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Hasegawa S, Shintani Y, Takuwa T, Aoe K, Kato K, Fujimoto N, Hida Y, Morise M, Moriya Y, Morohoshi T, Suzuki H, Chida M, Endo S, Kadokura M, Okumura M, Hattori S, Date H, Yoshino I. Nationwide prospective registry database of patients with newly diagnosed untreated pleural mesothelioma in Japan. Cancer Sci 2024; 115:507-528. [PMID: 38047872 PMCID: PMC10859622 DOI: 10.1111/cas.16021] [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: 08/30/2023] [Revised: 10/12/2023] [Accepted: 10/24/2023] [Indexed: 12/05/2023] Open
Abstract
Due to the scarcity of large-sized prospective databases, the Japanese Joint Committee for Lung Cancer Registry conducted a nationwide prospective registry for newly diagnosed and untreated pleural mesothelioma. All new cases diagnosed pathologically as any subtype of pleural mesothelioma in Japan during the period between April 1, 2017, to March 31, 2019, were included before treatment. Data on survival were collected in April 2021. The eligible 346 patients (285 men [82.3%]; 61 women [17.7%]; median age, 71.0 years [range, 44-88]) were included for analysis. Among these patients, 138 (39.9%) underwent surgery, 164 (47.4%) underwent non-surgical therapy, and the remaining 44 (12.7%) underwent best supportive care. The median overall survival for all 346 patients was 19.0 months. Survival rates at 1, 2, and 3 years for all patients were, 62.8%, 42.3%, and 26.5%, respectively. Median overall survival was significantly different among patients undergoing surgery, non-surgical treatment, and best supportive care (32.2 months vs. 14.0 months vs. 3.8 months, p < 0.001). The median overall survival of patients undergoing pleurectomy/decortication and extrapleural pneumonectomy was 41.8 months and 25.0 months, respectively. Macroscopic complete resection resulted in longer overall survival than R2 resection and partial pleurectomy/exploratory thoracotomy (41.8 months vs. 32.2 months vs. 16.8 months, p < 0.001). Tumor shape, maximum tumor thickness, and sum of three level thickness were significant prognostic factors. The data in the prospective database would serve as a valuable reference for clinical practice and further studies for pleural mesothelioma.
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Affiliation(s)
- Seiki Hasegawa
- Department of Thoracic SurgeryHyogo Medical UniversityHyogoJapan
| | - Yasushi Shintani
- Department of General Thoracic SurgeryOsaka University Graduate School of MedicineOsakaJapan
| | - Teruhisa Takuwa
- Department of Thoracic SurgeryHyogo Medical UniversityHyogoJapan
| | - Keisuke Aoe
- Department of Medical OncologyNational Hospital Organization Yamaguchi‐Ube Medical CenterYamaguchiJapan
| | - Katsuya Kato
- Department of Diagnostic Radiology 2Kawasaki Medical SchoolOkayamaJapan
| | | | - Yasuhiro Hida
- Department of Cardiovascular and Thoracic SurgeryHokkaido University Graduate School of MedicineHokkaidoJapan
| | - Masahiro Morise
- Department of Respiratory MedicineNagoya University Graduate School of MedicineAichiJapan
| | - Yasumitsu Moriya
- Division of General Thoracic SurgeryChiba Rosai HospitalChibaJapan
| | - Takao Morohoshi
- Division of General Thoracic SurgeryYokosuka‐Kyosai HospitalKanagawaJapan
| | - Hidemi Suzuki
- Department of General Thoracic SurgeryChiba University Graduate School of MedicineChibaJapan
| | - Masayuki Chida
- Department of General Thoracic SurgeryDokkyo Medical UniversityTochigiJapan
| | - Shunsuke Endo
- Department of Thoracic SurgeryJichi Medical UniversityShimotsukeJapan
| | - Mitsutaka Kadokura
- Division of Chest Surgery, Department of SurgeryShowa University School of MedicineTokyoJapan
| | - Meinoshin Okumura
- Department of General Thoracic SurgeryOsaka University Graduate School of MedicineOsakaJapan
| | - Satoshi Hattori
- Department of Biomedical StatisticsOsaka University Graduate School of MedicineOsakaJapan
| | - Hiroshi Date
- Department of Thoracic SurgeryKyoto University HospitalKyotoJapan
| | - Ichiro Yoshino
- Department of General Thoracic SurgeryChiba University Graduate School of MedicineChibaJapan
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Congedo MT, West EC, Evangelista J, Mattingly AA, Calabrese G, Sassorossi C, Nocera A, Chiappetta M, Flamini S, Abenavoli L, Margaritora S, Boccuto L, Lococo F. The genetic susceptibility in the development of malignant pleural mesothelioma: somatic and germline variants, clinicopathological features and implication in practical medical/surgical care: a narrative review. J Thorac Dis 2024; 16:671-687. [PMID: 38410609 PMCID: PMC10894363 DOI: 10.21037/jtd-23-611] [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: 04/11/2023] [Accepted: 08/18/2023] [Indexed: 02/28/2024]
Abstract
Background and Objective Malignant pleural mesothelioma (MPM) is a very aggressive primary tumor of the pleura whose main risk factor is exposure to asbestos. However, only a minority of exposed people develops MPM and the incidence of MPM cases without an apparent association with asbestos exposure has been increasing in recent years, suggesting that genetic predisposing factors may play a crucial role. In addition, several studies reported familial cases of MPM, suggesting that heredity may be an important and underestimated feature in MPM development. Several candidate genes have been associated with a predisposition to MPM and most of them play a role in DNA repair mechanisms: overall, approximately 20% of MPM cases may be related to genetic predisposition. A particular category of patients with high susceptibility to MPM is represented by carriers of pathogenic variants in the BAP1 gene. Germline variants in BAP1 predispose to the development of MPM following an autosomal dominant pattern of inheritance in the familial cases. MPMs in these patients are significantly less aggressive, and patients require a multidisciplinary approach that involves genetic counseling, medical genetics, pathology, surgical, medical, and radiation oncology expertise. In the present narrative review, we presented a comprehensive overview of genetic susceptibility in the development of MPM. Methods The narrative review is based on a selective literature carried out in PubMed in 2023. Inclusion criteria were original articles in English language, and clinical trials (randomized, prospective, or retrospective). Key Content and Findings We summarized the somatic and germline variants and the differences in terms of clinicopathological features and prognosis between gene-related MPM (GR-MPM) and asbestos-related MPM (AR-MPM). We also discussed the indications for screening, genetic testing, and surveillance of patients with BAP1 germline variants. Conclusions In this narrative review, we have emphasized that the BAP1 gene's harmful germline variations are inherited in an autosomal dominant manner in familial cases. MPMs in individuals with these variations are less severe, and their medical care necessitates a collaborative effort. Additionally, we have outlined the current therapeutic prospects for MPM, including the possibility of gene-specific therapy, which is currently promising but still requires clinical validation.
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Affiliation(s)
| | - Elizabeth Casey West
- Healthcare Genetics and Genomics, School of Nursing, Clemson University, Clemson, SC, USA
| | - Jessica Evangelista
- Thoracic Surgery, A. Gemelli University Hospital Foundation IRCCS, Rome, Italy
- Catholic University of Sacred Heart, Rome, Italy
| | - Aubrey Anne Mattingly
- Healthcare Genetics and Genomics, School of Nursing, Clemson University, Clemson, SC, USA
| | - Giuseppe Calabrese
- Thoracic Surgery, A. Gemelli University Hospital Foundation IRCCS, Rome, Italy
| | - Carolina Sassorossi
- Thoracic Surgery, A. Gemelli University Hospital Foundation IRCCS, Rome, Italy
| | - Adriana Nocera
- Thoracic Surgery, A. Gemelli University Hospital Foundation IRCCS, Rome, Italy
| | - Marco Chiappetta
- Thoracic Surgery, A. Gemelli University Hospital Foundation IRCCS, Rome, Italy
| | - Sara Flamini
- Thoracic Surgery, A. Gemelli University Hospital Foundation IRCCS, Rome, Italy
| | - Ludovico Abenavoli
- Department of Health Sciences, “Magna Græcia” University, Catanzaro, Italy
| | - Stefano Margaritora
- Thoracic Surgery, A. Gemelli University Hospital Foundation IRCCS, Rome, Italy
- Catholic University of Sacred Heart, Rome, Italy
| | - Luigi Boccuto
- Healthcare Genetics and Genomics, School of Nursing, Clemson University, Clemson, SC, USA
| | - Filippo Lococo
- Thoracic Surgery, A. Gemelli University Hospital Foundation IRCCS, Rome, Italy
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Yuce TH, Ak G, Metintas S, Dundar E, Roe OD, Panou V, Metintas M. BAP1, Wilms' tumor 1, and calretinin in predicting survival and response to first-line chemotherapy in patients with pleural mesothelioma. J Cancer Res Clin Oncol 2024; 150:38. [PMID: 38280040 PMCID: PMC10821830 DOI: 10.1007/s00432-023-05565-6] [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: 11/26/2023] [Accepted: 12/13/2023] [Indexed: 01/29/2024]
Abstract
PURPOSE There are currently no methods to predict response to chemotherapy in pleural mesothelioma (PM). The aim of this study is to investigate the predictive and prognostic role of BAP1, WT1 and calretinin expression and their combinations in pre-treatment tumor samples by immunohistochemical (IHC) staining. METHODS The study included consecutive PM patients treated with chemotherapy alone at a University hospital between 2009 and 2020. BAP1 analyses were performed on formalin-fixed, paraffin-embedded tumor tissue samples of the patients, while WT1 and calretinin information were obtained from the histopathological diagnosis records. RESULTS Of the total 107 patients included, 64% had loss of BAP1 expression, whereas 77% had WT1 and 86% had calretinin expression. Patients with the presence of BAP1 expression, one or both of the other two markers, or loss of expression of all three markers (unfavorable status) were more likely to not respond to chemotherapy than those with the presence of all three markers or loss of BAP1 expression and expression of one or two other markers (favorable status) (p = 0.001). Median survival time of patients with favorable and unfavorable status was 15 ± 1.7 and 8.0 ± 2.4 months, respectively (p = 0.027). After adjustment for histopathology and stage, loss of BAP1 (HR = 0.54, 95%CI 0.35-0.83), WT1 (1.75, 1.06-2.90), calretinin (2.09, 1.14-3.84) expression and favourable panel (0.50, 0.27-0.92) was associated with prognosis. CONCLUSIONS The IHC biomarkers BAP1, WT1, and calretinin, used in the routine diagnosis of PM and their combinations, are the first biomarkers associated with response to chemotherapy and may be a useful tool to select patients for first-line platinum pemetrexed treatment in PM patients. Validation in a large cohort is ongoing.
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Affiliation(s)
- Tuna Han Yuce
- Department of Chest Diseases, Eskisehir Osmangazi University Medical Faculty, Eskisehir, Turkey
| | - Guntulu Ak
- Department of Chest Diseases, Eskisehir Osmangazi University Medical Faculty, Eskisehir, Turkey
- Lung and Pleural Cancers Research and Clinical Center, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Selma Metintas
- Lung and Pleural Cancers Research and Clinical Center, Eskisehir Osmangazi University, Eskisehir, Turkey
- Department of Public Health, Eskisehir Osmangazi University Medical Faculty, Eskisehir, Turkey
| | - Emine Dundar
- Lung and Pleural Cancers Research and Clinical Center, Eskisehir Osmangazi University, Eskisehir, Turkey
- Department of Pathology, Eskisehir Osmangazi University Medical Faculty, Eskisehir, Turkey
| | - Oluf Dimitri Roe
- Department of Oncology, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Vasiliki Panou
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
- Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Respiratory Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Muzaffer Metintas
- Department of Chest Diseases, Eskisehir Osmangazi University Medical Faculty, Eskisehir, Turkey.
- Lung and Pleural Cancers Research and Clinical Center, Eskisehir Osmangazi University, Eskisehir, Turkey.
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Liou DZ, Wang Y, Bhandari P, Shrager JB, Lui NS, Backhus LM, Berry MF. Impact of guideline therapy on survival of patients with stage I-III epithelioid mesothelioma. J Thorac Dis 2023; 15:6661-6673. [PMID: 38249900 PMCID: PMC10797401 DOI: 10.21037/jtd-23-1334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 11/10/2023] [Indexed: 01/23/2024]
Abstract
Background Modern treatment guidelines recommend multimodal therapy with at least chemotherapy and surgery for patients with potentially resectable epithelioid mesothelioma. This study evaluated guideline compliance for patients with stage I-III epithelioid mesothelioma and tested the hypothesis that guideline-concordant therapy improved survival. Methods The National Cancer Database was queried for patients with stage I-III epithelioid malignant pleural mesothelioma between 2004 and 2016. The impact of therapy was evaluated using logistic regression, Kaplan-Meier analysis, Cox-proportional hazards analysis, and propensity-scoring methods. Results During the study period, guideline-concordant therapy was used in 677 patients (19.1%), and 2,857 patients (80.8%) did not have guideline-concordant therapy. Younger age, being insured, living in a census tract with a higher income, clinical stage, and being treated at an academic or research program were all predictors of receiving guideline-concordant therapy in multivariable analysis. Guideline-concordant therapy yielded improved median survival [24.7 (22.4-26.1) vs. 13.7 (13.2-14.4) months] and 5-year survival [17.7% (14.7-21.3%) vs. 8.0% (7.0-9.3%)] (P<0.001), and continued to be associated with better survival in both multivariable analysis and propensity-matched analysis. In the patients who received guideline therapy, median survival [24.9 (21.9-27.2) vs. 24.5 (21.7-28.1) months] and 5-year survival [14.9% (10.9-20.2%) vs. 20.1% (16.0-25.4%)] was not significantly different between patients who underwent induction (n=304) versus adjuvant (n=373) chemotherapy (P=0.444). Conclusions Guideline-concordant therapy for potentially resectable epithelioid mesothelioma is associated with significantly improved survival but used in a minority of patients. The timing of chemotherapy with surgery in this study did not have a significant impact on overall survival.
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Affiliation(s)
- Douglas Z. Liou
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University Medical Center, Falk Building, Stanford, CA, USA
| | - Yoyo Wang
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Prasha Bhandari
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University Medical Center, Falk Building, Stanford, CA, USA
| | - Joseph B. Shrager
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University Medical Center, Falk Building, Stanford, CA, USA
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Natalie S. Lui
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University Medical Center, Falk Building, Stanford, CA, USA
| | - Leah M. Backhus
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University Medical Center, Falk Building, Stanford, CA, USA
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Mark F. Berry
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University Medical Center, Falk Building, Stanford, CA, USA
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, VA Palo Alto Health Care System, Palo Alto, CA, USA
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Kang MS, Chae WR, Lee YJ, Moon KW. Occupational and Environmental Asbestos Exposure and Survival of Patients with Asbestos-Related Cancer: A Follow-Up Study on Patients with Malignant Mesothelioma and Asbestos-Related Lung Cancer in Korea. TOXICS 2023; 12:20. [PMID: 38250976 PMCID: PMC10819260 DOI: 10.3390/toxics12010020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 12/16/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024]
Abstract
Malignant mesothelioma and asbestos-related lung cancer are typically associated with a poor prognosis. However, it has been observed that some patients with these cancers survive significantly longer than the average survival period. While many preliminary studies have investigated factors influencing patient survival, the specific impact of asbestos exposure has not been thoroughly explored. We followed up with 546 patients with malignant mesothelioma and 902 patients with asbestos-related lung cancer, all identified as asbestos victims between 2009 and 2021. In both malignant mesothelioma and asbestos-related lung cancer, patients with occupational asbestos exposure exhibited not only shorter median survival times but also lower 3- and 5-year survival rates compared to those with environmental exposure. Additionally, a longer duration of occupational exposure and closer proximity to the source of asbestos were linked to shorter survival times and lower survival rates. Among the patients with occupational asbestos exposure, the highest hazard ratios (HRs) were observed in those who worked in the production of asbestos-containing products across both cancer types. In contrast, significant HRs were only noted in mesothelioma patients who lived near asbestos industries, slate houses, and redevelopment areas, within the environmentally exposed group.
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Affiliation(s)
- Min-Sung Kang
- Asbestos Environmental Health Center, Soonchunhyang University Cheonan Hospital, Soonchunhyang 6-gil 31, Dongnam-gu, Cheonan-si 31151, Republic of Korea; (M.-S.K.); (Y.-J.L.)
| | - Woo-Ri Chae
- Department of Health and Safety Convergence Science, Korea University, Anam-ro 145, Seongbuk-gu, Seoul 02841, Republic of Korea;
| | - Yong-Jin Lee
- Asbestos Environmental Health Center, Soonchunhyang University Cheonan Hospital, Soonchunhyang 6-gil 31, Dongnam-gu, Cheonan-si 31151, Republic of Korea; (M.-S.K.); (Y.-J.L.)
- Department of Occupational & Environmental Medicine, Soonchunhyang University, Soonchunhyang 6-gil 31, Dongnam-gu, Cheonan-si 31151, Republic of Korea
| | - Kyong Whan Moon
- School of Health and Environmental Science, Korea University, Anam-ro 145, Seongbuk-gu, Seoul 02841, Republic of Korea
- BK21 FOUR R&E Center for Learning Health System, Korea University, Anam-ro 145, Seongbuk-gu, Seoul 02841, Republic of Korea
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Zupanc C, Franko A, Štrbac D, Kovač V, Dolžan V, Goričar K. Serum Calretinin and Genetic Variability as a Prognostic and Predictive Factor in Malignant Mesothelioma. Int J Mol Sci 2023; 25:190. [PMID: 38203360 PMCID: PMC10778798 DOI: 10.3390/ijms25010190] [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: 11/25/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
Calretinin is a promising diagnostic biomarker for malignant mesothelioma (MM), but less is known about its prognostic role. Our aim was to evaluate the association between serum calretinin concentration or genetic factors and the survival or outcome of cisplatin-based chemotherapy in MM. Our study included 265 MM patients. Serum calretinin concentration was determined using ELISA. Patients were genotyped for seven polymorphisms in CALB2, E2F2, MIR335, NRF1, and SEPTIN7 using competitive allele-specific PCR. Nonparametric tests, logistic regression, and survival analysis were used for statistical analysis. Higher serum calretinin concentration was associated with shorter progression-free (PFS) (HR = 1.18 (1.02-1.37), p = 0.023) and overall survival (OS) (HR = 1.20 (1.03-1.41), p = 0.023), but the association was not significant after adjusting for clinical factors (HR = 1.05 (0.85-1.31), p = 0.653 and HR = 1.06 (0.84-1.34), p = 0.613, respectively). SEPTIN7 rs3801339 and MIR335 rs3807348 were associated with survival even after adjustment (HR = 1.76 (1.17-2.64), p = 0.007 and HR = 0.65 (0.45-0.95), p = 0.028, respectively). Calretinin concentration was higher in patients who progressed after treatment with cisplatin-based chemotherapy (1.68 vs. 0.45 ng/mL, p = 0.001). Calretinin concentration above 0.89 ng/mL was associated with shorter PFS and OS from the start of chemotherapy (HR = 1.88 (1.28-2.77), p = 0.001 and HR = 1.91 (1.22-2.97), p = 0.004, respectively), even after adjusting for clinical factors (p < 0.05). MIR335 rs3807348 was associated with a better response to chemotherapy (OR = 2.69 (1.17-6.18), p = 0.020). We showed that serum calretinin is associated with survival and chemotherapy treatment outcomes in MM and could serve as a predictive biomarker.
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Affiliation(s)
- Cita Zupanc
- Military Medical Unit-Slovenian Army, 1000 Ljubljana, Slovenia;
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia; (A.F.); (D.Š.); (V.K.)
| | - Alenka Franko
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia; (A.F.); (D.Š.); (V.K.)
- Clinical Institute of Occupational Medicine, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Danijela Štrbac
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia; (A.F.); (D.Š.); (V.K.)
- Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia
| | - Viljem Kovač
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia; (A.F.); (D.Š.); (V.K.)
- Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia
| | - Vita Dolžan
- Pharmacogenetics Laboratory, Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia;
| | - Katja Goričar
- Pharmacogenetics Laboratory, Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia;
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Zhang Y, Li N, Li R, Gu Y, Liu X, Zhang S. Predicting survival for patients with mesothelioma: development of the PLACE prognostic model. BMC Cancer 2023; 23:698. [PMID: 37495975 PMCID: PMC10369846 DOI: 10.1186/s12885-023-11180-y] [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: 08/03/2022] [Accepted: 07/13/2023] [Indexed: 07/28/2023] Open
Abstract
INTRODUCTION The overall survival of patients with mesothelioma is poor and heterogeneous. At present, the prediction model for Chinese patients needs to be improved. We sought to investigate predictors of survival in malignant pleural mesothelioma and develop prognostic prediction models. METHODS This Two-center retrospective cohort study recruited patients with pathologically diagnosed mesothelioma at Beijing Chao-Yang Hospital and Beijing Tong-Ren Hospital. We developed a new prognostic prediction model based on COX multivariable analysis using data from patients who were recruited from June 1, 2010 to July 1, 2021 in Beijing Chao-Yang Hospital (n = 95, development cohort) and validated this model using data from patients recruited from July 18, 2014 to May 9, 2022 in Beijing Tong-Ren Hospital (n = 23, validation cohort). Receiver operating characteristic analysis was used to estimate model accuracy. RESULTS The parameters in this new model included PLT > 289.5(10^9/L) (1 point), Lymphocyte > 1.785(10^9/L) (-1point), Age > 73 years old (1 point), Calcium > 2.145(mmol/L) (-1point), Eastern Cooperative Oncology Group performance status (ECOG PS) > 2 (2 points). When the sum of scores < 0, it is recognized as a low-risk group; when the score is 0 ~ 3, it is recognized as a high-risk group. The survival rate of patients in the high-risk group was significantly lower than that in the low-risk group (hazard ratio [HR], 3.878; 95% confidence interval [CI], 2.226-6.755; P < 0.001). The validation group had similar results (HR,3.574; 95%CI,1.064-12.001; P = 0.039). Furthermore, the areas under the curve 6 months after diagnosis in the two cohorts were 0.900 (95% CI: 0.839-0.962) and 0.761 (95% CI: 0.568-0.954) for development and validation cohorts, respectively. CONCLUSION We developed a simple, clinically relevant prognostic prediction model for PLACE by evaluating five variables routinely tested at the time of diagnosis. The predictive model can differentiate patients of Chinese ethnicity into different risk groups and further guide prognosis.
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Affiliation(s)
- Yuan Zhang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongtinan Rd, Chaoyang District, Beijing, 100020, China
- Department of Pulmonary and Critical Care Medicine, Beijing Hospital, Institute of Geriatric Medicine, National Center of Gerontology, Chinese Academy of Medical Sciences, Beijing, 100005, China
| | - Nan Li
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongtinan Rd, Chaoyang District, Beijing, 100020, China
| | - Ran Li
- Department of Respiratory and Critical Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, 100005, China
| | - Yumei Gu
- Department of Pathology, Beijing Chao-Yang Hospital , Capital Medical University, 8 Gongtinan Rd, Chaoyang District, Beijing, 100020, China
| | - Xiaofang Liu
- Department of Respiratory and Critical Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, 100005, China
| | - Shu Zhang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongtinan Rd, Chaoyang District, Beijing, 100020, China.
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Zhang Y, Li J, Zhang S. Prognostic significance of inflammation-related and electrolyte laboratory variables in patients with malignant pleural mesothelioma. Front Med (Lausanne) 2023; 10:1099685. [PMID: 37089600 PMCID: PMC10114925 DOI: 10.3389/fmed.2023.1099685] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/13/2023] [Indexed: 04/08/2023] Open
Abstract
ObjectiveMalignant pleural mesothelioma (MPM) is a kind of pleural cancer characterized by low incidence but high invasiveness. There is heterogeneity in survival among patients with MPM. Inflammation-related and electrolyte laboratory variables were previously reported as potential predictors of survival. We evaluated the relationship between overall survival and pre-treatment biomarkers.Materials and methodsPatients diagnosed with MPM in Beijing Chaoyang Hospital for more than 10 years were screened for this study. All basic, clinical, radiologic and laboratory variables were collected. The COX univariable and multivariable analysis were used to explore prognostic related risk factors.ResultsNinety patients with MPM were included. The median follow-up of all patients was 57 months [interquartile range (IQR): 27–100 months]. The median survival time was 24 months (IQR: 12–52 months). Univariate survival analyses indicated that age, Eastern Cooperative Oncology Group Performance Status, treatment, erythrocyte sedimentation rate, calcium, lymphocyte, hemoglobin, platelet-to-lymphocyte ratio (PLR), and monocyte-to-white blood cell ratio (MWR) were significantly related to survival. Multivariable analysis demonstrated that age [hazard ratio (HR), 2.548; 95% confidence interval (CI) 1.145–5.666; p = 0.022], calcium (HR, 0.480; 95% CI 0.270–0.855; p = 0.013), PLR (HR, 2.152; 95% CI 1.163–3.981; p = 0.015), and MWR (HR, 3.360; 95% CI 1.830–6.170; p < 0.001) might have a significant impact on the prognosis.ConclusionCalcium, MWR, and PLR might be related to the prognosis of MPM patients. Analyzing the relationship between the results of inflammation-related and electrolyte laboratory variables in peripheral blood and prognosis could help clinicians evaluate the situation of patients.
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Affiliation(s)
| | - Jie Li
- *Correspondence: Shu Zhang, ; Jie Li,
| | - Shu Zhang
- *Correspondence: Shu Zhang, ; Jie Li,
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Usefulness of NF2 hemizygous loss detected by fluorescence in situ hybridization in diagnosing pleural mesothelioma in tissue and cytology material: A multi-institutional study. Lung Cancer 2023; 175:27-35. [PMID: 36442384 DOI: 10.1016/j.lungcan.2022.11.013] [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: 08/21/2022] [Revised: 10/30/2022] [Accepted: 11/17/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVES BAP1, CDKN2A, and NF2 are the most frequently altered genes in pleural mesotheliomas (PM). Discriminating PM from benign mesothelial proliferation (BMP) is sometimes challenging; it is well established that BAP1 loss, determined by immunohistochemistry (IHC), and CDKN2A homozygous deletion (HD), determined by fluorescence in situ hybridization (FISH), are useful. However, data regarding the diagnostic utility of NF2 FISH in PM is limited. Thus, we performed a multi-institutional study examining the utility of NF2 alterations determined by FISH for diagnosing PM in combination with BAP1 loss and CDKN2A HD. MATERIALS AND METHODS Multi-institutional PM cases, including 106 surgical and 107 cell block samples as well as 37 tissue cases of benign mesothelial proliferation (BMP) and 31 cell block cases with reactive mesothelial cells (RMC), were collected and analyzed using IHC for BAP1 and FISH for CDKN2A and NF2. RESULTS In PM, NF2 FISH revealed hemizygous loss (HL) in 54.7% of tissue cases (TC) and 49.5% of cell block cases (CBC), with about 90% of HL being monosomy. CDKN2A HD or BAP1 loss were detected in 75.5%/65.4% TC or 63.6%/60% CBC, respectively. BMP or RMC showed no BAP1 loss, CDKN2A HD, or NF2 HL. For discriminating PM from BMP, a combination of BAP1 loss, CDKN2A HD, and NF2 HL yielded enhanced sensitivity of 98.1% TC/94.4% CBC. BAP1 loss, CDKN2A HD, or NF2 HL were observed in 69%, 70%, or 58% of epithelioid PM, but in 9%, 91%, or 27% of sarcomatoid PM, respectively. Histotype, histological gradings, and CDKN2A deletion status showed significant differences in overall survival, while BAP1 loss and NF2 HL did not. CONCLUSION NF2 HL, consisting predominantly of monosomy, can be detected by FISH in both TC and CBC of PM, and is effective for distinguishing PM from BMP, especially when combined with BAP1 loss and CDKN2A HD.
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10
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Nash AM, Aghlara-Fotovat S, Castillio B, Hernandez A, Pugazenthi A, Lee HS, Jang HJ, Nguyen A, Lu A, Burt BM, Ghanta RK, Veiseh O. Activation of Adaptive and Innate Immune Cells via Localized IL2 Cytokine Factories Eradicates Mesothelioma Tumors. Clin Cancer Res 2022; 28:5121-5135. [PMID: 35993913 PMCID: PMC9713361 DOI: 10.1158/1078-0432.ccr-22-1493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/21/2022] [Accepted: 08/12/2022] [Indexed: 01/24/2023]
Abstract
PURPOSE IL2 immunotherapy has the potential to elicit immune-mediated tumor lysis via activation of effector immune cells, but clinical utility is limited due to pharmacokinetic challenges as well as vascular leak syndrome and other life-threatening toxicities experienced by patients. We developed a safe and clinically translatable localized IL2 delivery system to boost the potency of therapy while minimizing systemic cytokine exposure. EXPERIMENTAL DESIGN We evaluated the therapeutic efficacy of IL2 cytokine factories in a mouse model of malignant mesothelioma. Changes in immune populations were analyzed using time-of-flight mass cytometry (CyTOF), and the safety and translatability of the platform were evaluated using complete blood counts and serum chemistry analysis. RESULTS IL2 cytokine factories enabled 150× higher IL2 concentrations in the local compartment with limited leakage into the systemic circulation. AB1 tumor burden was reduced by 80% after 1 week of monotherapy treatment, and 7 of 7 of animals exhibited tumor eradication without recurrence when IL2 cytokine factories were combined with anti-programmed cell death protein 1 (aPD1). Furthermore, CyTOF analysis showed an increase in CD69+CD44+ and CD69-CD44+CD62L- T cells, reduction of CD86-PD-L1- M2-like macrophages, and a corresponding increase in CD86+PD-L1+ M1-like macrophages and MHC-II+ dendritic cells after treatment. Finally, blood chemistry ranges in rodents demonstrated the safety of cytokine factory treatment and reinforced its potential for clinical use. CONCLUSIONS IL2 cytokine factories led to the eradication of aggressive mouse malignant mesothelioma tumors and protection from tumor recurrence, and increased the therapeutic efficacy of aPD1 checkpoint therapy. This study provides support for the clinical evaluation of this IL2-based delivery system. See related commentary by Palanki et al., p. 5010.
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Affiliation(s)
- Amanda M. Nash
- Department of Bioengineering, Rice University, Houston, Texas
| | | | | | | | - Aarthi Pugazenthi
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Hyun-Sung Lee
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Hee-Jin Jang
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Annie Nguyen
- Department of Bioengineering, Rice University, Houston, Texas
| | - Alexander Lu
- Department of Bioengineering, Rice University, Houston, Texas
| | - Bryan M. Burt
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Ravi K. Ghanta
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Omid Veiseh
- Department of Bioengineering, Rice University, Houston, Texas
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11
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Lee JT, Mittal DL, Warby A, Kao S, Dhillon HM, Vardy JL. Dying of mesothelioma: A qualitative exploration of caregiver experiences. Eur J Cancer Care (Engl) 2022; 31:e13627. [PMID: 35723508 PMCID: PMC9539703 DOI: 10.1111/ecc.13627] [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: 01/31/2022] [Revised: 04/26/2022] [Accepted: 05/11/2022] [Indexed: 11/30/2022]
Abstract
Objective To explore the experience of family caregivers of people with mesothelioma with focus on end‐of‐life issues. Methods A qualitative sub‐study using semi‐structured interviews and thematic analysis. Results Fourteen caregivers were interviewed; 11 were bereaved. The overarching theme was the impact of patients' diagnosis, treatment and death on caregivers and families. Three main themes were identified: (i) information provision and decision‐making; (ii) grief and bereavement; and (iii) involvement and timing of palliative care. Caregivers initially had minimal knowledge of mesothelioma and wanted more information. Prognostic uncertainty caused distress. Grief and bereavement sub‐themes were (i) coping and personal priorities; (ii) reflections on dying; and (iii) reflections on care. Caregivers highlighted the importance of creating meaningful events, having hope, ‘doing something’ and support from family and external sources. Reflections on dying contrasted regret after a ‘bad’, often unexpected death, with ‘good’ deaths. Care was made difficult by challenges navigating the health system and perceived gaps. Caregivers reported late referral to palliative care. Conclusion Lack of information caused challenges for caregivers. Grief and bereavement outcomes varied and may have been adversely impacted by lack of engagement with palliative care. Integrated care with lung cancer coordinators and improved palliative care access may reduce caregiver burden.
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Affiliation(s)
- Jessica T Lee
- Concord Cancer Centre, Concord Repatriation General Hospital, Concord, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,IMPACCT, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Dipti L Mittal
- Concord Cancer Centre, Concord Repatriation General Hospital, Concord, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Anne Warby
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Steven Kao
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Asbestos Diseases Research Institute, Concord, New South Wales, Australia.,Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Haryana M Dhillon
- Centre for Medical Psychology and Evidence-Based Decision-Making, The University of Sydney, Sydney, New South Wales, Australia
| | - Janette L Vardy
- Concord Cancer Centre, Concord Repatriation General Hospital, Concord, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Asbestos Diseases Research Institute, Concord, New South Wales, Australia.,Centre for Medical Psychology and Evidence-Based Decision-Making, The University of Sydney, Sydney, New South Wales, Australia
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12
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Luigi Banna G, Addeo A, Zygoura P, Tsourti Z, Popat S, Curioni-Fontecedro A, Nadal E, Shah R, Pope A, Fisher P, Spicer J, Roy A, Gilligan D, Gautschi O, Janthur WD, López-Castro R, Roschitzki-Voser H, Dafni U, Peters S, Stahel RA. A prognostic score for patients with malignant pleural mesothelioma (MPM) receiving second-line immunotherapy or chemotherapy in the ETOP 9–15 PROMISE-meso phase III trial. Lung Cancer 2022; 169:77-83. [DOI: 10.1016/j.lungcan.2022.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/10/2022] [Accepted: 05/26/2022] [Indexed: 10/18/2022]
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13
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Ziółkowska B, Cybulska-Stopa B, Papantoniou D, Suwiński R. Systemic treatment in patients with malignant pleural mesothelioma - real life experience. BMC Cancer 2022; 22:432. [PMID: 35443624 PMCID: PMC9022247 DOI: 10.1186/s12885-022-09490-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 10/25/2021] [Indexed: 12/24/2022] Open
Abstract
Background Malignant pleural mesothelioma (MPM) is a rare, aggressive malignancy of the pleural cavity linked to asbestos exposure. The combination of pemetrexed and platinum is a standard first-line therapy for malignant pleural mesothelioma. Despite some progress, almost all MPM patients experience progression after first-line therapy. The second-line treatment is still being under discussion and there are very limited data available on the second-line and subsequent treatments. Methods The retrospective analysis included 57 patients (16 females and 41 males) from two Polish oncological institutions treated for advanced mesothelioma between 2013 and 2019. We analysed the efficacy of first-line and second-line therapy: progression-free survival (PFS), overall survival (OS), overall response rate (ORR). Results In the first-line treatment, 55 patients received pemetrexed-based chemotherapy (PBC) and two cisplatin in monotherapy. Patients’ characteristics at baseline: median age was 64.2 years, ECOG PS ≤ 1 (86.2%), epithelial histology (85.7%). Median PFS and OS were 7.6 months and 14 months, respectively. Patients with ECOG PS ≤ 1 vs > 1 had a longer median OS (14.8 months vs 9.7 months, p = 0.057). One-year OS and PFS were 60.9% and 32.0%, respectively. Disease control rate (DCR) was 82.5%. Response to first-line therapy: PFS ≥ 6 months and PFS ≥ 12 months had a significant impact on median OS. Twelve patients received second-line therapy (seven PBC and five other cytotoxic single agents: navelbine, gemcitabine, or adriamycin/vincristine/methotrexate triplet). Median PFS and OS were 3.7 months and 7.2 months, respectively. DCR was 83%. One-year OS and PFS were 37% and 16.7%, respectively. In the group receiving PBC, OS was prolonged by 4.5 months compared to the non-PBC group (6.0 months vs 10.5 months, p = 0.47). Conclusion Patients who benefited from first-line therapy and had prolonged PFS at first-line and achieve PFS longer than 6 months at first-line should be offered second-line treatment. Consideration of retreatment with the same cytotoxic agent could to be a viable option when no other treatment are available.
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Affiliation(s)
- Barbara Ziółkowska
- Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Poland.
| | - Bożena Cybulska-Stopa
- Maria Sklodowska-Curie National Research Institute of Oncology, Cracow Branch, Poland
| | - Dimitrios Papantoniou
- Department of Medical Sciences, Endocrine Oncology, Uppsala University, Uppsala, Sweden.,Department of Oncology, Ryhov County Hospital, Jönköping, Sweden
| | - Rafał Suwiński
- Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Poland
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14
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López-Castro R, Recondo G, Gorría T, Mezquita L. A New Pretreatment Mesothelioma Risk Score: Integrating Clinical and Molecular Factors for Predicting Outcomes in Malignant Pleural Mesothelioma. J Thorac Oncol 2021; 16:1782-1784. [PMID: 34716000 DOI: 10.1016/j.jtho.2021.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 07/14/2021] [Accepted: 07/15/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Rafael López-Castro
- Oncology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Gonzalo Recondo
- Clinical Oncology, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina
| | - Teresa Gorría
- Medical Oncology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Laura Mezquita
- Medical Oncology Department, Hospital Clinic of Barcelona, Barcelona, Spain; Laboratory of Translational Genomics and Targeted therapies in Solid Tumors, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
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15
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Abstract
PURPOSE OF REVIEW Malignant pleural mesothelioma (MPM) is a rare, but aggressive tumor with still poor prognosis. In this article, we focus on recent developments in the management of MPM including diagnosis, staging, biomarkers, and treatment strategies. RECENT FINDINGS Molecular markers such as programmed death-ligand 1 (PDL-1), Breast Cancer gene 1-associated protein gene, and cyclin-dependent kinase inhibitor 2A (CDKN2A) have prognostic impact and should be considered for assessment in patient samples. In addition to histological subtype and tumor pattern, tumor volumetry plays an increasing important role in staging, assessment of treatment response, and prediction of survival. Several new blood-based biomarkers have been recently reported including peripheral blood DNA methylation, microRNAs, fibulin, and high-mobility group box 1, but have not been established in clinical routine use yet. Regarding treatment, targeted therapies, immunotherapy, and vaccination are considered as new promising strategies. Moreover, extended pleurectomy/decortication is favored over extrapleural pneumonectomy (EPP) and intensity-modulated radiotherapy represents a possible approach in combination with EPP and pleurectomy/decortication. Intracavitary treatment options are promising and deserve further investigations. SUMMARY Overall, there has not been a real breakthrough in the treatment of MPM. Further research and clinical trials are needed to evaluate outcome and to identify new potential treatment candidates.
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16
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Ringgaard Petersen T, Panou V, Meristoudis C, Weinreich UM, Røe OD. Clinical prognostic factors in pleural mesothelioma: best supportive care and anti-tumor treatments in a real-life setting. Acta Oncol 2021; 60:521-527. [PMID: 33502280 DOI: 10.1080/0284186x.2021.1876246] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND This study aims to investigate patient- and disease characteristics associated with survival in malignant pleural mesothelioma (MPM) patients with anti-tumor treatment or with best supportive care (BSC). MATERIALS AND METHODS Consecutive MPM cases diagnosed in North Denmark Region from 1972 to 2015 were reevaluated and verified by two pathologists using modern immunohistochemical techniques. Danish registries and hospital records were used to gather patient-, asbestos exposure-, and disease information. RESULTS Of the 279 patients, anti-tumor treatment was administered to 184 patients (66.0%). All of those received chemotherapy alone or as part of a multimodal treatment, where pemetrexed was given to 126 (68.5%) patients. Asbestos exposure was documented in 92.5% of all patients. In the treated group, mean age was lower (66 years versus 74 years, p < 0.01), rate of occupational asbestos exposure was higher (74.5 versus 54.7%, p < 0.01), more patients had better performance score (98.4 versus 60%, p < 0.01) and stage was lower (81 versus 63.2%, p < 0.01) compared to the BSC group. Multivariate analysis showed that epithelioid subtype was the only common prognostic factor for OS in both groups. In BSC patients, good PS and female gender was associated with improved OS. Median overall survival (OS) was 17 versus 4 months (p < 0.01), and independently of the histopathological subtype, the median and 2-year survival was higher in the treated versus the BSC group (p < 0.02). CONCLUSIONS This retrospective study showed that epithelioid subtype is the only independent positive prognostic factor of survival in treated patients with MPM. For BSC patients, the epithelioid subtype, good PS, and female gender were positive prognostic factors, while age and comorbidities were not significant. This study with long-term follow-up of treated and BSC MPM patients can contribute to the clinical stratification of patients. Further validation is appropriate to verify these findings.
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Affiliation(s)
- Thomas Ringgaard Petersen
- Department of Respiratory Disease, Aalborg University Hospital, Aalborg, Denmark
- Department of Oncology, Regional Hospital West Jutland, Herning, Danmark
| | - Vasiliki Panou
- Department of Respiratory Disease, Aalborg University Hospital, Aalborg, Denmark
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | | | - Ulla Møller Weinreich
- Department of Respiratory Disease, Aalborg University Hospital, Aalborg, Denmark
- The Clinical Institute, Aalborg University, Aalborg, Denmark
| | - Oluf Dimitri Røe
- The Clinical Institute, Aalborg University, Aalborg, Denmark
- Department of Oncology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
- Department of Oncology, Levanger Hospital, Nord-Trøndelag Health Trust, Levanger, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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17
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Opitz I, Furrer K. Preoperative Identification of Benefit from Surgery for Malignant Pleural Mesothelioma. Thorac Surg Clin 2021; 30:435-449. [PMID: 33012431 DOI: 10.1016/j.thorsurg.2020.08.003] [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] [Indexed: 02/07/2023]
Abstract
In the absence of standardized treatment algorithms for patients with malignant pleural mesothelioma, one of the main difficulties remains patient allocation to therapies with potential benefit. This article discusses clinical, radiologic, pathologic, and molecular prognostic factors as well as genetic background leading to preoperative identification of benefit from surgery, which have been investigated over the past years to simplify and at the same time specify patient selection for surgical treatment.
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Affiliation(s)
- Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Raemistrasse 100, Zurich 8091, Switzerland.
| | - Katarzyna Furrer
- Department of Thoracic Surgery, University Hospital Zurich, Raemistrasse 100, Zurich 8091, Switzerland
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18
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Fontana V, Pistillo MP, Vigani A, Canessa PA, Berisso G, Giannoni U, Ferro P, Franceschini MC, Carosio R, Tonarelli M, Dessanti P, Roncella S. Potential role of serum mesothelin in predicting survival of patients with malignant pleural mesothelioma. Oncol Lett 2020; 21:128. [PMID: 33552249 DOI: 10.3892/ol.2020.12389] [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: 04/25/2020] [Accepted: 10/05/2020] [Indexed: 11/05/2022] Open
Abstract
Malignant pleural mesothelioma (MPM) is an aggressive tumor with poor survival rates. Therefore, it is essential to have effective biological markers predicting the course of the disease and prognosis. The aim of the present study was to highlight the prognostic significance of serum soluble mesothelin-related protein (Se-SMRP) in patients with MPM at diagnosis. Se-SMRP was determined in 60 patients using an ELISA commercial kit. Se-SMRP levels were subdivided into three tertile-based categories and in each category overall survival (OS) indexes were determined using the Kaplan-Meier and Cox regression analyses. The association between Se-SMRP levels and OS was also assessed by restricted cubic spline (RCS) analysis. No notable differences in the Kaplan-Meier probabilities were identified across the Se-SMRP categories (<0.66 nM, 0.66-1.46 nM, >1.46 nM) although an upward trend in death rate ratios (RR) was pointed out by comparing the higher (RR=1.95) and intermediate (RR=1.86) categories with the lower category (RR=1.00). In addition, such an increasing tendency, particularly when the biomarker exceeded 1.0 nM, was confirmed by an RCS function of Se-SMPR levels fitted to survival data using the Cox regression equation. The present study provided evidence in favor of a prognostic value of Se-SMRP in patients with MPM.
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Affiliation(s)
- Vincenzo Fontana
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, I-16132 Genova, Italy
| | - Maria Pia Pistillo
- Tumor Epigenetics Unit, IRCCS Ospedale Policlinico San Martino, I-16132 Genova, Italy
| | - Antonella Vigani
- Department of Oncology, Azienda Sanitaria Locale 5, I-19124 La Spezia, Italy
| | - Pier Aldo Canessa
- Department of Pneumology, Azienda Sanitaria Locale 5, I-19124 La Spezia, Italy
| | - Giovanni Berisso
- Department of Medicine, Azienda Sanitaria Locale 5, I-19124 La Spezia, Italy
| | - Ugo Giannoni
- Department of Radiodiagnosis, Azienda Sanitaria Locale 5, I-19124 La Spezia, Italy
| | - Paola Ferro
- Department of Histopathology and Cytopathology, Azienda Sanitaria Locale 5, I-19124 La Spezia, Italy
| | | | - Roberta Carosio
- Tumor Epigenetics Unit, IRCCS Ospedale Policlinico San Martino, I-16132 Genova, Italy
| | - Marika Tonarelli
- Department of Histopathology and Cytopathology, Azienda Sanitaria Locale 5, I-19124 La Spezia, Italy
| | - Paolo Dessanti
- Department of Histopathology and Cytopathology, Azienda Sanitaria Locale 5, I-19124 La Spezia, Italy
| | - Silvio Roncella
- Department of Histopathology and Cytopathology, Azienda Sanitaria Locale 5, I-19124 La Spezia, Italy
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Lau B, Boyer M, Lee JH, Kao S. Clinical Trials Eligibility of Patients With Malignant Pleural Mesothelioma: Use of Novel Therapies and Outcomes. Clin Lung Cancer 2020; 21:378-383.e1. [PMID: 32249197 DOI: 10.1016/j.cllc.2020.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 12/30/2019] [Accepted: 01/20/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Studies of bevacizumab and pembrolizumab in the treatment of malignant pleural mesothelioma suggest anticancer efficacy; clinical trial populations are not reflective of real-world patients. We aimed to determine the proportion of real-world patients who would be eligible for trials, identify patients who participated in clinical trials, and examine treatment and outcome data. PATIENTS AND METHODS Consecutive patients with unresectable malignant pleural mesothelioma seen at our center from January 2012 to July 2018 were assessed with regards to their eligibility for Mesothelioma Avastin Cisplatin Study (MAPS) and KEYNOTE-028 clinical trials. Prognostic information, treatment use, and overall survival (OS) data were also collected. RESULTS A total of 133 patients were included: 50% and 37%, respectively, did not meet trial eligibility for MAPS or KEYNOTE-028, most commonly owing to age ≥75 (23%), Eastern Cooperative Oncology Group performance status of ≥2 (21%), concomitant medication (21%), or comorbidity (12%). MAPS eligibility did not correlate with use of bevacizumab (P = .30) or improved OS (P = .87). Eligibility for KEYNOTE-028 correlated with pembrolizumab use (P < .001), but not improved OS (P = .21). Patients who received an investigational anticancer therapy on any clinical trial had improved OS: 32.4 (95% CI, 23.9-40.9) months versus 20.5 (95% CI, 15.8-25.3) months (P = .01). CONCLUSION Only ≤63% of our patients were eligible for these trials, highlighting the differences between real-world patients and the highly select trial population. Our patients who participated in clinical trials had superior OS, further emphasizing the selection bias in the trial population.
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Affiliation(s)
- Brandon Lau
- Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown, NSW, Australia.
| | - Michael Boyer
- Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown, NSW, Australia; Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Jenny H Lee
- Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown, NSW, Australia; Department of Clinical Medicine, Macquarie Hospital, Macquarie University, Macquarie, NSW, Australia
| | - Steven Kao
- Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown, NSW, Australia; Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; Asbestos Diseases Research Institute, Hospital Road, Concord, NSW, Australia
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20
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Hinkamp CA, Dalal SN, Butt Y, Cabo Chan AV. Diffuse epithelioid malignant mesothelioma of the pleura presenting as a hydropneumothorax and vertebral body invasion. BMJ Case Rep 2020; 13:13/1/e231987. [PMID: 31900296 DOI: 10.1136/bcr-2019-231987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Malignant mesothelioma is an uncommon form of neoplastic transformation of the mesothelial cells that line the serosal surfaces of the body. It most commonly affects the pleura and is often associated with pleural effusions and pleural-based masses. The annual incidence in the United States is only 3300 cases, representing less than 0.3% of all cancers worldwide, although this is likely underestimated. We present a case of diffuse epithelioid malignant pleural mesothelioma in a patient with remote, short-term asbestos exposure complicated by recurrent left-sided hydropneumothoraces and pleural-based invasion of the T12 vertebral body, which represent two rare coexisting complications. This case illustrates the importance of maintaining a broad differential for hydropneumothorax, particularly as the risk factors may be decades removed and the degree of asbestos exposure to induce a malignant mesothelioma may be smaller than has been traditionally thought.
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Affiliation(s)
- Colin Andrew Hinkamp
- Department of Internal Medicine, University of Texas Southwestern, Dallas, Texas, USA
| | - Shanup N Dalal
- Department of Internal Medicine, University of Texas Southwestern, Dallas, Texas, USA
| | - Yasmeen Butt
- Division of Anatomic Pathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Alberto V Cabo Chan
- Department of Internal Medicine, University of Texas Southwestern, Dallas, Texas, USA
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21
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Carbone M, Adusumilli PS, Alexander HR, Baas P, Bardelli F, Bononi A, Bueno R, Felley-Bosco E, Galateau-Salle F, Jablons D, Mansfield AS, Minaai M, de Perrot M, Pesavento P, Rusch V, Severson DT, Taioli E, Tsao A, Woodard G, Yang H, Zauderer MG, Pass HI. Mesothelioma: Scientific clues for prevention, diagnosis, and therapy. CA Cancer J Clin 2019; 69:402-429. [PMID: 31283845 PMCID: PMC8192079 DOI: 10.3322/caac.21572] [Citation(s) in RCA: 273] [Impact Index Per Article: 54.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Mesothelioma affects mostly older individuals who have been occupationally exposed to asbestos. The global mesothelioma incidence and mortality rates are unknown, because data are not available from developing countries that continue to use large amounts of asbestos. The incidence rate of mesothelioma has decreased in Australia, the United States, and Western Europe, where the use of asbestos was banned or strictly regulated in the 1970s and 1980s, demonstrating the value of these preventive measures. However, in these same countries, the overall number of deaths from mesothelioma has not decreased as the size of the population and the percentage of old people have increased. Moreover, hotspots of mesothelioma may occur when carcinogenic fibers that are present in the environment are disturbed as rural areas are being developed. Novel immunohistochemical and molecular markers have improved the accuracy of diagnosis; however, about 14% (high-resource countries) to 50% (developing countries) of mesothelioma diagnoses are incorrect, resulting in inadequate treatment and complicating epidemiological studies. The discovery that germline BRCA1-asssociated protein 1 (BAP1) mutations cause mesothelioma and other cancers (BAP1 cancer syndrome) elucidated some of the key pathogenic mechanisms, and treatments targeting these molecular mechanisms and/or modulating the immune response are being tested. The role of surgery in pleural mesothelioma is controversial as it is difficult to predict who will benefit from aggressive management, even when local therapies are added to existing or novel systemic treatments. Treatment outcomes are improving, however, for peritoneal mesothelioma. Multidisciplinary international collaboration will be necessary to improve prevention, early detection, and treatment.
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Affiliation(s)
- Michele Carbone
- Thoracic Oncology Program, University of Hawaii Cancer Center, Honolulu, Hawaii
| | - Prasad S. Adusumilli
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - H. Richard Alexander
- Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Paul Baas
- Department of Thoracic Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Fabrizio Bardelli
- National Research Council Institute of Nanotechnology, La Sapienza University, Rome, Italy
| | - Angela Bononi
- Thoracic Oncology Program, University of Hawaii Cancer Center, Honolulu, Hawaii
| | - Raphael Bueno
- Division of Thoracic Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Emanuela Felley-Bosco
- Laboratory of Molecular Oncology, Division of Thoracic Surgery, University Hospital of Zurich, Zurich, Switzerland
| | | | - David Jablons
- Thoracic Oncology, Department of Surgery, Helen Diller Cancer Center, University of California at San Francisco, San Francisco, California
| | | | - Michael Minaai
- Thoracic Oncology Program, University of Hawaii Cancer Center, Honolulu, Hawaii
| | - Marc de Perrot
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Patricia Pesavento
- Pathology, Immunology, and Microbiology Laboratory, University of California at Davis, Sacramento, California
| | - Valerie Rusch
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David T. Severson
- Division of Thoracic Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Emanuela Taioli
- Translational Epidemiology and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Anne Tsao
- Division of Cancer Medicine, Department of Thoracic and Head/Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gavitt Woodard
- Thoracic Oncology, Department of Surgery, Helen Diller Cancer Center, University of California at San Francisco, San Francisco, California
| | - Haining Yang
- Thoracic Oncology Program, University of Hawaii Cancer Center, Honolulu, Hawaii
| | | | - Harvey I. Pass
- Department of Cardiothoracic Surgery, New York University Langone Medical Center, New York, New York
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22
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Bibby AC, Dorn P, Psallidas I, Porcel JM, Janssen J, Froudarakis M, Subotic D, Astoul P, Licht P, Schmid R, Scherpereel A, Rahman NM, Maskell NA, Cardillo G. ERS/EACTS statement on the management of malignant pleural effusions. Eur J Cardiothorac Surg 2019; 55:116-132. [PMID: 30060030 DOI: 10.1093/ejcts/ezy258] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 03/28/2018] [Indexed: 12/26/2022] Open
Abstract
Malignant pleural effusions (MPE) are a common pathology, treated by respiratory physicians and thoracic surgeons alike. In recent years, several well-designed randomized clinical trials have been published that have changed the landscape of MPE management. The European Respiratory Society (ERS) and the European Association for Cardio-Thoracic Surgery (EACTS) established a multidisciplinary collaboration of clinicians with expertise in the management of MPE with the aim of producing a comprehensive review of the scientific literature. Six areas of interest were identified, including the optimum management of symptomatic MPE, management of trapped lung in MPE, management of loculated MPE, prognostic factors in MPE, whether there is a role for oncological therapies prior to intervention for MPE and whether a histological diagnosis is always required in MPE. The literature revealed that talc pleurodesis and indwelling pleural catheters effectively manage the symptoms of MPE. There was limited evidence regarding the management of trapped lung or loculated MPE. The LENT score was identified as a validated tool for predicting survival in MPE, with Brims' prognostic score demonstrating utility in mesothelioma prognostication. There was no evidence to support the use of oncological therapies as an alternative to MPE drainage, and the literature supported the use of tissue biopsy as the gold standard for diagnosis and treatment planning.Management options for malignant pleural effusions have advanced over the past decade, with high-quality randomized trial evidence informing practice in many areas. However, uncertainties remain and further research is required http://ow.ly/rNt730jOxOS.
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Affiliation(s)
- Anna C Bibby
- Academic Respiratory Unit, University of Bristol Medical School Translational Health Sciences, Bristol, UK
- North Bristol Lung Centre, North Bristol NHS Trust, Bristol, UK
| | - Patrick Dorn
- Division of Thoracic Surgery, University Hospital Bern, Bern, Switzerland
| | | | - Jose M Porcel
- Pleural Medicine Unit, Arnau de Vilanova University Hospital, IRB Lleida, Lleida, Spain
| | - Julius Janssen
- Department of Pulmonary Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Marios Froudarakis
- Department of Respiratory Medicine, Medical School of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Dragan Subotic
- Clinic for Thoracic Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Phillippe Astoul
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Hospital North Aix-Marseille University, Marseille, France
| | - Peter Licht
- Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark
| | - Ralph Schmid
- Division of Thoracic Surgery, University Hospital Bern, Bern, Switzerland
| | - Arnaud Scherpereel
- Pulmonary and Thoracic Oncology Department, Hospital of the University (CHU) of Lille, Lille, France
| | - Najib M Rahman
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
- Oxford Centre for Respiratory Medicine, University Hospitals, NHS Foundation Trust, Oxford, UK
| | - Nick A Maskell
- Academic Respiratory Unit, University of Bristol Medical School Translational Health Sciences, Bristol, UK
- North Bristol Lung Centre, North Bristol NHS Trust, Bristol, UK
- Task force chairperson
| | - Giuseppe Cardillo
- Task force chairperson
- Department of Thoracic Surgery, Carlo Forlanini Hospital, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
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Verma V, Wegner RE, Ludmir EB, Hasan S, Colonias A, Grover S, Friedberg JS, Simone CB. Management of Malignant Pleural Mesothelioma in the Elderly Population. Ann Surg Oncol 2019; 26:2357-2366. [DOI: 10.1245/s10434-019-07351-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Indexed: 01/22/2023]
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24
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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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25
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Patterns of care and survival of older patients with malignant pleural mesothelioma. J Geriatr Oncol 2019; 10:573-576. [PMID: 30917938 DOI: 10.1016/j.jgo.2019.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 12/14/2018] [Accepted: 02/21/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Malignant pleural mesothelioma (MPM) is a cancer that primarily affects older adults. However this patient population is frequently under-represented in clinical studies. Therefore, we studied the impact of advancing age on treatment utilisation and clinical outcomes in an extensive series of minimally selected MPM patients. MATERIALS AND METHODS Patients with MPM receiving compensation from the New South Wales (NSW) Dust Diseases Authority (2002-2009) were assessed. They were categorised by age (<70 years, 70-80 years or > 80 years) and chi-square testing was used to assess the relationship between clinical and demographic variables, age, treatment and overall survival (OS). RESULTS We identified 910 patients; 41% were aged <70 years, 40% were aged 70-80 years, and 19% were aged >80 years old. Median OS decreased with increasing age: 13.5 months in <70 years, 9.5 months in 70-80 years and 7.1 months in >80 years as did chemotherapy use (66%, 35% and 8% respectively). Radical surgical intervention, adjuvant, and palliative radiotherapy were less frequently used with advanced age. A Kaplan Meier analysis revealed that there was a significant survival advantage (p < .001) for patients <70 and 70-80 years receiving chemotherapy (16.8 vs 7.0 months; 13.9 vs 5.8 months respectively), but not for patients >80 years. CONCLUSION Advancing age group of NSW patients with MPM was associated with reduced treatment utilisation and a decline in OS. Prospective studies are warranted to verify if current treatment guidelines are relevant for the older adults with MPM.
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Rojas L, Cardona AF, Trejo-Rosales R, Zatarain-Barrón ZL, Ramírez-Tirado LA, Ruiz-Patiño A, Campos Gómez S, Corrales L, Oblitas G, Bacon L, Martín C, de Lima VCC, Freitas HC, Mas L, Vargas C, Carranza H, Otero J, Pérez MA, González L, Chirinos L, Granados ST, Rodriguez J, Báez R, Remolina Bonilla YA, Núñez Cerrillo G, Archila P, Cuello M, Karachaliou N, Rosell R, Arrieta O. Characteristics and long-term outcomes of advanced pleural mesothelioma in Latin America (MeSO-CLICaP). Thorac Cancer 2019; 10:508-518. [PMID: 30706690 PMCID: PMC6397921 DOI: 10.1111/1759-7714.12967] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 12/12/2018] [Accepted: 12/12/2018] [Indexed: 12/27/2022] Open
Abstract
Background Malignant pleural mesothelioma (MPM) is an aggressive tumor, associated with poor prognosis. There is a lack of information about the clinical and pathological features related with survival in the Latin American population. Methods The MeSO‐CLICaP registry identified 302 patients with advanced MPM diagnosed and treated between January 2008 and March 2016. The Cox model was applied to determine the variables associated with survival. A random forest tree model was built to predict the response to first‐line chemotherapy among Latin American patients. Results The median age was 61.1 years (SD 10.6 years), 191 (63.2%) were men, 65.9% were ever smokers, and 38.7% had previous exposure to asbestos. A total of 237 (78.5%) had epithelioid tumors, and 188 (62.3%) and 114 (37.7%) cases had stage III or IV MPM, respectively. A total of 49 patients (16.2%) underwent pleurectomy, 57 (18.9%) received radiotherapy, and 279 patients received first‐line platinum‐based chemotherapy. The overall response rate to first‐line chemotherapy was 40.4%, progression‐free survival to first‐line treatment was 5.7 months (95% CI 4.9–6.5), and 63 (20.8%) patients had pemetrexed maintenance. The median overall survival was 16.8 months (95% CI 13.0–20.5), and multivariate analysis found that stage (P = 0.013), and pleurodesis (P = 0.048), were independent prognostic factors for first‐line overall survival. The model to predict response to first‐line chemotherapy obtained a 0.98 area under the curve, a sensitivity of 93%, and a specificity of 95% for detecting responders and non‐responders. Conclusion This study identifies factors associated with clinical benefit from chemotherapy among advanced MPM Latin American patients, emphasizing the impact of histology and the clinical benefit of chemotherapy on outcomes.
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Affiliation(s)
- Leonardo Rojas
- Clinical Oncology Department, Organización Sanitas Internacional, University Clinic Colombia, Bogota, Colombia.,Clinical and Traslational Oncology Group, Country Clinic, Bogota, Colombia.,Foundation for Clinical and Applied Cancer Research - FICMAC, Bogota, Colombia
| | - Andrés F Cardona
- Clinical and Traslational Oncology Group, Country Clinic, Bogota, Colombia.,Foundation for Clinical and Applied Cancer Research - FICMAC, Bogota, Colombia.,Clinical Research and Biology Systems Department, El Bosque University, Bogotá, Colombia
| | | | | | | | | | - Saúl Campos Gómez
- Medical Oncology Department, State Oncology Center ISSEMyM, Toluca, Mexico
| | - Luis Corrales
- Oncology Department, San Juan de Dios Hospital, San José Costa Rica, Costa Rica
| | | | - Ludwing Bacon
- Oncology Department, Roberto Calderón Hospital, Managua, Nicaragua
| | - Claudio Martín
- Thoracic Oncology Section, Alexander Fleming Institute, Buenos Aires, Argentina
| | | | - Helano C Freitas
- Medical Oncology Department, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Luis Mas
- Clinical Oncology Department, Naiional Institute for Neoplastic Diseases - INEN, Lima, Peru
| | - Carlos Vargas
- Clinical and Traslational Oncology Group, Country Clinic, Bogota, Colombia.,Foundation for Clinical and Applied Cancer Research - FICMAC, Bogota, Colombia.,Clinical Research and Biology Systems Department, El Bosque University, Bogotá, Colombia
| | - Hernán Carranza
- Clinical and Traslational Oncology Group, Country Clinic, Bogota, Colombia.,Foundation for Clinical and Applied Cancer Research - FICMAC, Bogota, Colombia.,Clinical Research and Biology Systems Department, El Bosque University, Bogotá, Colombia
| | - Jorge Otero
- Clinical and Traslational Oncology Group, Country Clinic, Bogota, Colombia.,Foundation for Clinical and Applied Cancer Research - FICMAC, Bogota, Colombia.,Clinical Research and Biology Systems Department, El Bosque University, Bogotá, Colombia
| | | | | | | | - Sara T Granados
- Foundation for Clinical and Applied Cancer Research - FICMAC, Bogota, Colombia
| | - July Rodriguez
- Foundation for Clinical and Applied Cancer Research - FICMAC, Bogota, Colombia.,Clinical Research and Biology Systems Department, El Bosque University, Bogotá, Colombia
| | - Renata Báez
- National Institute for Respiratory Diseases, Mexico City, Mexico
| | | | | | - Pilar Archila
- Foundation for Clinical and Applied Cancer Research - FICMAC, Bogota, Colombia.,Clinical Research and Biology Systems Department, El Bosque University, Bogotá, Colombia
| | - Mauricio Cuello
- Hospital de Clínicas, Republic University - UdeLAR, Montevideo, Uruguay
| | - Niki Karachaliou
- Dr. Rosell Oncology Institute (IOR), Catalan Institute of Oncology, Barcelona, Spain
| | - Rafael Rosell
- Dr. Rosell Oncology Institute (IOR), Catalan Institute of Oncology, Barcelona, Spain
| | - Oscar Arrieta
- Thoracic Oncology Unit, National Cancer Institute, Mexico City, Mexico
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Amin W, Linkov F, Landsittel DP, Silverstein JC, Bashara W, Gaudioso C, Feldman MD, Pass HI, Melamed J, Friedberg JS, Becich MJ. Factors influencing malignant mesothelioma survival: a retrospective review of the National Mesothelioma Virtual Bank cohort. F1000Res 2018; 7:1184. [PMID: 30410729 DOI: 10.12688/f1000research.15512.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/27/2018] [Indexed: 12/30/2022] Open
Abstract
Background: Malignant mesothelioma (MM) is a rare but deadly malignancy with about 3,000 new cases being diagnosed each year in the US. Very few studies have been performed to analyze factors associated with mesothelioma survival, especially for peritoneal presentation. The overarching aim of this study is to examine survival of the cohort of patients with malignant mesothelioma enrolled in the National Mesothelioma Virtual Bank (NMVB). Methods: 888 cases of pleural and peritoneal mesothelioma cases were selected from the NMVB database, which houses data and associated biospecimens for over 1400 cases that were diagnosed from 1990 to 2017. Kaplan Meier's method was performed for survival analysis. The association between prognostic factors and survival was estimated using Cox Hazard Regression method and using R software for analysis. Results: The median overall survival (OS) rate of all MM patients, including pleural and peritoneal mesothelioma cases is 15 months (14 months for pleural and 31 months for peritoneal). Significant prognostic factors associated with improved survival of malignant mesothelioma cases in this NMVB cohort were younger than 45, female gender, epithelioid histological subtype, stage I, peritoneal occurrence, and having combination treatment of surgical therapy with chemotherapy. Combined surgical and chemotherapy treatment was associated with improved survival of 23 months in comparison to single line therapies. Conclusions: There has not been improvement in the overall survival for patients with malignant mesothelioma over many years with current available treatment options. Our findings show that combined surgical and chemotherapy treatment in peritoneal mesothelioma is associated with improved survival compared to local therapy alone.
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Affiliation(s)
- Waqas Amin
- Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA, 15206, USA
| | - Faina Linkov
- Obstetrics, Gynecology and Reproductive Science,, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | | | | | - Wiam Bashara
- Department of Pathology and Lab. Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA
| | - Carmelo Gaudioso
- Department of Pathology and Lab. Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA.,Department of Biostatistics & Bioinformatics, Roswell Park Cancer Institute, Buffalo, NY, 14263, USA
| | - Michael D Feldman
- Department of Pathology and Laboratory Medicine, The Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Harvey I Pass
- Department of Surgery, New York University Langone Health, New York, NY, 10016, USA
| | - Jonathan Melamed
- Department of Pathology, New York University Langone Health, New York, NY, 10016, USA
| | - Joseph S Friedberg
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Michael J Becich
- Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA, 15206, USA
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Amin W, Linkov F, Landsittel DP, Silverstein JC, Bshara W, Gaudioso C, Feldman MD, Pass HI, Melamed J, Friedberg JS, Becich MJ. Factors influencing malignant mesothelioma survival: a retrospective review of the National Mesothelioma Virtual Bank cohort. F1000Res 2018; 7:1184. [PMID: 30410729 PMCID: PMC6198263 DOI: 10.12688/f1000research.15512.2] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2019] [Indexed: 07/26/2023] Open
Abstract
Background: Malignant mesothelioma (MM) is a rare but deadly malignancy with about 3,000 new cases being diagnosed each year in the US. Very few studies have been performed to analyze factors associated with mesothelioma survival, especially for peritoneal presentation. The overarching aim of this study is to examine survival of the cohort of patients with malignant mesothelioma enrolled in the National Mesothelioma Virtual Bank (NMVB). Methods: 888 cases of pleural and peritoneal mesothelioma cases were selected from the NMVB database, which houses data and associated biospecimens for over 1400 cases that were diagnosed from 1990 to 2017. Kaplan Meier's method was performed for survival analysis. The association between prognostic factors and survival was estimated using Cox Hazard Regression method and using R software for analysis. Results: The median overall survival (OS) rate of all MM patients, including pleural and peritoneal mesothelioma cases is 15 months (14 months for pleural and 31 months for peritoneal). Significant prognostic factors associated with improved survival of malignant mesothelioma cases in this NMVB cohort were younger than 45, female gender, epithelioid histological subtype, stage I, peritoneal occurrence, and having combination treatment of surgical therapy with chemotherapy. Combined surgical and chemotherapy treatment was associated with improved survival of 23 months in comparison to single line therapies. Conclusions: There has not been improvement in the overall survival for patients with malignant mesothelioma over many years with current available treatment options. Our findings show that combined surgical and chemotherapy treatment in peritoneal mesothelioma is associated with improved survival compared to local therapy alone.
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Affiliation(s)
- Waqas Amin
- Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA, 15206, USA
| | - Faina Linkov
- Obstetrics, Gynecology and Reproductive Science,, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | | | | | - Wiam Bshara
- Department of Pathology and Lab. Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA
| | - Carmelo Gaudioso
- Department of Pathology and Lab. Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA
- Department of Biostatistics & Bioinformatics, Roswell Park Cancer Institute, Buffalo, NY, 14263, USA
| | - Michael D. Feldman
- Department of Pathology and Laboratory Medicine, The Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Harvey I. Pass
- Department of Surgery, New York University Langone Health, New York, NY, 10016, USA
| | - Jonathan Melamed
- Department of Pathology, New York University Langone Health, New York, NY, 10016, USA
| | - Joseph S. Friedberg
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Michael J. Becich
- Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA, 15206, USA
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29
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Amin W, Linkov F, Landsittel DP, Silverstein JC, Bashara W, Gaudioso C, Feldman MD, Pass HI, Melamed J, Friedberg JS, Becich MJ. Factors influencing malignant mesothelioma survival: a retrospective review of the National Mesothelioma Virtual Bank cohort. F1000Res 2018; 7:1184. [PMID: 30410729 PMCID: PMC6198263 DOI: 10.12688/f1000research.15512.3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2019] [Indexed: 12/16/2022] Open
Abstract
Background: Malignant mesothelioma (MM) is a rare but deadly malignancy with about 3,000 new cases being diagnosed each year in the US. Very few studies have been performed to analyze factors associated with mesothelioma survival, especially for peritoneal presentation. The overarching aim of this study is to examine survival of the cohort of patients with malignant mesothelioma enrolled in the National Mesothelioma Virtual Bank (NMVB). Methods: 888 cases of pleural and peritoneal mesothelioma cases were selected from the NMVB database, which houses data and associated biospecimens for over 1400 cases that were diagnosed from 1990 to 2017. Kaplan Meier’s method was performed for survival analysis. The association between prognostic factors and survival was estimated using Cox Hazard Regression method and using R software for analysis. Results: The median overall survival (OS) rate of all MM patients, including pleural and peritoneal mesothelioma cases is 15 months (14 months for pleural and 31 months for peritoneal). Significant prognostic factors associated with improved survival of malignant mesothelioma cases in this NMVB cohort were younger than 45, female gender, epithelioid histological subtype, stage I, peritoneal occurrence, and having combination treatment of surgical therapy with chemotherapy. Combined surgical and chemotherapy treatment was associated with improved survival of 23 months in comparison to single line therapies. Conclusions: There has not been improvement in the overall survival for patients with malignant mesothelioma over many years with current available treatment options. Our findings show that combined surgical and chemotherapy treatment in peritoneal mesothelioma is associated with improved survival compared to local therapy alone.
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Affiliation(s)
- Waqas Amin
- Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA, 15206, USA
| | - Faina Linkov
- Obstetrics, Gynecology and Reproductive Science,, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | | | | | - Wiam Bashara
- Department of Pathology and Lab. Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA
| | - Carmelo Gaudioso
- Department of Pathology and Lab. Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA.,Department of Biostatistics & Bioinformatics, Roswell Park Cancer Institute, Buffalo, NY, 14263, USA
| | - Michael D Feldman
- Department of Pathology and Laboratory Medicine, The Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Harvey I Pass
- Department of Surgery, New York University Langone Health, New York, NY, 10016, USA
| | - Jonathan Melamed
- Department of Pathology, New York University Langone Health, New York, NY, 10016, USA
| | - Joseph S Friedberg
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Michael J Becich
- Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA, 15206, USA
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Bibby AC, Dorn P, Psallidas I, Porcel JM, Janssen J, Froudarakis M, Subotic D, Astoul P, Licht P, Schmid R, Scherpereel A, Rahman NM, Cardillo G, Maskell NA. ERS/EACTS statement on the management of malignant pleural effusions. Eur Respir J 2018; 52:13993003.00349-2018. [DOI: 10.1183/13993003.00349-2018] [Citation(s) in RCA: 116] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 03/28/2018] [Indexed: 02/07/2023]
Abstract
Malignant pleural effusions (MPE) are a common pathology, treated by respiratory physicians and thoracic surgeons alike. In recent years, several well-designed randomised clinical trials have been published that have changed the landscape of MPE management. The European Respiratory Society (ERS) and the European Association for Cardio-Thoracic Surgery (EACTS) established a multidisciplinary collaboration of clinicians with expertise in the management of MPE with the aim of producing a comprehensive review of the scientific literature.Six areas of interest were identified, including the optimum management of symptomatic MPE, management of trapped lung in MPE, management of loculated MPE, prognostic factors in MPE, whether there is a role for oncological therapies prior to intervention for MPE and whether a histological diagnosis is always required in MPE.The literature revealed that talc pleurodesis and indwelling pleural catheters effectively manage the symptoms of MPE. There was limited evidence regarding the management of trapped lung or loculated MPE. The LENT score was identified as a validated tool for predicting survival in MPE, with Brims' prognostic score demonstrating utility in mesothelioma prognostication. There was no evidence to support the use of oncological therapies as an alternative to MPE drainage, and the literature supported the use of tissue biopsy as the gold standard for diagnosis and treatment planning.
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Khanna S, Graef S, Mussai F, Thomas A, Wali N, Yenidunya BG, Yuan C, Morrow B, Zhang J, Korangy F, Greten TF, Steinberg SM, Stetler-Stevenson M, Middleton G, De Santo C, Hassan R. Tumor-Derived GM-CSF Promotes Granulocyte Immunosuppression in Mesothelioma Patients. Clin Cancer Res 2018; 24:2859-2872. [PMID: 29602801 PMCID: PMC6601632 DOI: 10.1158/1078-0432.ccr-17-3757] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 02/09/2018] [Accepted: 03/23/2018] [Indexed: 12/12/2022]
Abstract
Purpose: The cross-talk between tumor cells, myeloid cells, and T cells can play a critical role in tumor pathogenesis and response to immunotherapies. Although the etiology of mesothelioma is well understood, the impact of mesothelioma tumor cells on the surrounding immune microenvironment is less well studied. In this study, the effect of the mesothelioma tumor microenvironment on circulating and infiltrating granulocytes and T cells is investigated.Experimental Design: Tumor tissues and peripheral blood from mesothelioma patients were evaluated for presence of granulocytes, which were then tested for their T-cell suppression potential. Different cocultures of granulocytes and/or mesothelioma tumor cells and/or T cells were set up to identify the mechanism of T-cell inhibition.Results: Analysis of human tumors showed that the mesothelioma microenvironment is enriched in infiltrating granulocytes, which inhibit T-cell proliferation and activation. Characterization of the whole blood at diagnosis identified similar, circulating, immunosuppressive CD11b+CD15+HLADR- granulocytes at increased frequency compared with healthy controls. Culture of healthy-donor granulocytes with human mesothelioma cells showed that GM-CSF upregulates NOX2 expression and the release of reactive oxygen species (ROS) from granulocytes, resulting in T-cell suppression. Immunohistochemistry and transcriptomic analysis revealed that a majority of mesothelioma tumors express GM-CSF and that higher GM-CSF expression correlated with clinical progression. Blockade of GM-CSF with neutralizing antibody, or ROS inhibition, restored T-cell proliferation, suggesting that targeting of GM-CSF could be of therapeutic benefit in these patients.Conclusions: Our study presents the mechanism behind the cross-talk between mesothelioma tumors and the immune microenvironment and indicates that targeting GM-CSF could be a novel treatment strategy to augment immunotherapy in patients with mesothelioma. Clin Cancer Res; 24(12); 2859-72. ©2018 AACR.
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Affiliation(s)
- Swati Khanna
- Thoracic and GI Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Suzanne Graef
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Francis Mussai
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Anish Thomas
- Thoracic and GI Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Neha Wali
- University of Maryland Baltimore County, Baltimore, Maryland
| | | | - Constance Yuan
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Betsy Morrow
- Thoracic and GI Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Jingli Zhang
- Thoracic and GI Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Firouzeh Korangy
- Thoracic and GI Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Tim F Greten
- Thoracic and GI Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Seth M Steinberg
- Biostatistics and Data Management Section, Office of the Clinical Director, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Maryalice Stetler-Stevenson
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Gary Middleton
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Carmela De Santo
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Raffit Hassan
- Thoracic and GI Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
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Wu TH, Lee LJH, Yuan CT, Chen TWW, Yang JCH. Prognostic factors and treatment outcomes of malignant pleural mesothelioma in Eastern Asian patients - A Taiwanese study. J Formos Med Assoc 2018; 118:230-236. [PMID: 29709339 DOI: 10.1016/j.jfma.2018.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 03/27/2018] [Accepted: 04/03/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND/PURPOSE There are scarce reports on the prognostic factors and treatment outcomes of patients with malignant pleural mesothelioma (MPM) in Asia. This study aimed to address these matters in a real-world setting. METHODS Medical records of patients with histologically proven MPM diagnosed between 1977 and 2016 at the National Taiwan University Hospital were reviewed. Variables including age, gender, performance status, asbestos exposure, smoking history, histology subtype, staging, and treatment received were recorded. All patients were followed until death or March 1st, 2017. Survival and prognostic factors were analyzed by the Kaplan-Meir method and the Cox proportional hazard model. RESULTS A total of 93 patients was identified, including 65 men and 28 women. An increasing trend of MPM cases diagnosed was observed in the past 40 years. Stage I/II disease (HR 0.24, 95% CI 0.13-0.46) and epithelioid histology (HR 0.42, 95% CI 0.23-0.75) were associated with favorable prognosis, whereas age ≥70 years (HR 2.66, 95% CI 1.36-5.22) and ECOG ≥2 (HR 5.03, 95% CI 2.69-9.4) were poor prognostic factors. After adjustment for prognostic factors, surgery in stage I-III MPM (HR 0.36, 95% CI 0.15-0.83) and systemic therapy in stage III/IV disease (HR 0.42, 95% CI 0.19-0.94) conferred a survival benefit. CONCLUSION This is one of the largest case series of MPM reported in Asia outside of Japan. Prognostic factors in the study population included age, performance status, stage, and histology subtype. Surgery in potentially resectable disease and systemic therapy in advanced MPM confer a survival benefit in Asian patients.
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Affiliation(s)
- Ting-Hui Wu
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Lukas Jyuhn-Hsiarn Lee
- National Institute of Environmental Health Sciences, National Health Research Institutes, Zhunan, Miaoli, Taiwan; Department of Environmental and Occupational Medicine, National Taiwan University Hospital, Taipei, Taiwan; Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chang-Tsu Yuan
- Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan
| | - Tom Wei-Wu Chen
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan; National Taiwan University Cancer Center, Taipei, Taiwan; Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan.
| | - James Chih-Hsin Yang
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan; National Taiwan University Cancer Center, Taipei, Taiwan; Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan
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Chouaid C, Assié JB, Andujar P, Blein C, Tournier C, Vainchtock A, Scherpereel A, Monnet I, Pairon JC. Determinants of malignant pleural mesothelioma survival and burden of disease in France: a national cohort analysis. Cancer Med 2018; 7:1102-1109. [PMID: 29479845 PMCID: PMC5911629 DOI: 10.1002/cam4.1378] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 12/03/2017] [Accepted: 12/04/2017] [Indexed: 01/02/2023] Open
Abstract
This study was undertaken to determine the healthcare burden of malignant pleural mesothelioma (MPM) in France and to analyze its associations with socioeconomic deprivation, population density, and management outcomes. A national hospital database was used to extract incident MPM patients in years 2011 and 2012. Cox models were used to analyze 1- and 2-year survival according to sex, age, co-morbidities, management, population-density index, and social deprivation index. The analysis included 1,890 patients (76% men; age: 73.6 ± 10.0 years; 84% with significant co-morbidities; 57% living in urban zones; 53% in highly underprivileged areas). Only 1% underwent curative surgical procedure; 65% received at least one chemotherapy cycle, 72% of them with at least one pemetrexed and/or bevacizumab administration. One- and 2-year survival rates were 64% and 48%, respectively. Median survival was 14.9 (95% CI: 13.7-15.7) months. The mean cost per patient was 27,624 ± 17,263 euros (31% representing pemetrexed and bevacizumab costs). Multivariate analyses retained men, age >70 years, chronic renal failure, chronic respiratory failure, and never receiving pemetrexed as factors of poor prognosis. After adjusting the analysis to age, sex, and co-morbidities, living in rural/semi-rural area was associated with better 2-year survival (HR: 0.83 [95% CI: 0.73-0.94]; P < 0.01); social deprivation index was not significantly associated with survival. With approximately 1,000 new cases per year in France, MPMs represents a significant national health care burden. Co-morbidities, sex, age, and living place appear to be significant factors of prognosis.
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Affiliation(s)
- Christos Chouaid
- GRC OncoThoParisEstService de Pneumologie, CHI CréteilUPECCréteilFrance
| | | | - Pascal Andujar
- Inserm U955Institut Santé Travail Paris EstService de Pneumologie et de Pathologie ProfessionnelleCHI CréteilCréteilFrance
| | | | | | | | - Arnaud Scherpereel
- Thoracic Oncology DepartmentUniversity of LilleCHU Lille, CIIL, Inserm U1019CréteilFrance
| | - Isabelle Monnet
- GRC OncoThoParisEstService de Pneumologie, CHI CréteilUPECCréteilFrance
| | - Jean Claude Pairon
- Inserm U955Institut Santé Travail Paris EstService de Pneumologie et de Pathologie ProfessionnelleCHI CréteilCréteilFrance
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Kresoja-Rakic J, Kapaklikaya E, Ziltener G, Dalcher D, Santoro R, Christensen BC, Johnson KC, Schwaller B, Weder W, Stahel RA, Felley-Bosco E. Identification of cis- and trans-acting elements regulating calretinin expression in mesothelioma cells. Oncotarget 2018; 7:21272-86. [PMID: 26848772 PMCID: PMC5008284 DOI: 10.18632/oncotarget.7114] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 01/18/2016] [Indexed: 12/16/2022] Open
Abstract
Calretinin (CALB2) is a diagnostic marker for epithelioid mesothelioma. It is also a prognostic marker since patients with tumors expressing high calretinin levels have better overall survival. Silencing of calretinin decreases viability of epithelioid mesothelioma cells. Our aim was to elucidate mechanisms regulating calretinin expression in mesothelioma. Analysis of calretinin transcript and protein suggested a control at the mRNA level. Treatment with 5-aza-2′-deoxycytidine and analysis of TCGA data indicated that promoter methylation is not likely to be involved. Therefore, we investigated CALB2 promoter by analyzing ~1kb of genomic sequence surrounding the transcription start site (TSS) + 1 using promoter reporter assay. Deletion analysis of CALB2 proximal promoter showed that sequence spanning the −161/+80bp region sustained transcriptional activity. Site-directed analysis identified important cis-regulatory elements within this −161/+80bp CALB2 promoter. EMSA and ChIP assays confirmed binding of NRF-1 and E2F2 to the CALB2 promoter and siRNA knockdown of NRF-1 led to decreased expression of calretinin. Cell synchronization experiment showed that calretinin expression was cell cycle regulated with a peak of expression at G1/S phase. This study provides the first insight in the regulation of CALB2 expression in mesothelioma cells.
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Affiliation(s)
- Jelena Kresoja-Rakic
- Laboratory of Molecular Oncology, Clinic of Oncology, University Hospital Zürich, Zürich, Switzerland
| | - Esra Kapaklikaya
- Laboratory of Molecular Oncology, Clinic of Oncology, University Hospital Zürich, Zürich, Switzerland
| | - Gabriela Ziltener
- Laboratory of Molecular Oncology, Clinic of Oncology, University Hospital Zürich, Zürich, Switzerland
| | - Damian Dalcher
- Institute of Veterinary Biochemistry and Molecular Biology, University of Zürich, Zürich, Switzerland
| | - Raffaella Santoro
- Institute of Veterinary Biochemistry and Molecular Biology, University of Zürich, Zürich, Switzerland
| | - Brock C Christensen
- Departments of Epidemiology, Pharmacology and Toxicology and Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Kevin C Johnson
- Departments of Epidemiology, Pharmacology and Toxicology and Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Beat Schwaller
- Anatomy, Department of Medicine, University of Fribourg, Fribourg, Switzerland
| | - Walter Weder
- Division of Thoracic Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Rolf A Stahel
- Laboratory of Molecular Oncology, Clinic of Oncology, University Hospital Zürich, Zürich, Switzerland
| | - Emanuela Felley-Bosco
- Laboratory of Molecular Oncology, Clinic of Oncology, University Hospital Zürich, Zürich, Switzerland
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Barone E, Gemignani F, Landi S. Overexpressed genes in malignant pleural mesothelioma: implications in clinical management. J Thorac Dis 2018; 10:S369-S382. [PMID: 29507807 PMCID: PMC5830549 DOI: 10.21037/jtd.2017.10.158] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 10/25/2017] [Indexed: 01/11/2023]
Abstract
Malignant pleural mesothelioma (MPM) is a very aggressive cancer poorly responsive to current therapies. MPM patients have a very poor prognosis with a median survival of less than one year from the onset of symptoms. The biomarkers proposed so far do not lead to a sufficiently early diagnosis for a radical treatment of the disease. Thus, the finding of novel diagnostic and prognostic biomarkers and therapeutic targets is needed. Gene overexpression has been frequently associated with a malignant phenotype in several cancer types; therefore the identification of overexpressed genes may lead to the detection of novel prognostic or diagnostic marker and to the development of novel therapeutic approaches, based on their inhibition. In the last years, several overexpressed genes have been identified in MPM through gene expression profiling techniques: among them it has been found a group of 51 genes that resulted overexpressed in more than one independent study, revealing their consistency among studies. This article reviews the clinical implications of confirmed overexpressed genes in MPM described so far in literature.
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Affiliation(s)
- Elisa Barone
- Department of Biology, Genetic Unit, University of Pisa, Pisa, Italy
| | | | - Stefano Landi
- Department of Biology, Genetic Unit, University of Pisa, Pisa, Italy
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36
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Bibby AC, De Fonseka D, Morley AJ, Keenan E, Addeo A, Smith S, Edey AJ, Maskell NA. Exploring the characteristics of patients with mesothelioma who chose active symptom control over chemotherapy as first-line treatment: a prospective, observational, single centre study. BMC Palliat Care 2017; 16:71. [PMID: 29221485 PMCID: PMC5723074 DOI: 10.1186/s12904-017-0255-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 11/30/2017] [Indexed: 12/29/2022] Open
Abstract
Background Mesothelioma is an aggressive thoracic tumour with a poor prognosis. The only treatment that extends survival is chemotherapy. However, in the UK, up to 50% of patients who are suitable for chemotherapy choose not to receive it, opting for active symptom control instead. The aim of this prospective, single-centre observational study was to describe the characteristics of patients who chose active symptom control over chemotherapy and explore their reasons for doing so. Methods Two hundred consecutive patients with mesothelioma from one UK centre were included. Eligibility for chemotherapy and choice of first-line treatment were recorded prospectively. Patient characteristics and outcomes were compared using descriptive statistics, regression analysis and survival analysis. Reasons for choosing active symptom control over chemotherapy were extracted, retrospectively. Results People who chose active symptom control were older, more likely to be female and had worse performance statuses than patients who received front-line chemotherapy. Concern over side effects, the modest survival benefit and previous adverse experiences with chemotherapy were reported as reasons for the decision. Median survival was 13.9 months in the chemotherapy group compared with 6.7 months in the active symptom control group. Conclusions This is the first study to describe the characteristics of patients with mesothelioma who chose active symptom control over chemotherapy, in the front-line setting. Important differences were seen between this group and patients who received chemotherapy, although confounding is likely to have affected some outcomes. Future research could use qualitative methods to explore patients’ reasons for choosing active symptom control, and to further elucidate the decision-making process. Electronic supplementary material The online version of this article (10.1186/s12904-017-0255-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anna C Bibby
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Southmead Hospital, 2nd Floor L&R Building, Bristol, BS10 5NB, UK. .,Department of Respiratory Medicine, North Bristol NHS Trust, Southmead Hospital, Bristol, BS10 5NB, UK.
| | - Duneesha De Fonseka
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Southmead Hospital, 2nd Floor L&R Building, Bristol, BS10 5NB, UK.,Department of Respiratory Medicine, North Bristol NHS Trust, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Anna J Morley
- Department of Respiratory Medicine, North Bristol NHS Trust, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Emma Keenan
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Southmead Hospital, 2nd Floor L&R Building, Bristol, BS10 5NB, UK
| | - Alfredo Addeo
- Bristol Cancer Institute, Bristol Haematology & Oncology Centre, Horfield Rd, Bristol, BS2 8ED, UK
| | - Sarah Smith
- Department of Respiratory Medicine, North Bristol NHS Trust, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Anthony J Edey
- Department of Radiology, North Bristol NHS Trust, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Nick A Maskell
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Southmead Hospital, 2nd Floor L&R Building, Bristol, BS10 5NB, UK.,Department of Respiratory Medicine, North Bristol NHS Trust, Southmead Hospital, Bristol, BS10 5NB, UK
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The role of the systemic inflammatory response in predicting outcomes in patients with operable cancer: Systematic review and meta-analysis. Sci Rep 2017; 7:16717. [PMID: 29196718 PMCID: PMC5711862 DOI: 10.1038/s41598-017-16955-5] [Citation(s) in RCA: 198] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 11/17/2017] [Indexed: 02/06/2023] Open
Abstract
Cancer remains a leading causes of death worldwide and an elevated systemic inflammatory response (SIR) is associated with reduced survival in patients with operable cancer. This review aims to examine the evidence for the role of systemic inflammation based prognostic scores in patients with operable cancers. A wide-ranging literature review using targeted medical subject headings for human studies in English was carried out in the MEDLINE, EMBASE, and CDSR databases until the end of 2016. The SIR has independent prognostic value, across tumour types and geographical locations. In particular neutrophil lymphocyte ratio (NLR) (n = 158), platelet lymphocyte ratio (PLR) (n = 68), lymphocyte monocyte ratio (LMR) (n = 21) and Glasgow Prognostic Score/ modified Glasgow Prognostic Score (GPS/mGPS) (n = 60) were consistently validated. On meta-analysis there was a significant relationship between elevated NLR and overall survival (OS) (p < 0.00001)/ cancer specific survival (CSS) (p < 0.00001), between elevated LMR and OS (p < 0.00001)/CSS (p < 0.00001), and elevated PLR and OS (p < 0.00001)/CSS (p = 0.005). There was also a significant relationship between elevated GPS/mGPS and OS (p < 0.00001)/CSS (p < 0.00001). These results consolidate the prognostic value of the NLR, PLR, LMR and GPS/mGPS in patients with resectable cancers. This is particularly true for the NLR/GPS/mGPS which should form part of the routine preoperative and postoperative workup.
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Chou A, Toon CW, Clarkson A, Sheen A, Sioson L, Gill AJ. The epithelioid BAP1-negative and p16-positive phenotype predicts prolonged survival in pleural mesothelioma. Histopathology 2017; 72:509-515. [DOI: 10.1111/his.13392] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 09/05/2017] [Indexed: 12/23/2022]
Affiliation(s)
- Angela Chou
- Cancer Diagnosis and Pathology Group; Kolling Institute of Medical Research; St Leonards NSW Australia
- University of Sydney; Sydney NSW Australia
- Department of Anatomical Pathology; SYDPATH, St Vincent's Hospital; Darlinghurst NSW Australia
- The Kinghorn Cancer Centre and Garvan Institute of Medical Research; Darlinghurst NSW Australia
| | - Christopher W Toon
- Cancer Diagnosis and Pathology Group; Kolling Institute of Medical Research; St Leonards NSW Australia
- University of Sydney; Sydney NSW Australia
- Histopath Pathology; Macquarie Park NSW Australia
| | - Adele Clarkson
- Cancer Diagnosis and Pathology Group; Kolling Institute of Medical Research; St Leonards NSW Australia
- NSW Health Pathology, Department of Anatomical Pathology; Royal North Shore Hospital; St Leonards NSW Australia
| | - Amy Sheen
- Cancer Diagnosis and Pathology Group; Kolling Institute of Medical Research; St Leonards NSW Australia
| | - Loretta Sioson
- Cancer Diagnosis and Pathology Group; Kolling Institute of Medical Research; St Leonards NSW Australia
| | - Anthony J Gill
- Cancer Diagnosis and Pathology Group; Kolling Institute of Medical Research; St Leonards NSW Australia
- University of Sydney; Sydney NSW Australia
- NSW Health Pathology, Department of Anatomical Pathology; Royal North Shore Hospital; St Leonards NSW Australia
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Tumor Suppressor microRNAs Contribute to the Regulation of PD-L1 Expression in Malignant Pleural Mesothelioma. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.05.024] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Bonomi M, De Filippis C, Lopci E, Gianoncelli L, Rizzardi G, Cerchiaro E, Bortolotti L, Zanello A, Ceresoli GL. Clinical staging of malignant pleural mesothelioma: current perspectives. LUNG CANCER-TARGETS AND THERAPY 2017; 8:127-139. [PMID: 28860886 PMCID: PMC5571821 DOI: 10.2147/lctt.s102113] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Malignant pleural mesothelioma (MPM) is a disease with limited therapeutic options, the management of which is still controversial. Diagnosis is usually made by thoracoscopy, which allows multiple biopsies with histological subtyping and is indicated for staging purposes in surgical candidates. The recommended and recently updated classification for clinical use is the TNM staging system established by the International Mesothelioma Interest Group and the International Association for the Study of Lung Cancer, which is based mainly on surgical and pathological variables, as well as on cross-sectional imaging. Contrast-enhanced computed tomography is the primary imaging procedure. Currently, the most used measurement system for MPM is the modified Response Evaluation Criteria in Solid Tumors (RECIST) method, which is based on unidimensional measurements of tumor thickness perpendicular to the chest wall or mediastinum. Magnetic resonance imaging and functional imaging with 18F-fluoro-2-deoxy-D-glucose positron-emission tomography can provide additional staging information in selected cases, although the usefulness of this method is limited in patients undergoing pleurodesis. Molecular reclassification of MPM and gene expression or miRNA prognostic models have the potential to improve prognostication and patient selection for a proper treatment algorithm; however, they await prospective validation to be introduced in clinical practice.
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Affiliation(s)
- Maria Bonomi
- Department of Oncology, Thoracic and GU Oncology Unit
| | | | - Egesta Lopci
- Nuclear Medicine Unit, Humanitas Clinical and Research Hospital, Milan
| | | | - Giovanna Rizzardi
- Department of Thoracic Surgery, Cliniche Humanitas Gavazzeni, Bergamo, Italy
| | | | - Luigi Bortolotti
- Department of Thoracic Surgery, Cliniche Humanitas Gavazzeni, Bergamo, Italy
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Cornelissen R, Hegmans JPJJ, Maat APWM, Kaijen-Lambers MEH, Bezemer K, Hendriks RW, Hoogsteden HC, Aerts JGJV. Extended Tumor Control after Dendritic Cell Vaccination with Low-Dose Cyclophosphamide as Adjuvant Treatment in Patients with Malignant Pleural Mesothelioma. Am J Respir Crit Care Med 2017; 193:1023-31. [PMID: 26652184 DOI: 10.1164/rccm.201508-1573oc] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE We demonstrated previously that autologous tumor lysate-pulsed dendritic cell-based immunotherapy in patients with malignant pleural mesothelioma is feasible, well-tolerated, and capable of inducing immunologic responses against tumor cells. In our murine model, we found that reduction of regulatory T cells with metronomic cyclophosphamide increased the efficacy of immunotherapy. OBJECTIVES To assess the decrease in number of peripheral blood regulatory T cells during combination therapy of low-dose cyclophosphamide and dendritic cell immunotherapy and determine the induction of immunologic responses with this treatment in patients with mesothelioma. METHODS Ten patients with malignant pleural mesothelioma received metronomic cyclophosphamide and dendritic cell-based immunotherapy. During the treatment, peripheral blood mononuclear cells were analyzed for regulatory T cells and immunologic responses. MEASUREMENTS AND MAIN RESULTS Administration of dendritic cells pulsed with autologous tumor lysate combined with cyclophosphamide in patients with mesothelioma was safe, the only side effect being moderate fever. Dendritic cell vaccination combined with cyclophosphamide resulted in radiographic disease control in 8 of the 10 patients. Overall survival was promising, with 7 out of 10 patients having a survival of greater than or equal to 24 months and two patients still alive after 50 and 66 months. Low-dose cyclophosphamide reduced the percentage of regulatory T cells of total CD4 cells in peripheral blood from 9.43 (range, 4.34-26.10) to 4.51 (range, 0.27-10.30) after 7 days of cyclophosphamide treatment (P = 0.02). CONCLUSIONS Consolidation therapy with autologous tumor lysate-pulsed dendritic cell-based therapy and simultaneously reducing the tumor-induced immune suppression is well-tolerated and shows signs of clinical activity in patients with mesothelioma. Clinical trial registered with www.clinicaltrials.gov (NCT 01241682).
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Affiliation(s)
| | | | - Alexander P W M Maat
- 2 Department of Cardio-Thoracic Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; and
| | | | | | | | | | - Joachim G J V Aerts
- 1 Department of Pulmonary Medicine and.,3 Department of Pulmonary Medicine, Amphia Hospital, Breda, the Netherlands
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Mancuso MR, Neal JW. Novel systemic therapy against malignant pleural mesothelioma. Transl Lung Cancer Res 2017; 6:295-314. [PMID: 28713675 PMCID: PMC5504105 DOI: 10.21037/tlcr.2017.06.01] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 04/28/2017] [Indexed: 12/14/2022]
Abstract
Malignant pleural mesothelioma is an aggressive tumor of the pleura with an overall poor prognosis. Even with surgical resection, for which only a subset of patients are eligible, long term disease free survival is rare. Standard first-line systemic treatment consists of a platinum analog, an anti-metabolite, and sometimes anti-angiogenic therapy, but there is currently no well-established standard therapy for refractory or relapsed disease. This review focuses on efforts to develop improved systemic therapy for the treatment of malignant pleural mesothelioma (MPM) including cytotoxic systemic therapy, a variety of tyrosine kinase inhibitors and their downstream effector pathways, pharmacologic targeting of the epigenome, novel approaches to target proteins expressed on mesothelioma cells (such as mesothelin), arginine depletion therapy, and the emerging role of immunotherapy. Overall, these studies demonstrate the challenges of improving systemic therapy for MPM and highlight the need to develop therapeutic strategies to control this disease.
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Affiliation(s)
- Michael R Mancuso
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Joel W Neal
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Beddowes E, Spicer J, Chan PY, Khadeir R, Corbacho JG, Repana D, Steele JP, Schmid P, Szyszko T, Cook G, Diaz M, Feng X, Johnston A, Thomson J, Sheaff M, Wu BW, Bomalaski J, Pacey S, Szlosarek PW. Phase 1 Dose-Escalation Study of Pegylated Arginine Deiminase, Cisplatin, and Pemetrexed in Patients With Argininosuccinate Synthetase 1-Deficient Thoracic Cancers. J Clin Oncol 2017; 35:1778-1785. [PMID: 28388291 PMCID: PMC6141244 DOI: 10.1200/jco.2016.71.3230] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Purpose Pegylated arginine deiminase (ADI-PEG 20) depletes essential amino acid levels in argininosuccinate synthetase 1 (ASS1) -negative tumors by converting arginine to citrulline and ammonia. The main aim of this study was to determine the recommended dose, safety, and tolerability of ADI-PEG 20, cisplatin, and pemetrexed in patients with ASS1-deficient malignant pleural mesothelioma (MPM) or non-small-cell lung cancer (NSCLC). Patients and Methods Using a 3 + 3 + 3 dose-escalation study, nine chemotherapy-naïve patients (five MPM, four NSCLC) received weekly ADI-PEG 20 doses of 18 mg/m2, 27 mg/m2, or 36 mg/m2, together with pemetrexed 500 mg/m2 and cisplatin 75 mg/m2 which were given every three weeks (maximum of six cycles). Patients achieving stable disease or better could continue ADI-PEG 20 monotherapy until disease progression or withdrawal. Adverse events were assessed by Common Terminology Criteria for Adverse Events version 4.03, and pharmacodynamics and immunogenicity were also evaluated. Tumor response was assessed by Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 for NSCLC and by modified RECIST criteria for MPM. Results No dose-limiting toxicities were reported; nine of 38 reported adverse events (all grade 1 or 2) were related to ADI-PEG 20. Circulating arginine concentrations declined rapidly, and citrulline levels increased; both changes persisted at 18 weeks. Partial responses were observed in seven of nine patients (78%), including three with either sarcomatoid or biphasic MPM. Conclusion Target engagement with depletion of arginine was maintained throughout treatment with no dose-limiting toxicities. In this biomarker-selected group of patients with ASS1-deficient cancers, clinical activity was observed in patients with poor-prognosis tumors. Therefore, we recommend a dose for future studies of weekly ADI-PEG 20 36 mg/m2 plus three-weekly cisplatin 75 mg/m2 and pemetrexed 500 mg/m2.
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Affiliation(s)
- Emma Beddowes
- Emma Beddowes, Javier Garcia Corbacho, and Simon Pacey, University of Cambridge, Cambridge; James Spicer, Dimitra Repana, Teresa Szyszko, and Gary Cook, King's College London; Pui Ying Chan, Jeremy P. Steele, Peter Schmid, Michael Sheaff, and Peter W. Szlosarek, St Bartholomew’s Hospital; Ramsay Khadeir, Peter Schmid, and Peter W. Szlosarek, Queen Mary University of London, London, United Kindgom; and Monica Diaz, Xiaoxing Feng, Amanda Johnston, Jim Thomson, Bor-Wen Wu, and John Bomalaski, Polaris Pharmaceuticals, San Diego, CA
| | - James Spicer
- Emma Beddowes, Javier Garcia Corbacho, and Simon Pacey, University of Cambridge, Cambridge; James Spicer, Dimitra Repana, Teresa Szyszko, and Gary Cook, King's College London; Pui Ying Chan, Jeremy P. Steele, Peter Schmid, Michael Sheaff, and Peter W. Szlosarek, St Bartholomew’s Hospital; Ramsay Khadeir, Peter Schmid, and Peter W. Szlosarek, Queen Mary University of London, London, United Kindgom; and Monica Diaz, Xiaoxing Feng, Amanda Johnston, Jim Thomson, Bor-Wen Wu, and John Bomalaski, Polaris Pharmaceuticals, San Diego, CA
| | - Pui Ying Chan
- Emma Beddowes, Javier Garcia Corbacho, and Simon Pacey, University of Cambridge, Cambridge; James Spicer, Dimitra Repana, Teresa Szyszko, and Gary Cook, King's College London; Pui Ying Chan, Jeremy P. Steele, Peter Schmid, Michael Sheaff, and Peter W. Szlosarek, St Bartholomew’s Hospital; Ramsay Khadeir, Peter Schmid, and Peter W. Szlosarek, Queen Mary University of London, London, United Kindgom; and Monica Diaz, Xiaoxing Feng, Amanda Johnston, Jim Thomson, Bor-Wen Wu, and John Bomalaski, Polaris Pharmaceuticals, San Diego, CA
| | - Ramsay Khadeir
- Emma Beddowes, Javier Garcia Corbacho, and Simon Pacey, University of Cambridge, Cambridge; James Spicer, Dimitra Repana, Teresa Szyszko, and Gary Cook, King's College London; Pui Ying Chan, Jeremy P. Steele, Peter Schmid, Michael Sheaff, and Peter W. Szlosarek, St Bartholomew’s Hospital; Ramsay Khadeir, Peter Schmid, and Peter W. Szlosarek, Queen Mary University of London, London, United Kindgom; and Monica Diaz, Xiaoxing Feng, Amanda Johnston, Jim Thomson, Bor-Wen Wu, and John Bomalaski, Polaris Pharmaceuticals, San Diego, CA
| | - Javier Garcia Corbacho
- Emma Beddowes, Javier Garcia Corbacho, and Simon Pacey, University of Cambridge, Cambridge; James Spicer, Dimitra Repana, Teresa Szyszko, and Gary Cook, King's College London; Pui Ying Chan, Jeremy P. Steele, Peter Schmid, Michael Sheaff, and Peter W. Szlosarek, St Bartholomew’s Hospital; Ramsay Khadeir, Peter Schmid, and Peter W. Szlosarek, Queen Mary University of London, London, United Kindgom; and Monica Diaz, Xiaoxing Feng, Amanda Johnston, Jim Thomson, Bor-Wen Wu, and John Bomalaski, Polaris Pharmaceuticals, San Diego, CA
| | - Dimitra Repana
- Emma Beddowes, Javier Garcia Corbacho, and Simon Pacey, University of Cambridge, Cambridge; James Spicer, Dimitra Repana, Teresa Szyszko, and Gary Cook, King's College London; Pui Ying Chan, Jeremy P. Steele, Peter Schmid, Michael Sheaff, and Peter W. Szlosarek, St Bartholomew’s Hospital; Ramsay Khadeir, Peter Schmid, and Peter W. Szlosarek, Queen Mary University of London, London, United Kindgom; and Monica Diaz, Xiaoxing Feng, Amanda Johnston, Jim Thomson, Bor-Wen Wu, and John Bomalaski, Polaris Pharmaceuticals, San Diego, CA
| | - Jeremy P. Steele
- Emma Beddowes, Javier Garcia Corbacho, and Simon Pacey, University of Cambridge, Cambridge; James Spicer, Dimitra Repana, Teresa Szyszko, and Gary Cook, King's College London; Pui Ying Chan, Jeremy P. Steele, Peter Schmid, Michael Sheaff, and Peter W. Szlosarek, St Bartholomew’s Hospital; Ramsay Khadeir, Peter Schmid, and Peter W. Szlosarek, Queen Mary University of London, London, United Kindgom; and Monica Diaz, Xiaoxing Feng, Amanda Johnston, Jim Thomson, Bor-Wen Wu, and John Bomalaski, Polaris Pharmaceuticals, San Diego, CA
| | - Peter Schmid
- Emma Beddowes, Javier Garcia Corbacho, and Simon Pacey, University of Cambridge, Cambridge; James Spicer, Dimitra Repana, Teresa Szyszko, and Gary Cook, King's College London; Pui Ying Chan, Jeremy P. Steele, Peter Schmid, Michael Sheaff, and Peter W. Szlosarek, St Bartholomew’s Hospital; Ramsay Khadeir, Peter Schmid, and Peter W. Szlosarek, Queen Mary University of London, London, United Kindgom; and Monica Diaz, Xiaoxing Feng, Amanda Johnston, Jim Thomson, Bor-Wen Wu, and John Bomalaski, Polaris Pharmaceuticals, San Diego, CA
| | - Teresa Szyszko
- Emma Beddowes, Javier Garcia Corbacho, and Simon Pacey, University of Cambridge, Cambridge; James Spicer, Dimitra Repana, Teresa Szyszko, and Gary Cook, King's College London; Pui Ying Chan, Jeremy P. Steele, Peter Schmid, Michael Sheaff, and Peter W. Szlosarek, St Bartholomew’s Hospital; Ramsay Khadeir, Peter Schmid, and Peter W. Szlosarek, Queen Mary University of London, London, United Kindgom; and Monica Diaz, Xiaoxing Feng, Amanda Johnston, Jim Thomson, Bor-Wen Wu, and John Bomalaski, Polaris Pharmaceuticals, San Diego, CA
| | - Gary Cook
- Emma Beddowes, Javier Garcia Corbacho, and Simon Pacey, University of Cambridge, Cambridge; James Spicer, Dimitra Repana, Teresa Szyszko, and Gary Cook, King's College London; Pui Ying Chan, Jeremy P. Steele, Peter Schmid, Michael Sheaff, and Peter W. Szlosarek, St Bartholomew’s Hospital; Ramsay Khadeir, Peter Schmid, and Peter W. Szlosarek, Queen Mary University of London, London, United Kindgom; and Monica Diaz, Xiaoxing Feng, Amanda Johnston, Jim Thomson, Bor-Wen Wu, and John Bomalaski, Polaris Pharmaceuticals, San Diego, CA
| | - Monica Diaz
- Emma Beddowes, Javier Garcia Corbacho, and Simon Pacey, University of Cambridge, Cambridge; James Spicer, Dimitra Repana, Teresa Szyszko, and Gary Cook, King's College London; Pui Ying Chan, Jeremy P. Steele, Peter Schmid, Michael Sheaff, and Peter W. Szlosarek, St Bartholomew’s Hospital; Ramsay Khadeir, Peter Schmid, and Peter W. Szlosarek, Queen Mary University of London, London, United Kindgom; and Monica Diaz, Xiaoxing Feng, Amanda Johnston, Jim Thomson, Bor-Wen Wu, and John Bomalaski, Polaris Pharmaceuticals, San Diego, CA
| | - Xiaoxing Feng
- Emma Beddowes, Javier Garcia Corbacho, and Simon Pacey, University of Cambridge, Cambridge; James Spicer, Dimitra Repana, Teresa Szyszko, and Gary Cook, King's College London; Pui Ying Chan, Jeremy P. Steele, Peter Schmid, Michael Sheaff, and Peter W. Szlosarek, St Bartholomew’s Hospital; Ramsay Khadeir, Peter Schmid, and Peter W. Szlosarek, Queen Mary University of London, London, United Kindgom; and Monica Diaz, Xiaoxing Feng, Amanda Johnston, Jim Thomson, Bor-Wen Wu, and John Bomalaski, Polaris Pharmaceuticals, San Diego, CA
| | - Amanda Johnston
- Emma Beddowes, Javier Garcia Corbacho, and Simon Pacey, University of Cambridge, Cambridge; James Spicer, Dimitra Repana, Teresa Szyszko, and Gary Cook, King's College London; Pui Ying Chan, Jeremy P. Steele, Peter Schmid, Michael Sheaff, and Peter W. Szlosarek, St Bartholomew’s Hospital; Ramsay Khadeir, Peter Schmid, and Peter W. Szlosarek, Queen Mary University of London, London, United Kindgom; and Monica Diaz, Xiaoxing Feng, Amanda Johnston, Jim Thomson, Bor-Wen Wu, and John Bomalaski, Polaris Pharmaceuticals, San Diego, CA
| | - Jim Thomson
- Emma Beddowes, Javier Garcia Corbacho, and Simon Pacey, University of Cambridge, Cambridge; James Spicer, Dimitra Repana, Teresa Szyszko, and Gary Cook, King's College London; Pui Ying Chan, Jeremy P. Steele, Peter Schmid, Michael Sheaff, and Peter W. Szlosarek, St Bartholomew’s Hospital; Ramsay Khadeir, Peter Schmid, and Peter W. Szlosarek, Queen Mary University of London, London, United Kindgom; and Monica Diaz, Xiaoxing Feng, Amanda Johnston, Jim Thomson, Bor-Wen Wu, and John Bomalaski, Polaris Pharmaceuticals, San Diego, CA
| | - Michael Sheaff
- Emma Beddowes, Javier Garcia Corbacho, and Simon Pacey, University of Cambridge, Cambridge; James Spicer, Dimitra Repana, Teresa Szyszko, and Gary Cook, King's College London; Pui Ying Chan, Jeremy P. Steele, Peter Schmid, Michael Sheaff, and Peter W. Szlosarek, St Bartholomew’s Hospital; Ramsay Khadeir, Peter Schmid, and Peter W. Szlosarek, Queen Mary University of London, London, United Kindgom; and Monica Diaz, Xiaoxing Feng, Amanda Johnston, Jim Thomson, Bor-Wen Wu, and John Bomalaski, Polaris Pharmaceuticals, San Diego, CA
| | - Bor-Wen Wu
- Emma Beddowes, Javier Garcia Corbacho, and Simon Pacey, University of Cambridge, Cambridge; James Spicer, Dimitra Repana, Teresa Szyszko, and Gary Cook, King's College London; Pui Ying Chan, Jeremy P. Steele, Peter Schmid, Michael Sheaff, and Peter W. Szlosarek, St Bartholomew’s Hospital; Ramsay Khadeir, Peter Schmid, and Peter W. Szlosarek, Queen Mary University of London, London, United Kindgom; and Monica Diaz, Xiaoxing Feng, Amanda Johnston, Jim Thomson, Bor-Wen Wu, and John Bomalaski, Polaris Pharmaceuticals, San Diego, CA
| | - John Bomalaski
- Emma Beddowes, Javier Garcia Corbacho, and Simon Pacey, University of Cambridge, Cambridge; James Spicer, Dimitra Repana, Teresa Szyszko, and Gary Cook, King's College London; Pui Ying Chan, Jeremy P. Steele, Peter Schmid, Michael Sheaff, and Peter W. Szlosarek, St Bartholomew’s Hospital; Ramsay Khadeir, Peter Schmid, and Peter W. Szlosarek, Queen Mary University of London, London, United Kindgom; and Monica Diaz, Xiaoxing Feng, Amanda Johnston, Jim Thomson, Bor-Wen Wu, and John Bomalaski, Polaris Pharmaceuticals, San Diego, CA
| | - Simon Pacey
- Emma Beddowes, Javier Garcia Corbacho, and Simon Pacey, University of Cambridge, Cambridge; James Spicer, Dimitra Repana, Teresa Szyszko, and Gary Cook, King's College London; Pui Ying Chan, Jeremy P. Steele, Peter Schmid, Michael Sheaff, and Peter W. Szlosarek, St Bartholomew’s Hospital; Ramsay Khadeir, Peter Schmid, and Peter W. Szlosarek, Queen Mary University of London, London, United Kindgom; and Monica Diaz, Xiaoxing Feng, Amanda Johnston, Jim Thomson, Bor-Wen Wu, and John Bomalaski, Polaris Pharmaceuticals, San Diego, CA
| | - Peter W. Szlosarek
- Emma Beddowes, Javier Garcia Corbacho, and Simon Pacey, University of Cambridge, Cambridge; James Spicer, Dimitra Repana, Teresa Szyszko, and Gary Cook, King's College London; Pui Ying Chan, Jeremy P. Steele, Peter Schmid, Michael Sheaff, and Peter W. Szlosarek, St Bartholomew’s Hospital; Ramsay Khadeir, Peter Schmid, and Peter W. Szlosarek, Queen Mary University of London, London, United Kindgom; and Monica Diaz, Xiaoxing Feng, Amanda Johnston, Jim Thomson, Bor-Wen Wu, and John Bomalaski, Polaris Pharmaceuticals, San Diego, CA
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Kresoja-Rakic J, Sulemani M, Kirschner MB, Ronner M, Reid G, Kao S, Schwaller B, Weder W, Stahel RA, Felley-Bosco E. Posttranscriptional Regulation Controls Calretinin Expression in Malignant Pleural Mesothelioma. Front Genet 2017; 8:70. [PMID: 28611824 PMCID: PMC5447031 DOI: 10.3389/fgene.2017.00070] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 05/12/2017] [Indexed: 01/08/2023] Open
Abstract
Calretinin (CALB2) is a diagnostic and prognostic marker in malignant pleural mesothelioma (MPM). We previously reported that calretinin expression is regulated at the mRNA level. The presence of a medium-sized (573 nucleotide) 3' untranslated region (3'UTR) predicted to contain binding sites for miR-30a/b/c/d/e and miR-9 as well as an adenine/uridine-rich element (ARE) in all three transcripts arising from the CALB2 gene, suggests that calretinin expression is regulated via posttranscriptional mechanisms. Our aim was to investigate the role of the CALB2-3'UTR in the posttranscriptional regulation of calretinin expression in MPM. CALB2-3'UTR was inserted downstream of the luciferase reporter gene using pmiRGLO vector and reporter expression was determined after transfection into MPM cells. Targeted mutagenesis was used to generate variants harboring mutated miR-30 family and ARE binding sites. Electrophoretic mobility shift assay was used to test for the presence of ARE binding proteins. CALB2-3'UTR significantly decreased luciferase activity in MPM cells. Analysis of mutation in the ARE site revealed a further destabilization of the reporter and human antigen R (HuR) binding to the ARE sequence was detected. The mutation of two miR-30 binding sites abolished CALB2-3'UTR destabilization effect; a transient delivery of miR-30e-5p mimics or anti-miR into MPM cells resulted in a significant decrease/increase of the luciferase reporter expression and calretinin protein, respectively. Moreover, overexpression of CALB2-3'UTR quenched the effect of miR-30e-5p mimics on calretinin protein levels, possibly by sequestering the mimics, thereby suggesting a competitive endogenous RNA network. Finally, by data mining we observed that expression of miR-30e-5p was negatively correlated with the calretinin expression in a cohort of MPM patient samples. Our data show the role of (1) adenine-uridine (AU)-binding proteins in calretinin stabilization and (2) miR-30e-5p in the posttranscriptional negative regulation of calretinin expression via interaction with its 3'UTR. Furthermore, our study demonstrates a possible physiological role of calretinin's alternatively spliced transcripts.
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Affiliation(s)
- Jelena Kresoja-Rakic
- Laboratory of Molecular Oncology, Division of Thoracic SurgeryUniversity Hospital Zurich, Switzerland
| | - Merve Sulemani
- Laboratory of Molecular Oncology, Division of Thoracic SurgeryUniversity Hospital Zurich, Switzerland
| | | | - Manuel Ronner
- Laboratory of Molecular Oncology, Division of Thoracic SurgeryUniversity Hospital Zurich, Switzerland
| | - Glen Reid
- Asbestos Diseases Research Institute, SydneyNSW, Australia.,School of Medicine, The University of Sydney, SydneyNSW, Australia
| | - Steven Kao
- Asbestos Diseases Research Institute, SydneyNSW, Australia.,School of Medicine, The University of Sydney, SydneyNSW, Australia.,Department of Medical Oncology, Chris O'Brien Lifehouse, SydneyNSW, Australia
| | - Beat Schwaller
- Department of Medicine, Anatomy, University of FribourgFribourg, Switzerland
| | - Walter Weder
- Division of Thoracic SurgeryUniversity Hospital Zurich, Switzerland
| | - Rolf A Stahel
- Clinic for OncologyUniversity Hospital Zurich, Zurich
| | - Emanuela Felley-Bosco
- Laboratory of Molecular Oncology, Division of Thoracic SurgeryUniversity Hospital Zurich, Switzerland
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45
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Rouka E, Vavougios GD, Solenov EI, Gourgoulianis KI, Hatzoglou C, Zarogiannis SG. Transcriptomic Analysis of the Claudin Interactome in Malignant Pleural Mesothelioma: Evaluation of the Effect of Disease Phenotype, Asbestos Exposure, and CDKN2A Deletion Status. Front Physiol 2017; 8:156. [PMID: 28377727 PMCID: PMC5359316 DOI: 10.3389/fphys.2017.00156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 02/28/2017] [Indexed: 01/14/2023] Open
Abstract
Malignant pleural mesothelioma (MPM) is a highly aggressive tumor primarily associated with asbestos exposure. Early detection of MPM is restricted by the long latency period until clinical presentation, the ineffectiveness of imaging techniques in early stage detection and the lack of non-invasive biomarkers with high sensitivity and specificity. In this study we used transcriptome data mining in order to determine which CLAUDIN (CLDN) genes are differentially expressed in MPM as compared to controls. Using the same approach we identified the interactome of the differentially expressed CLDN genes and assessed their expression profile. Subsequently, we evaluated the effect of tumor histology, asbestos exposure, CDKN2A deletion status, and gender on the gene expression level of the claudin interactome. We found that 5 out of 15 studied CLDNs (4, 5, 8, 10, 15) and 4 out of 27 available interactors (S100B, SHBG, CDH5, CXCL8) were differentially expressed in MPM specimens vs. healthy tissues. The genes encoding the CLDN-15 and S100B proteins present differences in their expression profile between the three histological subtypes of MPM. Moreover, CLDN-15 is significantly under-expressed in the cohort of patients with previous history of asbestos exposure. CLDN-15 was also found significantly underexpressed in patients lacking the CDKN2A gene. These results warrant the detailed in vitro investigation of the role of CDLN-15 in the pathobiology of MPM.
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Affiliation(s)
- Erasmia Rouka
- Gradute Program in Primary Health Care, Faculty of Medicine, University of Thessaly Larissa, Greece
| | - Georgios D Vavougios
- Department of Respiratory Medicine, University of Thessaly Medical School Larissa, Greece
| | - Evgeniy I Solenov
- Institute of Cytology and Genetics of the Siberian Branch of the Russian Academy of SciencesNovosibirsk, Russia; Department of Physiology, Novosibirsk State UniversityNovosibirsk, Russia
| | - Konstantinos I Gourgoulianis
- Gradute Program in Primary Health Care, Faculty of Medicine, University of ThessalyLarissa, Greece; Department of Respiratory Medicine, University of Thessaly Medical SchoolLarissa, Greece
| | - Chrissi Hatzoglou
- Gradute Program in Primary Health Care, Faculty of Medicine, University of ThessalyLarissa, Greece; Department of Respiratory Medicine, University of Thessaly Medical SchoolLarissa, Greece; Department of Physiology, Faculty of Medicine, University of ThessalyLarissa, Greece
| | - Sotirios G Zarogiannis
- Gradute Program in Primary Health Care, Faculty of Medicine, University of ThessalyLarissa, Greece; Department of Respiratory Medicine, University of Thessaly Medical SchoolLarissa, Greece; Department of Physiology, Faculty of Medicine, University of ThessalyLarissa, Greece
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46
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Linton A, Soeberg M, Broome R, Kao S, van Zandwijk N. Geographic and socioeconomic factors in patients with malignant pleural mesothelioma in New South Wales and their impact upon clinical outcomes. Respirology 2017; 22:978-985. [PMID: 28139858 DOI: 10.1111/resp.12981] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 11/07/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Whilst the impact of clinicopathological factors on the prognosis of malignant pleural mesothelioma (MPM) is well understood, socioeconomic and geographic factors have received less attention. We analysed the relationship between geographic and socioeconomic factors upon survival and treatment provision in a large series of patients with MPM. METHODS We assessed MPM patients awarded compensation between 2002 and 2009 with additional MPM incidence data from the New South Wales (NSW) Cancer Registry. The impact of geographic remoteness, distance from oncological multidisciplinary team (MDT) and Index of Relative Socioeconomic Advantage and Disadvantage (IRSAD) upon survival, clinical features and treatment received was analysed. RESULTS We identified 910 patients (67% residing in major cities; 92% <50 km from MDT). Median overall survival was 10.0 months. On multivariate analysis, age >70 (hazard ratio (HR) = 1.39), male gender (HR =1.36), non-epithelioid histological subtype (HR = 2.18) and IRSAD status by decreasing quintile (HR = 1.06) were independent prognostic factors. There was no significant advantage for patients residing in major cities (10.6 months vs 8.8 months; P = 0.162) or within 50 km of MDT (10.3 months vs 7.8 months; P = 0.539). Patient's geographic location and distance to MDT did not impact chemotherapy, adjuvant radiotherapy or extrapleural pneumonectomy provision. Socioeconomically disadvantaged patients were significantly less likely to receive chemotherapy (37.4% vs 54.8%; P = 0.001). CONCLUSION This study provides evidence for differences in the treatment and survival according to socioeconomic status for compensated MPM patients in NSW. Further research is warranted to seek additional explanations for the differences noted by comparing the treatments and outcomes of compensated and non-compensated MPM patients in NSW.
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Affiliation(s)
- Anthony Linton
- Asbestos Diseases Research Institute, Sydney, New South Wales, Australia.,Concord Cancer Centre, Concord Hospital, Sydney, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia
| | - Matthew Soeberg
- Asbestos Diseases Research Institute, Sydney, New South Wales, Australia
| | - Richard Broome
- Public Health Observatory, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Steven Kao
- Asbestos Diseases Research Institute, Sydney, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia.,Department of Medical Oncology, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Nico van Zandwijk
- Asbestos Diseases Research Institute, Sydney, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia
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Zhuo Y, Lin L, Zhang M. Pretreatment thrombocytosis as a significant prognostic factor in malignant mesothelioma: a meta-analysis. Platelets 2016; 28:560-566. [PMID: 27848258 DOI: 10.1080/09537104.2016.1246712] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The current meta-analysis analyzed the prognostic impact of elevated platelet count before the treatment of malignant mesothelioma (MM). We performed a search for articles published up to April 15, 2016 in PubMed, MEDLINE, EMBASE, and Web of Science, which evaluated elevated platelet count and survival outcome of MM. STATA version 12 was used for statistical analysis. The pooled hazard ratios (HRs) and their 95% confidence intervals (CIs) were combined to calculate overall effects. The assessment of heterogeneity was tested by the Cochran Q and I2 statistics. The sensitivity and meta-regression analyses were performed to explore the origin of heterogeneity. We analyzed 18 eligible studies (3602 patients) that evaluated the correlation between pretreatment platelet count and overall survival (OS). Elevated platelet count was a prognostic factor of poor OS, with a pooled HR of 1.56 (95% CI = 1.36-1.77). However, significant heterogeneity was observed in the included studies (I2 = 86.0%, p < 0.001). Sensitivity and meta-regression analyses were performed to trace the origin of heterogeneity. Only the variable type (multivariable or univariate model) was traced as the origin of heterogeneity. Hence, we conducted a subgroup analysis of variable type. The HR was 1.66 (95% CI = 1.41-1.91) in the multivariable group and no significant heterogeneity was observed (I2 = 0.0%, p = 0.476). In conclusion, high pretreatment platelet count resulted in poor OS in MM. Therefore, platelet count could be an adequate and useful factor of prognosis for MM.
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Affiliation(s)
- Yi Zhuo
- a Department of Thoracic Surgery , First Affiliated Hospital of Fujian Medical University , Fuzhou , Fujian , People's Republic of China
| | - Lanying Lin
- b Department of Anesthesiology , First Affiliated Hospital of Fujian Medical University , Fuzhou , Fujian , People's Republic of China
| | - Mingwei Zhang
- c Department of Radiotherapy , First Affiliated Hospital of Fujian Medical University , Fuzhou , Fujian , People's Republic of China
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A case of pseudoachalasia hiding a malignant pleural mesothelioma. TUMORI JOURNAL 2016; 102:8E398D5A-BB37-422B-A2EF-7AFACC6992C9. [PMID: 27373784 DOI: 10.5301/tj.5000521] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE Malignant pleural mesothelioma (MPM) is a rare cancer with a poor prognosis. We describe a case of MPM with an uncommon onset, characterized by pseudoachalasia as demonstrated with high-resolution manometry (HRM). METHODS A 56-year-old man was referred to our hospital reporting worsening dysphagia. On the hypothesis of an esophageal motor disorder, the patient was referred for an HRM examination, which revealed features consistent with a diagnosis of type II achalasia. RESULTS At the time of the first pneumatic dilation the endoscopist stopped the procedure in order to prevent perforation when he noticed only partial expansion of the pneumatic balloon. A CT scan and subsequent CT-guided excisional biopsy revealed an epithelioid pleural mesothelioma infiltrating the muscle wall. Given his good clinical condition, the patient was eligible for chemotherapy with cisplatin 75 mg/m2 and pemetrexed 500 mg/m2, resulting in a good response with partial remission of the disease and resolution of the dysphagia symptoms. CONCLUSIONS Pseudoachalasia as the first or only manifestation of mesothelioma is a rare occurrence that may expose patients to the risk of diagnostic delay. Close attention should be paid whenever a patient with symptoms and signs consistent with achalasia shows unusual features.
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Thapa B, Walkiewicz M, Murone C, Asadi K, Deb S, Barnett S, Knight S, Mitchell P, Liew D, Watkins DN, John T. Calretinin but not caveolin-1 correlates with tumour histology and survival in malignant mesothelioma. Pathology 2016; 48:660-665. [PMID: 27780599 DOI: 10.1016/j.pathol.2016.08.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 08/14/2016] [Accepted: 08/18/2016] [Indexed: 12/28/2022]
Abstract
Malignant mesothelioma (MM) continues to be a disease with poor prognosis and limited treatment options. Calretinin and caveolin-1 expression by tumour in MM have recently been described to be associated with tumour histology, differentiation and consequently survival. In a large, well annotated cohort, we studied both of these biomarkers and explored their association with clinicopathological parameters and survival. A retrospective search of patients with MM who underwent surgery at the Austin Hospital in Melbourne, Australia, was conducted. Clinical history and outcome data were retrieved from patient records. Tissue microarrays (TMAs) were constructed and stained for calretinin and caveolin-1. 'H scores' were derived, taking intensity and distribution of staining, and the cohort was dichotomised using median values for both markers. In the 329 patients evaluated, median age was 67 years. Males outnumbered females by 5:1. Epithelioid histology 202/319 (62.9%) was the most common, followed by biphasic 72/319 (21.8%) and sarcomatoid 45/319 (13.6%); histology could not be confirmed in 10 patients. Calretinin expression was detected in 246 of the 324 (76%) evaluable patients and high expression was associated with epithelioid histology (p < 0.0001). Caveolin-1 was expressed in 298 (94%) of 317 evaluable patients which was much higher compared to its expression in a cohort of lung adenocarcinomas (8/58, 13.7%). However, no association with histology was found (p = 0.409). When taken as a continuous variable, calretinin expression was found to be an independent predictor of survival, alongside histology, neutrophil-lymphocyte ratio, weight loss and stage. No prognostic value was demonstrable for caveolin-1 expression and calretinin/caveolin-1 ratio. There was no relationship between calretinin and caveolin-1 expression. In MM, increased calretinin expression is associated with epithelioid histology and better survival. Caveolin-1 is a sensitive MM marker and is expressed in a high proportion of cases but lacks association with histology and survival.
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Affiliation(s)
- Bibhusal Thapa
- Department of Medicine, University of Melbourne, Vic, Australia; Olivia Newton John Cancer Research Institute, Vic, Australia
| | | | - Carmel Murone
- Olivia Newton John Cancer Research Institute, Vic, Australia; Department of Pathology, Austin Health, Vic, Australia
| | | | - Siddhartha Deb
- Olivia Newton John Cancer Research Institute, Vic, Australia; Anatpath, Gardenvale, Vic, Australia
| | - Stephen Barnett
- Department of Thoracic Surgery, Austin Hospital, Melbourne, Vic, Australia
| | - Simon Knight
- Department of Thoracic Surgery, Austin Hospital, Melbourne, Vic, Australia
| | - Paul Mitchell
- Department of Medical Oncology, Austin Health, Olivia-Newton John Cancer and Wellness Centre, Vic, Australia
| | - Danny Liew
- Department of Epidemiology and Preventive Medicine, Monash University, Vic, Australia
| | | | - Thomas John
- Olivia Newton John Cancer Research Institute, Vic, Australia; Department of Medical Oncology, Austin Health, Olivia-Newton John Cancer and Wellness Centre, Vic, Australia; School of Cancer Medicine, La Trobe University, Vic, Australia.
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50
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Maggioni C, Barletta G, Rijavec E, Biello F, Gualco E, Grossi F. Advances in treatment of mesothelioma. Expert Opin Pharmacother 2016; 17:1197-205. [DOI: 10.1080/14656566.2016.1176145] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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