alto Health Care System, Palo Alto, CA
| | - Millie Das
- Department of Medicine, Division of Oncology, Stanford University, Stanford, CA; Stanford Cancer Institute, Stanford, CA; Department of Medicine, VA Palo Alto Health Care System, Palo Alto, CA
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3
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Cui W, Popat S. Pleural mesothelioma (PM) - The status of systemic therapy. Cancer Treat Rev 2021; 100:102265. [PMID: 34399145 DOI: 10.1016/j.ctrv.2021.102265] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 07/28/2021] [Accepted: 07/31/2021] [Indexed: 10/20/2022]
Abstract
Pleural mesothelioma (PM) remains a malignancy with poor prognosis. Despite initial disappointing response rates to single-agent chemotherapy, upfront platinum and anti-folate-based combination chemotherapy has remained the backbone of treatment for PM for the last three decades. The role of maintenance chemotherapy remains unclear; switch-maintenance gemcitabine has shown improvements in progression-free but not overall survival. The addition of antiangiogenic agents to chemotherapy yielded modest improvements in survival, both upfront in combination with platinum-pemetrexed, and in the relapsed setting. Immunotherapy, particularly PD-(L)1 inhibitors, has shown important but variable effectiveness in relapsed PM when used as monotherapy, and is an important salvage treatment after first-line chemotherapy. Furthermore, the randomized phase 3 trial of ipilimumab-nivolumab versus platinum-pemetrexed chemotherapy demonstrated improved overall survival favouring ipilimumab-nivolumab (HR 0.74, 96.6% CI 0.60-0.91; p = 0.0020), establishing this regimen as the new standard first-line treatment for PM, particularly in those with non-epithelioid histology. Increased interest in PM genomics has led to development of novel personalized therapeutics, such as those targeting DNA repair and EZH2 pathways, however with variable outcomes in trials. Targeting the membrane glycoprotein mesothelin and arginine deprivation are other important strategies under ongoing investigation. The field of PM is changing and new treatments bring hope to a largely lethal and poor prognostic malignancy. Despite these developments, current challenges include understanding the role of combination and multimodality treatments, drivers of resistance to treatment, and establishing predictive biomarkers to improve patient selection and treatment sequencing.
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Affiliation(s)
- Wanyuan Cui
- Lung Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Sanjay Popat
- Lung Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom; National Heart and Lung Institute, Imperial College London, London, United Kingdom; Thoracic Oncology, Institute of Cancer Research, London, United Kingdom.
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Kiss E, Forika G, Mohacsi R, Nemeth Z, Krenacs T, Dank M. Methyl-Donors Can Induce Apoptosis and Attenuate Both the Akt and the Erk1/2 Mediated Proliferation Pathways in Breast and Lung Cancer Cell Lines. Int J Mol Sci 2021; 22:ijms22073598. [PMID: 33808426 PMCID: PMC8036837 DOI: 10.3390/ijms22073598] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/23/2021] [Accepted: 03/27/2021] [Indexed: 01/04/2023] Open
Abstract
Dietary methyl-donors play important roles in physiological processes catalyzed by B vitamins as coenzymes, and are used for complementary support in oncotherapy. Our hypothesis was that methyl-donors can not only assist in tolerating cancer treatment but may also directly interfere with tumor growth and proliferation. Therefore, we investigated the proposed cancer inhibitory effects of methyl-donors (in a mixture of L-methionine, choline chloride, folic acid, and vitamin B12) on MCF7 and T47D breast cancer as well as A549 and H1650 lung cancer cell lines. Indeed, methyl-donor treatment significantly reduced the proliferation in all cell lines, possibly through the downregulation of MAPK/ERK and AKT signaling. These were accompanied by the upregulation of the pro-apoptotic Bak and Bax, both in MCF7 and H1650 cells, at reduced anti-apoptotic Mcl-1 and Bcl-2 levels in MCF7 and H1650 cells, respectively. The treatment-induced downregulation of p-p53(Thr55) was likely to contribute to protecting the nuclear localization and apoptosis inducing functions of p53. The presented features are known to improve the sensitivity of cancer therapy. Therefore, these data support the hypothesis, i.e., that methyl-donors may promote apoptotic signaling by protecting p53 functions through downregulating both the MAPK/ERK and the AKT pathways both in breast and lung adenocarcinoma cell lines. Our results can emphasize the importance and benefits of the appropriate dietary supports in cancer treatments. However, further studies are required to confirm these effects without any adverse outcome in clinical settings.
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Affiliation(s)
- Eva Kiss
- 1st Department of Internal Medicine and Oncology, Oncology Profile, Semmelweis University, 1085 Budapest, Hungary; (E.K.); (R.M.); (M.D.)
| | - Gertrud Forika
- 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, 1085 Budapest, Hungary; (G.F.); (T.K.)
| | - Reka Mohacsi
- 1st Department of Internal Medicine and Oncology, Oncology Profile, Semmelweis University, 1085 Budapest, Hungary; (E.K.); (R.M.); (M.D.)
| | - Zsuzsanna Nemeth
- 1st Department of Internal Medicine and Oncology, Oncology Profile, Semmelweis University, 1085 Budapest, Hungary; (E.K.); (R.M.); (M.D.)
- Correspondence: ; Tel.: +36-20-670-1025
| | - Tibor Krenacs
- 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, 1085 Budapest, Hungary; (G.F.); (T.K.)
| | - Magdolna Dank
- 1st Department of Internal Medicine and Oncology, Oncology Profile, Semmelweis University, 1085 Budapest, Hungary; (E.K.); (R.M.); (M.D.)
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5
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Warby A, Dhillon HM, Kao S, Vardy JL. A survey of patient and caregiver experience with malignant pleural mesothelioma. Support Care Cancer 2019; 27:4675-4686. [PMID: 30944991 DOI: 10.1007/s00520-019-04760-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 03/19/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Malignant pleural mesothelioma (MPM) is a rare cancer with poor prognosis. As there is little information on the lived experience of MPM, our aim was to document the experience of MPM patients and their caregivers. METHODS Surveys for MPM patients and caregivers were developed from previous interviews with patients, caregivers, and health professionals, about treatments and decision-making. Participants were recruited from two hospitals, government compensation body, and support groups. RESULTS Survey responses were received from 78 MPM patients and 106 caregivers from January to September 2014. PATIENTS 85% male, median age 69 years, median time since diagnosis 15 months. Caregivers: median age 68, 91% female, 90% spouse of MPM patient, 95% bereaved. Most participants felt informed about treatment options but only 69% thought all treatment options were discussed. Chemotherapy was discussed most frequently (92-95%); ~80% had sufficient information for decision-making. Decision regarding chemotherapy was made by patient considering doctor's opinion (24%), doctor and patient equally (18%), and doctor (17%). Participants 'agreed'/'strongly agreed' that they made the right decision about chemotherapy (patients 81%, caregivers 60%), but 5% and 16%, respectively, regretted the decision. Most participants received 'sufficient' support (71%). A quarter reported seeing cancer nurse specialists. Palliative care referral: 31% patients, 85% caregivers. Caregivers would have liked to talk to someone by themselves (41%), more time with doctors (30%), psychological support (29%), and clearer information (31%). Bereaved caregivers requested grief counselling (39%) and post-death consultation with specialists (23-25%). CONCLUSIONS Satisfaction with treatment was high, but participants identified need for improved communication and quality information, discussion about all treatments, end-of-life assistance, and caregiver support after the patient's death.
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Affiliation(s)
- Anne Warby
- Centre for Medical Psychology and Evidence-Based Decision-Making, The University of Sydney, Sydney, NSW, 2006, Australia.,Asbestos Diseases Research Institute, Bernie Banton Centre, Gate 3, Hospital Rd., Concord, NSW, 2139, Australia
| | - Haryana M Dhillon
- Centre for Medical Psychology and Evidence-Based Decision-Making, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Steven Kao
- Asbestos Diseases Research Institute, Bernie Banton Centre, Gate 3, Hospital Rd., Concord, NSW, 2139, Australia.,Chris O'Brien Lifehouse, 119-143 Missenden Rd, Camperdown, NSW, 2050, Australia.,Sydney Medical School, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Janette L Vardy
- Centre for Medical Psychology and Evidence-Based Decision-Making, The University of Sydney, Sydney, NSW, 2006, Australia. .,Asbestos Diseases Research Institute, Bernie Banton Centre, Gate 3, Hospital Rd., Concord, NSW, 2139, Australia. .,Sydney Medical School, The University of Sydney, Sydney, NSW, 2006, Australia. .,Concord Cancer Centre, Concord Repatriation General Hospital, Hospital Rd., Concord, NSW, 2139, Australia.
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6
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Komurcuoglu B, Cirak AK, Kirakli SC, Polat G, Yucel N, Usluer O, Erer O, Balci G, Gayaf M, Guldaval F, Aktogu S, Guclu S, Ozsoz A, Halilcolar H. Prognostic Factors Affecting Survival in Malignant Pleural Mesothelioma: Analysis of 125 Subjects. TUMORI JOURNAL 2018. [DOI: 10.1177/1430.15816] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Berna Komurcuoglu
- Respiratory Medicine Mesothelioma Study Group of Izmir Dr Suat Seren, Respiratory Diseases and Thoracic Surgery Training and Research Hospital, Mavisehir-Izmir, Turkey
| | - A Kadri Cirak
- Respiratory Medicine Mesothelioma Study Group of Izmir Dr Suat Seren, Respiratory Diseases and Thoracic Surgery Training and Research Hospital, Mavisehir-Izmir, Turkey
| | - S Cenk Kirakli
- Respiratory Medicine Mesothelioma Study Group of Izmir Dr Suat Seren, Respiratory Diseases and Thoracic Surgery Training and Research Hospital, Mavisehir-Izmir, Turkey
| | - Gulru Polat
- Respiratory Medicine Mesothelioma Study Group of Izmir Dr Suat Seren, Respiratory Diseases and Thoracic Surgery Training and Research Hospital, Mavisehir-Izmir, Turkey
| | - Nur Yucel
- Pathology Department, and Mesothelioma Study Group of Izmir Dr Suat Seren, Respiratory Diseases and Thoracic Surgery Training and Research Hospital, Mavisehir-Izmir, Turkey
| | - Ozan Usluer
- Thoracic Surgery, Mesothelioma Study Group of Izmir Dr Suat Seren, Respiratory Diseases and Thoracic Surgery Training and Research Hospital, Mavisehir-Izmir, Turkey
| | - Onur Erer
- Respiratory Medicine Mesothelioma Study Group of Izmir Dr Suat Seren, Respiratory Diseases and Thoracic Surgery Training and Research Hospital, Mavisehir-Izmir, Turkey
| | - Gunseli Balci
- Respiratory Medicine Mesothelioma Study Group of Izmir Dr Suat Seren, Respiratory Diseases and Thoracic Surgery Training and Research Hospital, Mavisehir-Izmir, Turkey
| | - Mine Gayaf
- Respiratory Medicine Mesothelioma Study Group of Izmir Dr Suat Seren, Respiratory Diseases and Thoracic Surgery Training and Research Hospital, Mavisehir-Izmir, Turkey
| | - Filiz Guldaval
- Respiratory Medicine Mesothelioma Study Group of Izmir Dr Suat Seren, Respiratory Diseases and Thoracic Surgery Training and Research Hospital, Mavisehir-Izmir, Turkey
| | - Serir Aktogu
- Respiratory Medicine Mesothelioma Study Group of Izmir Dr Suat Seren, Respiratory Diseases and Thoracic Surgery Training and Research Hospital, Mavisehir-Izmir, Turkey
| | - Salih Guclu
- Respiratory Medicine Mesothelioma Study Group of Izmir Dr Suat Seren, Respiratory Diseases and Thoracic Surgery Training and Research Hospital, Mavisehir-Izmir, Turkey
| | - Ayse Ozsoz
- Respiratory Medicine Mesothelioma Study Group of Izmir Dr Suat Seren, Respiratory Diseases and Thoracic Surgery Training and Research Hospital, Mavisehir-Izmir, Turkey
| | - Huseyin Halilcolar
- Respiratory Medicine Mesothelioma Study Group of Izmir Dr Suat Seren, Respiratory Diseases and Thoracic Surgery Training and Research Hospital, Mavisehir-Izmir, Turkey
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Abstract
OBJECTIVE Malignant pleural mesothelioma (MPM) is a deadly disease with varying treatment options. This study retrospectively describes treatment practices at the University of Washington Medical System from 1980 to 2011, and evaluates the impact of trimodality therapy and radiation (photon and neutron) on survival. METHODS A retrospective study was conducted on patients treated for MPM. Univariate and multivariate methods were utilized to evaluate potential factors associated with survival. Treatments received and baseline characteristics were included. Survival analysis of trimodality therapy was performed using a propensity score method to control for baseline characteristics. RESULTS Among 78 eligible patients, the median age at diagnosis was 59 years and the median survival was 13.7 months. On multivariate analysis, the significant predictors of improved survival were age, smoking history, location, and receipt of radiation therapy or chemotherapy. In the 48 patients receiving radiation therapy, the difference in survival between neutron therapy and non-neutron therapy patients was not statistically significant: hazard ratio, 1.20 (95% confidence interval, 0.68-2.13), P=0.52. Patients receiving trimodality therapy were more likely to have early-stage disease (60% vs. 30%) and epithelioid histology (86% vs. 58%). In a propensity score-weighted Cox proportional hazards model, trimodality therapy patients had improved overall survival, hazard ratio 0.45, P=0.004, median 14.6 versus 8.6 months. CONCLUSIONS Trimodality therapy was significantly associated with prolonged survival in patients with MPM, even when adjusting for baseline patient factors. Radiation therapy was associated with improved survival, but the modality of radiation therapy used was not associated with outcome.
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8
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Lau B, Kumar S, Yan T, Burn J, Kennedy C, McLean J, Boyer M, McCaughan B, Kao S. Pathological complete response in malignant pleural mesothelioma patients following induction chemotherapy: Predictive factors and outcomes. Lung Cancer 2017; 111:75-78. [PMID: 28838403 DOI: 10.1016/j.lungcan.2017.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Revised: 03/30/2017] [Accepted: 07/09/2017] [Indexed: 11/26/2022]
Abstract
A small proportion of patients with malignant pleural mesothelioma (MPM) achieve pathological complete response (CR) following treatment with current practice induction chemotherapy. Our analysis of 58 patients with MPM treated with platinum-based chemotherapy showed 4 patients (7%) attained pathological CR at subsequent extrapleural pneumonectomy (EPP). Patient and tumour factors such as age, gender, smoking habit, histological subtype, and clinical stage were not found to be associated with pathological CR. Patients with pathological CR had longer disease-free survival (29.2 vs. 13.8 months; p=0.08) and overall survival (76.4 vs. 23.4 months; p=0.06) but this did not reach statistical significance. Our study suggests that patients who achieve pathological CR after chemotherapy may have improved survival in MPM.
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Affiliation(s)
- Brandon Lau
- Department of Medical Oncology, Chris O'Brien Lifehouse, Sydney, Australia
| | - Sanjeev Kumar
- Department of Medical Oncology, Chris O'Brien Lifehouse, Sydney, Australia; Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Tristan Yan
- Sydney Medical School, The University of Sydney, Sydney, Australia; Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Juliet Burn
- Douglas Hanly Moir Pathology, Sydney, Australia
| | - Catherine Kennedy
- Sydney Medical School, The University of Sydney, Sydney, Australia; Strathfield Private Hospital, Sydney, Australia
| | | | - Michael Boyer
- Department of Medical Oncology, Chris O'Brien Lifehouse, Sydney, Australia; Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Brian McCaughan
- Sydney Medical School, The University of Sydney, Sydney, Australia; Sydney Cardiothoracic Surgeons, Sydney, Australia
| | - Steven Kao
- Department of Medical Oncology, Chris O'Brien Lifehouse, Sydney, Australia; Sydney Medical School, The University of Sydney, Sydney, Australia; Asbestos Diseases Research Institute, Sydney, Australia.
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9
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Szulkin A, Szatmári T, Hjerpe A, Dobra K. Chemosensitivity and resistance testing in malignant effusions with focus on primary malignant mesothelioma and metastatic adenocarcinoma. Pleura Peritoneum 2016; 1:119-133. [PMID: 30911616 DOI: 10.1515/pp-2016-0013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 08/22/2016] [Indexed: 12/24/2022] Open
Abstract
Cell based chemosensitivity and resistance testing is an attractive approach that offers functional measurement of drug response ex vivo with the ultimate goal to guide the choice of chemotherapy for various cancers. Thus, it has a great potential to select patients for the optimal treatment option, thereby offering a tool for personalized cancer therapy. Despite several decades of intensive scientific efforts ex-vivo tests are still not incorporated in the standard of care. Limited access to fresh tumor tissue, unsatisfactory models and single readout as endpoint constitute major hindrance. Thus, establishing and validating clinically useful and reliable model systems still remains a major challenge. Here we present malignant effusions as valuable sources for ex-vivo chemosensitivity and resistance testing. Accumulation of a malignant effusion in the pleura, peritoneum or pericardium is often the first diagnostic material for both primary malignant mesothelioma and a broad spectrum of metastatic adenocarcinoma originating from lung-, breast-, ovary- and gastro-intestinal organs as well as lymphoma. In contrast to biopsies, in these effusions malignant cells are easily accessible and often abundant. Effusion derived cells can occur dissociated or forming three-dimensional papillary structures that authentically recapitulate the biology of the corresponding tumor tissue and offer models for ex vivo testing. In addition, effusions have the advantage of being available prior to or concurrent with the pathological review, thus constituting an excellent source of viable cells for simultaneous molecular profiling, biomarker analysis and for establishing primary cells for studying tumor biology and resistance mechanisms. For a reliable test, however, a careful validation is needed, taking into account the inherited heterogeneity of malignant tumors, but also the complex interplay between malignant and benign cells, which are always present in this setting.
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Affiliation(s)
- Adam Szulkin
- Division of Pathology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Tünde Szatmári
- Division of Pathology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anders Hjerpe
- Division of Pathology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Katalin Dobra
- Division of Pathology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
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10
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Buikhuisen WA, Hiddinga BI, Baas P, van Meerbeeck JP. Second line therapy in malignant pleural mesothelioma: A systematic review. Lung Cancer 2015; 89:223-31. [DOI: 10.1016/j.lungcan.2015.06.018] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 06/21/2015] [Indexed: 12/28/2022]
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11
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Szulkin A, Otvös R, Hillerdal CO, Celep A, Yousef-Fadhel E, Skribek H, Hjerpe A, Székely L, Dobra K. Characterization and drug sensitivity profiling of primary malignant mesothelioma cells from pleural effusions. BMC Cancer 2014; 14:709. [PMID: 25253633 PMCID: PMC4190467 DOI: 10.1186/1471-2407-14-709] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 08/27/2014] [Indexed: 12/15/2022] Open
Abstract
Background Patients with malignant mesothelioma have a poor prognosis and only 40% respond to first line treatment; a combination of pemetrexed and cisplatin or carboplatin. We used primary malignant mesothelioma cells and an ex vivo chemosensitivity assay with future purpose to predict best choice of treatment. The clinical outcome of these patients might be predicted by measuring drug sensitivity. Methods Pleural effusions containing primary malignant mesothelioma cells were received from the diagnostic routine. We characterized and tested the chemosensitivity of 18 malignant samples and four benign samples from 16 different patients with pleural effusions. Cells were seeded in a 384-well plate for a robotized ex vivo testing of drug sensitivity to 32 different drugs. The primary cells were further characterized by immunocytochemistry to evaluate the proportion of malignant cells and to study the RRM1 and ERCC1 reactivity, two proteins associated with drug resistance. Results We observed great individual variability in the drug sensitivity. Primary cell isolates were affected by between one and ten drugs, and resistant to the remaining tested drugs. Actinomycin D and daunorubicin were the two drugs effective in most cases. Adjusting efficiency of individual drugs for varying proportion of tumor cells and to the average effect on benign cells correlated with effect of pemetrexed, cisplatin and survival time. General drug sensitivity, proportion of malignant cells and reactivity to RRM1 correlated to each other and to survival time of the patients. Conclusions The proportion of malignant cells and RRM1 reactivity in the pleural effusions correlate to drug sensitivity and survival time. The variability in response to the commonly used chemotherapies emphasizes the need for tests that indicate best individual choice of cytotoxic drugs. The efficiency of the obtained results should preferably be corrected for admixture of benign cells and effects of given drugs on benign cells. Electronic supplementary material The online version of this article (doi:10.1186/1471-2407-14-709) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Katalin Dobra
- Karolinska Institutet, Department of Laboratory Medicine, Division of Pathology, Karolinska University Hospital F-46, SE-141 86 Stockholm, Sweden.
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12
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Ai J, Stevenson JP. Current issues in malignant pleural mesothelioma evaluation and management. Oncologist 2014; 19:975-84. [PMID: 25061089 PMCID: PMC4153452 DOI: 10.1634/theoncologist.2014-0122] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Accepted: 06/11/2014] [Indexed: 01/09/2023] Open
Abstract
Malignant pleural mesothelioma (MPM) is an uncommon disease most often associated with occupational asbestos exposure and is steadily increasing in worldwide incidence. Patients typically present at an older age, with advanced clinical stage and other medical comorbidities, making management quite challenging. Despite great efforts, the prognosis of MPM remains poor, especially at progression after initial treatment. Macroscopic complete resection of MPM can be achieved through extrapleural pneumonectomy (EPP) or extended (ie, radical) pleurectomy (e-P/D) in selected patients and can result in prolonged survival when incorporated into a multimodality approach. Given the morbidity associated with surgical resection of MPM, optimizing identification of appropriate patients is essential. Unfortunately, most patients are not candidates for EPP or e-P/D due to advanced stage, age, and/or medical comorbidity. Pemetrexed and platinum combination chemotherapy has become the cornerstone of therapy for patients with unresectable disease because the combination is associated with improved survival and quality of life in treated patients. However, MPM eventually becomes resistant to initial therapy, and benefit to further lines of therapy has not been substantiated in randomized clinical trials. Translational research has provided exciting insights into tumorigenesis, biomarkers, and immune response in MPM, leading to the development of multiple novel therapeutic agents that are currently in clinical trials. These advances hold the promise of a new era in the treatment of MPM and suggest that this disease will not be left behind in the war on cancer.
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Affiliation(s)
- Jing Ai
- Cleveland Clinic Foundation, Taussig Cancer Institute, Cleveland, Ohio, USA
| | - James P Stevenson
- Cleveland Clinic Foundation, Taussig Cancer Institute, Cleveland, Ohio, USA
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13
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Szulkin A, Nilsonne G, Mundt F, Wasik AM, Souri P, Hjerpe A, Dobra K. Variation in drug sensitivity of malignant mesothelioma cell lines with substantial effects of selenite and bortezomib, highlights need for individualized therapy. PLoS One 2013; 8:e65903. [PMID: 23840376 PMCID: PMC3688685 DOI: 10.1371/journal.pone.0065903] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 04/29/2013] [Indexed: 12/20/2022] Open
Abstract
Background Malignant mesothelioma cells have an epithelioid or sarcomatoid morphology, both of which may be present in the same tumor. The sarcomatoid phenotype is associated with worse prognosis and heterogeneity of mesothelioma cells may contribute to therapy resistance, which is often seen in mesothelioma. This study aimed to investigate differences in sensitivity between mesothelioma cell lines to anti-cancer drugs. We studied two novel drugs, selenite and bortezomib and compared their effect to four conventional drugs. We also investigated the immunoreactivity of potential predictive markers for drug sensitivity; Pgp, MRP-1, ERCC1, RRM1, TS, xCT and proteasome 20S subunit. Materials and methods We treated six mesothelioma cell lines with selenite, bortezomib, carboplatin, pemetrexed, doxorubicin or gemcitabine as single agents and in combinations. Viability was measured after 24 and 48 hours. Immunocytochemistry was used to detect predictive markers. Results As a single agent, selenite was effective on four out of six cell lines, and in combination with bortezomib yielded the greatest response in the studied mesothelioma cell lines. Cells with an epithelioid phenotype were generally more sensitive to the different drugs than the sarcomatoid cells. Extensive S-phase arrest was seen in pemetrexed-sensitive cell lines. MRP-1 predicted sensitivity of cell lines to treatment with carboplatin and xCT predicted pemetrexed effect. Conclusions The observed heterogeneity in sensitivity of mesothelioma cell lines with different morphology highlights the need for more individualized therapy, requiring development of methods to predict drug sensitivity of individual tumors. Selenite and bortezomib showed a superior effect compared to conventional drugs, motivating clinical testing of these agents as future treatment regime components for patients with malignant mesothelioma.
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Affiliation(s)
- Adam Szulkin
- Karolinska Institutet, Department of Laboratory Medicine, Division of Pathology, Stockholm, Sweden
- * E-mail:
| | - Gustav Nilsonne
- Karolinska Institutet, Department of Laboratory Medicine, Division of Pathology, Stockholm, Sweden
- Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden
- Stockholm University, Stress Research Institute, Stockholm, Sweden
| | - Filip Mundt
- Karolinska Institutet, Department of Laboratory Medicine, Division of Pathology, Stockholm, Sweden
| | - Agata M. Wasik
- Karolinska Institutet, Department of Laboratory Medicine, Division of Pathology, Stockholm, Sweden
| | - Pega Souri
- Karolinska Institutet, Department of Laboratory Medicine, Division of Pathology, Stockholm, Sweden
| | - Anders Hjerpe
- Karolinska Institutet, Department of Laboratory Medicine, Division of Pathology, Stockholm, Sweden
| | - Katalin Dobra
- Karolinska Institutet, Department of Laboratory Medicine, Division of Pathology, Stockholm, Sweden
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14
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Volta V, Ranzato E, Martinotti S, Gallo S, Russo MV, Mutti L, Biffo S, Burlando B. Preclinical demonstration of synergistic Active Nutrients/Drug (AND) combination as a potential treatment for malignant pleural mesothelioma. PLoS One 2013; 8:e58051. [PMID: 23526965 PMCID: PMC3590277 DOI: 10.1371/journal.pone.0058051] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 01/30/2013] [Indexed: 11/19/2022] Open
Abstract
Malignant pleural mesothelioma (MPM) is a poor prognosis disease lacking adequate therapy. We have previously shown that ascorbic acid administration is toxic to MPM cells. Here we evaluated a new combined therapy consisting of ascorbate/epigallocatechin-3-gallate/gemcitabine mixture (called AND, for Active Nutrients/Drug). In vitro effects of AND therapy on various MPM cell lines revealed a synergistic cytotoxic mechanism. In vivo experiments on a xenograft mouse model for MPM, obtained by REN cells injection in immunocompromised mice, showed that AND strongly reduced the size of primary tumor as well as the number and size of metastases, and prevented abdominal hemorrhage. Kaplan Meier curves and the log-rank test indicated a marked increase in the survival of AND-treated animals. Histochemical analysis of dissected tumors showed that AND induced a shift from cell proliferation to apoptosis in cancer cells. Lysates of tumors from AND-treated mice, analyzed with an antibody array, revealed decreased TIMP-1 and -2 expressions and no effects on angiogenesis regulating factors. Multiplex analysis for signaling protein phosphorylation exhibited inactivation of cell proliferation pathways. The complex of data showed that the AND treatment is synergistic in vitro on MPM cells, and blocks in vivo tumor progression and metastasization in REN-based xenografts. Hence, the AND combination is proposed as a new treatment for MPM.
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Affiliation(s)
- Viviana Volta
- Molecular Histology and Cell Growth Laboratory, San Raffaele Science Institute, Milano, Italy
| | - Elia Ranzato
- Dipartimento di Scienze e Innovazione Tecnologica, University of Piemonte Orientale, Alessandria, Italy
| | - Simona Martinotti
- Dipartimento di Scienze e Innovazione Tecnologica, University of Piemonte Orientale, Alessandria, Italy
| | - Simone Gallo
- Molecular Histology and Cell Growth Laboratory, San Raffaele Science Institute, Milano, Italy
| | - Maria Veronica Russo
- Molecular Histology and Cell Growth Laboratory, San Raffaele Science Institute, Milano, Italy
| | - Luciano Mutti
- Department of General Medicine, Vercelli National Health Trust, Vercelli, Italy
| | - Stefano Biffo
- Molecular Histology and Cell Growth Laboratory, San Raffaele Science Institute, Milano, Italy
- Dipartimento di Scienze e Innovazione Tecnologica, University of Piemonte Orientale, Alessandria, Italy
| | - Bruno Burlando
- Dipartimento di Scienze e Innovazione Tecnologica, University of Piemonte Orientale, Alessandria, Italy
- * E-mail:
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Santarelli L, Strafella E, Staffolani S, Amati M, Emanuelli M, Sartini D, Pozzi V, Carbonari D, Bracci M, Pignotti E, Mazzanti P, Sabbatini A, Ranaldi R, Gasparini S, Neuzil J, Tomasetti M. Association of MiR-126 with soluble mesothelin-related peptides, a marker for malignant mesothelioma. PLoS One 2011; 6:e18232. [PMID: 21483773 PMCID: PMC3069972 DOI: 10.1371/journal.pone.0018232] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Accepted: 02/23/2011] [Indexed: 12/31/2022] Open
Abstract
Background Improved detection methods for diagnosis of malignant pleural mesothelioma
(MPM) are essential for early and reliable detection as well as treatment.
Since recent data point to abnormal levels of microRNAs (miRNAs) in tumors,
we hypothesized that a profile of deregulated miRNAs may be a marker of MPM
and that the levels of specific miRNAs may be used for monitoring its
progress. Methods and Results miRNAs isolated from fresh-frozen biopsies of MPM patients were tested for
the expression of 88 types of miRNA involved in cancerogenesis. Most of the
tested miRNAs were downregulated in the malignant tissues compared with the
normal tissues. Of eight significantly downregulated, three miRNAs were
assayed in cancerous tissue and adjacent non-cancerous tissue sample pairs
collected from 27 formalin-fixed, paraffin-embedded MPM tissues by
quantitative RT-PCR. Among the miRNAs tested, only miR-126 significantly
remained downregulated in the malignant tissues. Furthermore, the
performance of the selected miR-126 as biomarker was evaluated in serum
samples of asbestos-exposed subjects and MPM patients and compared with
controls. MiR-126 was not affected by asbestos exposure, whereas it was
found strongly associated with VEGF serum levels. Levels of miR-126 in
serum, and its levels in patients' serum in association with a specific
marker of MPM, SMRPs, correlate with subjects at high risk to develop
MPM. Conclusions and Significance We propose miR-126, in association with SMRPs, as a marker for early
detection of MPM. The identification of tumor biomarkers used alone or, in
particular, in combination could greatly facilitate the surveillance
procedure for cohorts of subjects exposed to asbestos.
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Affiliation(s)
- Lory Santarelli
- Department of Molecular Pathology and Innovative Therapies, Polytechnic
University of Marche, Ancona, Italy
| | - Elisabetta Strafella
- Department of Molecular Pathology and Innovative Therapies, Polytechnic
University of Marche, Ancona, Italy
| | - Sara Staffolani
- Department of Molecular Pathology and Innovative Therapies, Polytechnic
University of Marche, Ancona, Italy
| | - Monica Amati
- Department of Molecular Pathology and Innovative Therapies, Polytechnic
University of Marche, Ancona, Italy
| | - Monica Emanuelli
- Department of Biochemistry, Biology and Genetics, Polytechnic University
of Marche, Ancona, Italy
| | - Davide Sartini
- Department of Biochemistry, Biology and Genetics, Polytechnic University
of Marche, Ancona, Italy
| | - Valentina Pozzi
- Department of Biochemistry, Biology and Genetics, Polytechnic University
of Marche, Ancona, Italy
| | - Damiano Carbonari
- Department of Molecular Pathology and Innovative Therapies, Polytechnic
University of Marche, Ancona, Italy
| | - Massimo Bracci
- Department of Molecular Pathology and Innovative Therapies, Polytechnic
University of Marche, Ancona, Italy
| | - Elettra Pignotti
- Department of Statistic Science, University of Bologna, Bologna,
Italy
| | - Paola Mazzanti
- Department of Medical Oncology, Hospital University of Ancona, Ancona,
Italy
| | | | - Renzo Ranaldi
- Pathological Anatomy Unit, Hospital University of Ancona, Ancona,
Italy
| | | | - Jiri Neuzil
- Apoptosis Research Group, School of Medical Science and Griffith Health
Institute, Griffith University, Southport, Queensland, Australia
- Molecular Therapy Group, Institute of Biotechnology, Academy of Sciences
of the Czech Republic, Prague, Czech Republic
| | - Marco Tomasetti
- Department of Molecular Pathology and Innovative Therapies, Polytechnic
University of Marche, Ancona, Italy
- * E-mail:
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16
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Expert opinions of the first italian consensus conference on the management of malignant pleural mesothelioma. Am J Clin Oncol 2011; 34:99-109. [PMID: 20414089 DOI: 10.1097/coc.0b013e3181d31f02] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Malignant pleural mesothelioma (MPM) is a very important public health issue. A large amount of data indicates a relationship between mesothelioma and asbestos exposure. The incidence has both considerably and constantly increased over the past 2 decades in the industrialized countries and is expected to peak in 2010-2020. In Italy, a standardized-rate incidence in 2002 among men was 2.98 per 100,000 and 0.98 per 100,000 among women, with wide differences from one region to another. Stage diagnosis and definition may be difficult. Management of patients with MPM remains complex, so an optimal treatment strategy has not yet been clearly defined. The First Italian Consensus Conference on Malignant Pleural Mesothelioma was held Bologna (Italy) in May 20, 2008. The Consensus Conference was given the patronage of the Italian scientific societies AIOM, AIRO, AIPO, SIC, SICO, SICT, SIAPEC-IAP, AIOT, GOAM, and GIME. This Consensus did not answer all of the unresolved questions in MPM management, but the Expert Opinions have nonetheless provided recommendations, presented in this report, on MPM management for clinicians and patients.
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Mujoomdar AA, Tilleman TR, Richards WG, Bueno R, Sugarbaker DJ. Prevalence of in vitro chemotherapeutic drug resistance in primary malignant pleural mesothelioma: result in a cohort of 203 resection specimens. J Thorac Cardiovasc Surg 2010; 140:352-5. [PMID: 20653100 DOI: 10.1016/j.jtcvs.2009.11.072] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Optimizing the multimodality treatment of malignant pleural mesothelioma depends on many factors including an adequate chemotherapeutic response. Currently, chemotherapy regimens for patients with mesothelioma are empirically selected. In vitro chemotherapy resistance in human mesothelioma has not been reported. Our goal was to determine the prevalence of drug resistance in a large sample of malignant pleural mesothelioma using a commercially available assay. METHODS Tumors specimens (n = 203) were cultured for analysis of chemoresistance using the extreme drug resistance assay. Evaluable results were obtained in 168 (168/203 = 83%) specimens. Each specimen was tested with 3 drugs: cisplatin, gemcitabine, and vinorelbine. Drug resistance was characterized as low, intermediate, or extreme. Median age was 64 years (30-85 years). Forty-four (26%) patients received neoadjuvant chemotherapy before sampling and testing. The distribution of histopathologic cell types was epithelial (103; 61%), mixed (57; 34%), and sarcomatoid (8; 5%). RESULTS A significant proportion of tumors had extreme/intermediate drug resistance to cisplatin (27%), gemcitabine (31%), or vinorelbine (59%). Nineteen tumors (11%) had extreme/intermediate resistance to all 3 drugs. Resistance (extreme/intermediate) to cisplatin was more prevalent in epithelial tumors than in nonepithelial (33% vs 18%; P = .0394). No significant differences in chemoresistance were found in tumors of patients who had received neoadjuvant chemotherapy compared with those who had not. CONCLUSIONS The feasibility of performing off-site in vitro drug resistance assays on resected malignant mesothelioma specimens is reported. A significant proportion of mesothelioma tumors exhibited extreme/intermediate resistance to cisplatin, gemcitabine, or vinorelbine.
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Affiliation(s)
- Aneil A Mujoomdar
- Division of Thoracic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA
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COX-2 specific inhibitors enhance the cytotoxic effects of pemetrexed in mesothelioma cell lines. Lung Cancer 2010; 67:160-5. [DOI: 10.1016/j.lungcan.2009.04.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2009] [Revised: 04/07/2009] [Accepted: 04/17/2009] [Indexed: 01/29/2023]
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Tilleman TR, Richards WG, Zellos L, Johnson BE, Jaklitsch MT, Mueller J, Yeap BY, Mujoomdar AA, Ducko CT, Bueno R, Sugarbaker DJ. Extrapleural pneumonectomy followed by intracavitary intraoperative hyperthermic cisplatin with pharmacologic cytoprotection for treatment of malignant pleural mesothelioma: a phase II prospective study. J Thorac Cardiovasc Surg 2009; 138:405-11. [PMID: 19619785 DOI: 10.1016/j.jtcvs.2009.02.046] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2008] [Revised: 01/09/2009] [Accepted: 02/23/2009] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We sought to prospectively determine the feasibility and safety of hyperthermic intraoperative intracavitary cisplatin perfusion immediately after extrapleural pneumonectomy in the treatment of malignant pleural mesothelioma. METHODS Patients with malignant pleural mesothelioma who were surgical candidates underwent extrapleural pneumonectomy followed by hyperthermic intraoperative intracavitary cisplatin perfusion, consisting of a 1-hour lavage of the chest and abdomen with cisplatin (42 degrees C) at 225 mg/m(2). Pharmacologic cytoprotection consisted of intravenous sodium thiosulfate with or without amifostine. Morbidity and mortality were recorded prospectively. RESULTS Ninety-six (79%) of 121 enrolled patients underwent extrapleural pneumonectomy, of whom 92 (76%) received hyperthermic intraoperative intracavitary cisplatin perfusion after extrapleural pneumonectomy. Fifty-three (58%) patients had epithelial tumors, and 39 (42%) had nonepithelial histology. Hospital mortality was 4.3%. Morbidity (grade 3 or 4, 49%) included atrial fibrillation in 22 (23.9%) patients, venous thrombosis in 12 (13%) patients, and laryngeal nerve dysfunction in 10 (11%) patients. Nine patients had renal toxicity, which was attributable to cisplatin in 8 of them. Among the 27 patients who also received amifostine (910 mg/m(2)), 1 patient had grade 3 renal toxicity attributable to cisplatin. Recurrence of malignant pleural mesothelioma was documented in 47 (51%) patients, with ipsilateral recurrence in 17.4% of patients. The median survival of the 121 enrolled patients was 12.8 months. CONCLUSIONS Hyperthermic intraoperative intracavitary cisplatin perfusion following extrapleural pneumonectomy can be performed with acceptable morbidity and mortality. The use of amifostine in addition to sodium thiosulfate might reduce cisplatin-associated renal toxicity. Hyperthermic intraoperative intracavitary cisplatin perfusion following extrapleural pneumonectomy might enhance local control in the chest.
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Affiliation(s)
- Tamara R Tilleman
- Department of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA
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Tsao AS, Wistuba I, Roth JA, Kindler HL. Malignant pleural mesothelioma. J Clin Oncol 2009; 27:2081-90. [PMID: 19255316 PMCID: PMC4881753 DOI: 10.1200/jco.2008.19.8523] [Citation(s) in RCA: 237] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2008] [Accepted: 12/10/2008] [Indexed: 02/03/2023] Open
Abstract
Malignant pleural mesothelioma (MPM) is a deadly disease that occurs in 2,000 to 3,000 people each year in the United States. Although MPM is an extremely difficult disease to treat, with the median overall survival ranging between 9 and 17 months regardless of stage, there has been significant progress over the last few years that has reshaped the clinical landscape. This article will provide a comprehensive discussion of the latest developments in the treatment of MPM. We will provide an update of the major clinical trials that impact mesothelioma treatment in the resectable and unresectable settings, discuss the impact of novel therapeutics, and provide perspective on where the clinical research in mesothelioma is moving. In addition, there are controversial issues, such as the role of extrapleural pneumonectomy, adjuvant radiotherapy, and use of intensity-modulated radiotherapy versus hemithoracic therapy that will also be addressed in this manuscript.
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Affiliation(s)
- Anne S Tsao
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Unit 432, Houston, TX 77030, USA.
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21
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Bertino P, Carbone M, Pass H. Chemotherapy of malignant pleural mesothelioma. Expert Opin Pharmacother 2008; 10:99-107. [DOI: 10.1517/14656560802631285] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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22
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Single-agent pemetrexed for chemonaïve and pretreated patients with malignant pleural mesothelioma: results of an International Expanded Access Program. J Thorac Oncol 2008; 3:764-71. [PMID: 18594323 DOI: 10.1097/jto.0b013e31817c73ec] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Pemetrexed has established efficacy, and is the backbone for chemotherapy in patients with malignant pleural mesothelioma (MPM). An International Expanded Access Program provided >3000 mesothelioma patients with access to single-agent pemetrexed or pemetrexed plus platinum analogs (cisplatin or carboplatin) in 13 countries. In this article, we report the safety and efficacy data of MPM patients who were treated with single-agent pemetrexed (n = 812). METHODS Patients with histologically confirmed MPM, not amenable to curative surgery, received pemetrexed (500 mg/m) once (day 1) every 21 days with standard premedication and vitamin supplementation. Investigator-determined response and survival data were recorded at the end of study participation. Myelosuppression data were also collected. RESULTS All 812 MPM patients (319 chemonaïve; 493 pretreated) received single-agent pemetrexed (>or=1 dose) and were evaluated for safety. A total of 643 patients (247 chemonaïve, 396 pretreated) were evaluated for efficacy. Of the chemonaïve patients evaluated for efficacy (n = 247), the overall response rate was 10.5%, median time to progressive disease (TTPD) was 6.0 months, and median survival was 14.1 month. Of the pretreated patients evaluated for efficacy (n = 396), the overall response rate was 12.1%, median TTPD was 4.9 months, and the median survival was not estimable due to high censoring. Common terminology criteria grade 3/4 hematologic toxicity was mild in both groups, with neutropenia (<18%) as the main toxicity. CONCLUSIONS In the present expanded access program, single-agent pemetrexed demonstrated promising activity in MPM in both chemonaïve and pretreated patients, with TTPD of 6.0 and 4.9 months, respectively, 1-year survival >or=54.7%, and mild hematologic toxicity.
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Muers MF, Stephens RJ, Fisher P, Darlison L, Higgs CMB, Lowry E, Nicholson AG, O'Brien M, Peake M, Rudd R, Snee M, Steele J, Girling DJ, Nankivell M, Pugh C, Parmar MKB. Active symptom control with or without chemotherapy in the treatment of patients with malignant pleural mesothelioma (MS01): a multicentre randomised trial. Lancet 2008; 371:1685-94. [PMID: 18486741 PMCID: PMC2431123 DOI: 10.1016/s0140-6736(08)60727-8] [Citation(s) in RCA: 148] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Malignant pleural mesothelioma is almost always fatal, and few treatment options are available. Although active symptom control (ASC) has been recommended for the management of this disease, no consensus exists for the role of chemotherapy. We investigated whether the addition of chemotherapy to ASC improved survival and quality of life. METHODS 409 patients with malignant pleural mesothelioma, from 76 centres in the UK and two in Australia, were randomly assigned to ASC alone (treatment could include steroids, analgesic drugs, bronchodilators, palliative radiotherapy [n=136]); to ASC plus MVP (four cycles of mitomycin 6 mg/m2, vinblastine 6 mg/m2, and cisplatin 50 mg/m2 every 3 weeks [n=137]); or to ASC plus vinorelbine (one injection of vinorelbine 30 mg/m2 every week for 12 weeks [n=136]). Randomisation was done by minimisation, with stratification for WHO performance status, histology, and centre. Follow-up was every 3 weeks to 21 weeks after randomisation, and every 8 weeks thereafter. Because of slow accrual, the two chemotherapy groups were combined and compared with ASC alone for the primary outcome of overall survival. Analysis was by intention to treat. This study is registered, number ISRCTN54469112. FINDINGS At the time of analysis, 393 (96%) patients had died (ASC 132 [97%], ASC plus MVP 132 [96%], ASC plus vinorelbine 129 [95%]). Compared with ASC alone, we noted a small, non-significant survival benefit for ASC plus chemotherapy (hazard ratio [HR] 0.89 [95% CI 0.72-1.10]; p=0.29). Median survival was 7.6 months in the ASC alone group and 8.5 months in the ASC plus chemotherapy group. Exploratory analyses suggested a survival advantage for ASC plus vinorelbine compared with ASC alone (HR 0.80 [0.63-1.02]; p=0.08), with a median survival of 9.5 months. There was no evidence of a survival benefit with ASC plus MVP (HR 0.99 [0.78-1.27]; p=0.95). We observed no between-group differences in four predefined quality-of-life subscales (physical functioning, pain, dyspnoea, and global health status) at any of the assessments in the first 6 months. INTERPRETATION The addition of chemotherapy to ASC offers no significant benefits in terms of overall survival or quality of life. However, exploratory analyses suggested that vinorelbine merits further investigation.
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Affiliation(s)
| | - Richard J Stephens
- MRC Clinical Trials Unit, London, UK
- Correspondence to: Richard Stephens, MRC Clinical Trials Unit, 222 Euston Road, London NW1 2DA, UK
| | | | - Liz Darlison
- University Hospitals of Leicester, Leicester, UK
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Jänne PA, Simon GR, Langer CJ, Taub RN, Dowlati A, Fidias P, Monberg M, Obasaju C, Kindler H. Phase II trial of pemetrexed and gemcitabine in chemotherapy-naive malignant pleural mesothelioma. J Clin Oncol 2008; 26:1465-71. [PMID: 18349397 DOI: 10.1200/jco.2007.14.7611] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Pemetrexed and gemcitabine have single-agent activity in malignant pleural mesothelioma (MPM). The combination of pemetrexed/gemcitabine has not previously been studied in MPM to our knowledge. PATIENTS AND METHODS Patients with histologic or cytologic diagnosis of MPM were included. Cohort 1 received gemcitabine 1,250 mg/m(2) on days 1 and 8, with pemetrexed 500 mg/m(2) on day 8, and cohort 2 received gemcitabine 1,250 mg/m(2) on days 1 and 8, with pemetrexed 500 mg/m(2) on day 1. Cycles were repeated every 21 days; all patients were supplemented with folic acid and vitamin B(12) and received dexamethasone. RESULTS One hundred eight patients (cohort 1, n = 56; cohort 2, n = 52) with pleural mesothelioma were enrolled. Among assessable patients, response rate was 26.0% in cohort 1 and 17.1% in cohort 2. Median time to disease progression was 4.34 months for cohort 1 and 7.43 months for cohort 2. Median survival was 8.08 months for cohort 1 (1-year survival = 31.14%) and 10.12 months for cohort 2 (1-year survival = 45.80%). In cohorts 1 and 2, incidence of grade 4 neutropenia was 25.0% and 29.4%, grade 4 thrombocytopenia was 14.3% and 3.9%, grade 3 or 4 anemia was 5.4% and 5.9%, and grade 3 or 4 fatigue was 23.2% and 15.7%, respectively. CONCLUSION The combination of pemetrexed and gemcitabine resulted in moderate clinical activity in MPM. However, the median survival times are similar to those with single-agent pemetrexed and inferior to outcomes observed with cisplatin in combination with an antifolate.
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Affiliation(s)
- Pasi A Jänne
- Dana Farber Cancer Institute, Lowe Center for Thoracic Oncology, 44 Binney St, Dana D820A, Boston, MA 02115, USA.
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Local recurrence of tumor at sites of intervention in malignant pleural mesothelioma. Lung Cancer 2008; 61:255-61. [PMID: 18304688 DOI: 10.1016/j.lungcan.2007.12.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2007] [Revised: 10/28/2007] [Accepted: 12/24/2007] [Indexed: 11/30/2022]
Abstract
In malignant pleural mesothelioma (MPM) patients, local dissemination (LD) of the tumor is frequently observed at the sites of intervention where diagnosis/treatment are performed. We evaluate the factors affecting LD frequency and discuss the use of PR in MPM patients. Histopathologically diagnosed 212 MPM patients who had not received PR were evaluated in terms of development of LD. Of the 212 patients, 29 received supportive therapy, 157 received chemotherapy and 26 received multi-modal therapy. The LD frequency was 13.2% for all patients. The median survival rate was 9 or 10 months in patients with or without LD, respectively. A higher LD frequency was observed in patients receiving thoracotomy. The LD appearance time in supportive care is short. The LD frequency in patients treated with chemotherapy that revealed progressive disease was higher than the patients who revealed stable disease or objective response. LD developed in 2 months in patients with sarcomatous and mixed cell type, and the survival rate was low. LD was not associated with the stage of the disease. The most suitable candidate groups for PR are patients receiving supportive therapy, thoracotomy without multi-modal therapy or patients with sarcomatous and mixed cell type tumors.
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