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Annual Review of Medicine Jan 2018Malignant pleural mesothelioma (MPM) is a highly aggressive and generally incurable cancer. Current anti-MPM chemotherapy-based treatments are only marginally effective,... (Review)
Review
Malignant pleural mesothelioma (MPM) is a highly aggressive and generally incurable cancer. Current anti-MPM chemotherapy-based treatments are only marginally effective, and long-term survival remains an unmet goal. Nonetheless, in selected cases, personalized surgery-based multimodality treatments (MMT) have been shown to significantly extend survival. The design of MMT and selection of patients are challenging, and optimal results require accurate presurgical diagnosis, staging, and risk stratification. Further, meticulous surgical techniques and advanced radiation protocols must be applied. We review key principles and evolving concepts in the care of MPM patients with a focus on the expanding role of MMT in MPM.
Topics: Angiogenesis Inhibitors; Antineoplastic Agents, Immunological; Antineoplastic Combined Chemotherapy Protocols; Chemotherapy, Adjuvant; Combined Modality Therapy; Humans; Lung Neoplasms; Maintenance Chemotherapy; Mesothelioma; Mesothelioma, Malignant; Neoadjuvant Therapy; Neoplasm Staging; Pleural Neoplasms; Radiotherapy; Radiotherapy, Adjuvant; Radiotherapy, Intensity-Modulated; Risk Assessment; Thoracic Surgical Procedures
PubMed: 29029582
DOI: 10.1146/annurev-med-041316-085813 -
International Journal of Molecular... Jun 2023Malignant pleural mesothelioma (MPM) is a rare and aggressive malignancy associated with poor prognosis and a 5-year survival rate of 12%. Many drugs have been tested... (Review)
Review
Malignant pleural mesothelioma (MPM) is a rare and aggressive malignancy associated with poor prognosis and a 5-year survival rate of 12%. Many drugs have been tested over the years with conflicting results. The aim of this review is to provide an overview of current therapies in MPM and how to best interpret the data available on these drugs. Furthermore, we focused on promising treatments under investigation, such as immunotherapy with targets different from anti-PD-1/PD-L1 inhibitors, vaccines, target therapies, and metabolism-based strategies.
Topics: Humans; Mesothelioma, Malignant; Mesothelioma; Lung Neoplasms; Pleural Neoplasms; Immunotherapy
PubMed: 37445594
DOI: 10.3390/ijms241310415 -
Diagnostic Cytopathology Jun 2021Malignant mesothelioma, a neoplasm arising within the serosal surfaces, has been linked closely to asbestos exposure. We present a case of 72-year-old male with a...
Malignant mesothelioma, a neoplasm arising within the serosal surfaces, has been linked closely to asbestos exposure. We present a case of 72-year-old male with a 27 year work-related history of asbestos exposure who presented with dyspnea. Chest computed tomography scan showed a large, right pleural effusion with compressive right lung atelectasis. Biopsies, subsequent pleurectomy and lung wedge resections revealed epithelioid malignant mesothelioma with associated focal non-keratinizing squamous-cell carcinoma, supported by extensive immunohistochemical stains and molecular studies. The patient was treated with 6 cycles of carboplatin/pemetrexed, showing no new metastases. Seven months post-treatment, the patient presented with progressive dyspnea and large pleural effusions. Bilateral pleural fluid was collected and showed malignant epithelioid cells, morphologically similar to the patient's pleural neoplastic cells. However, the tumor was positive for squamous cells markers and showed BAP1 loss, while negative for mesothelial markers. The findings support the diagnosis of squamous-cell carcinoma and were consistent with the patient's previously diagnosed pleural neoplastic origin. A malignant mesothelioma associated with squamous-cell carcinoma is a rare phenonmenon. To our knowledge, only two case reports are available in current literature. This unique case shows a single pleura tumor differentiating as both malignant mesothelioma and squamous-cell carcinoma. Squamous-cell carcinoma is the predominating malignancy seen within the bilateral pleural effusions, a potential pitfall for cytology specimen diagnosis.
Topics: Aged; Asbestos; Carcinoma, Squamous Cell; Cell Differentiation; Humans; Male; Mesothelioma, Malignant; Occupational Exposure; Pleural Neoplasms
PubMed: 33347735
DOI: 10.1002/dc.24686 -
The American Journal of Case Reports Jan 2023BACKGROUND Epithelioid sarcoma is a rare tumor and that is extremely rare as a primary pleural neoplasm. On imaging, it may appear similar to malignant pleural...
BACKGROUND Epithelioid sarcoma is a rare tumor and that is extremely rare as a primary pleural neoplasm. On imaging, it may appear similar to malignant pleural mesothelioma; thus, it can be difficult to diagnose. CASE REPORT A 64-year-old Asian woman, who had a treatment history of cervix adenocarcinoma, was admitted with dyspnea and right massive pleural effusion. Chest drainage was performed, and malignant cells were found in the pleural effusion. The malignant cells were thought to be metastasized from previous cervical cancer. We continued pleural drainage; however, the volume of the pleural effusion did not decrease. On the 5th hospital day, the chest tube became occluded. Computed tomography showed structures similar to empyema. Pleural irrigation and fibrinolytic therapy did not improve her condition. Empyema curettage was performed on the 14th hospital day. The resected pleura was submitted for pathological examination and showed tumor lesion but not metastatic adenocarcinoma of the cervix. The intrathoracic tumor grew extremely rapidly, and the patient died of respiratory failure on postoperative day 8 (22nd hospital day) before a diagnosis could be made. The final pathological diagnosis obtained on the 34th hospital day was epithelioid sarcoma. CONCLUSIONS For patients who appear to have empyema complicated by neoplastic lesions, a histopathological examination should also be performed to ensure accurate diagnosis. In addition, if a tumorous lesion is detected and it is neither metastatic nor malignant pleural mesothelioma, pleural epithelioid sarcoma should be added to the differential diagnosis in the presence of a rapidly growing and histologically difficult-to-diagnose pleural tumor.
Topics: Female; Humans; Middle Aged; Pleura; Mesothelioma, Malignant; Mesothelioma; Pleural Neoplasms; Pleural Effusion; Adenocarcinoma; Sarcoma
PubMed: 36597286
DOI: 10.12659/AJCR.938696 -
The International Journal of Biological... Jun 2023There is a need for a rapid, accurate, less-invasive approach to distinguishing malignant from benign pleural effusions. We investigated the diagnostic value of five...
INTRODUCTION
There is a need for a rapid, accurate, less-invasive approach to distinguishing malignant from benign pleural effusions. We investigated the diagnostic value of five pleural tumor markers in exudative pleural effusions.
METHODS
By immunochemiluminescence assay, we measured pleural concentrations of tumor markers. We used the receiver operating characteristic curve analysis to assess their diagnostic values.
RESULTS
A total of 281 patients were enrolled. All tumor markers were significantly higher in malignant pleural effusions than benign ones. The area under the curve of carcinoembryonic antigen (CEA), carbohydrate antigen (CA) 15-3, cytokeratin fragment 19 (CYFRA) 21-1, CA-19-9, and CA-125 were 0.81, 0.78, 0.75, 0.65, and 0.65, respectively. Combined markers of CEA + CA-15-3 and CEA + CA-15-3 + CYFRA 21-1 had a sensitivity of 87% and 94%, and specificity of 75% and 58%, respectively. We designed a diagnostic algorithm by combining pleural cytology with pleural tumor marker assay. CEA + CYFRA 21-1 + CA-19-9 + CA-15-3 was the best tumor markers panel detecting 96% of cytologically negative malignant pleural effusions, with a negative predictive value of 98%.
CONCLUSIONS
Although cytology is specific enough, it has less sensitivity in identifying malignant pleural fluids. As a result, the main gap is detecting malignant pleural effusions with negative cytology. CEA was the best single marker, followed by CA-15-3 and CYFRA 21-1. Through both cytology and suggested panels of tumor markers, malignant and benign pleural effusions could be truly diagnosed with an accuracy of about 98% without the need for more invasive procedures, except for the cohort with negative cytology and a positive tumor markers panel, which require more investigations.
Topics: Humans; Carcinoembryonic Antigen; Biomarkers, Tumor; Pleural Effusion, Malignant; Antigens, Neoplasm; Keratin-19; Pleural Effusion; Pleural Neoplasms; CA-125 Antigen; Mucin-1; Sensitivity and Specificity
PubMed: 36942429
DOI: 10.1177/03936155231158661 -
Der Chirurg; Zeitschrift Fur Alle... May 2016Malignant pleural mesothelioma (MPM) is a rare and aggressive tumor disease, which rapidly leads to death if untreated. In Germany the incidence of newly occurring... (Review)
Review
Malignant pleural mesothelioma (MPM) is a rare and aggressive tumor disease, which rapidly leads to death if untreated. In Germany the incidence of newly occurring disease is expected to reach a peak in the coming 5 years. An R0 resection for MPM is technically impossible; therefore, the aim of surgical procedures is to achieve the maximum amount of cytoreduction. There are two established surgical techniques for treatment of MPM, extrapleural pneumonectomy and tumor pleurectomy with decortication. The type and extent of surgery are currently controversially discussed. Within multimodal therapy concepts including cytoreductive surgery, long-term remission is possible in selected patients. When choosing the appropriate surgical therapy the high incidence of recurrence has to be borne in mind.
Topics: Cytoreduction Surgical Procedures; Follow-Up Studies; Humans; Mesothelioma; Neoplasm Recurrence, Local; Neoplasm Staging; Pleura; Pleural Neoplasms; Pneumonectomy; Thoracic Surgery, Video-Assisted; Thoracotomy
PubMed: 27169584
DOI: 10.1007/s00104-016-0186-1 -
Clinics in Chest Medicine Dec 2021
Review
Topics: Asbestos; Humans; Mesothelioma; Mesothelioma, Malignant; Physicians; Pleural Neoplasms
PubMed: 34774176
DOI: 10.1016/j.ccm.2021.08.006 -
The Thoracic and Cardiovascular Surgeon Mar 2021Objective of this study was to assess postoperative morbidity and mortality as well as recurrence-free and overall survival in patients with thymic malignancies and...
BACKGROUND
Objective of this study was to assess postoperative morbidity and mortality as well as recurrence-free and overall survival in patients with thymic malignancies and pleural dissemination undergoing surgical cytoreduction and hyperthermic intrathoracic chemotherapy (HITOC).
METHODS
Retrospective study between September 2008 and December 2017 with follow-up analysis in May 2018.
RESULTS
A total of 29 patients (male: = 17) with thymic malignancies and pleural spread (primary stage IVa: = 11; pleural recurrence: = 18) were included. Surgical cytoreduction was performed via pleurectomy/decortication (P/D; = 11), extended P/D ( = 15), and extrapleural pneumonectomy (EPP; = 3). These procedures resulted in 25 (86%) patients with macroscopically complete (R0/R1) resection. Intraoperative HITOC was performed for 60 minutes at 42°C either with cisplatin (100 mg/m body surface area [BSA] = 8; 150 mg/m BSA = 6; 175 mg/m BSA = 1) or with a combination of cisplatin (175 mg/m BSA)/doxorubicin (65 mg; = 14). Postoperative complications occurred in nine patients (31%). Cytoprotective therapy resulted in lower postoperative creatinine levels ( = 0.036), and there was no need for temporary dialysis in these patients. The 90-day mortality rate was 3.4%, as one patient developed multiple organ failure. While recurrence-free 5-year survival was 54%, an overall 5-year survival rate of 80.1% was observed. Survival depended on histological subtype ( = 0.01).
CONCLUSION
Surgical cytoreduction with HITOC is feasible in selected patients and offers encouraging survival rates. The application of cytoprotective agents appears to be effective for the prevention of postoperative renal insufficiency.
Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Chemotherapy, Adjuvant; Cisplatin; Cytoreduction Surgical Procedures; Disease Progression; Doxorubicin; Female; Humans; Hyperthermia, Induced; Male; Middle Aged; Neoplasm Recurrence, Local; Pleural Neoplasms; Retrospective Studies; Risk Assessment; Risk Factors; Thymus Neoplasms; Time Factors; Treatment Outcome
PubMed: 31731316
DOI: 10.1055/s-0039-1700883 -
Journal of Bronchology & Interventional... Apr 2016
Topics: Humans; Lymphoma, Large B-Cell, Diffuse; Male; Middle Aged; Pleural Neoplasms; Thoracoscopy
PubMed: 27058717
DOI: 10.1097/LBR.0000000000000270 -
Biochemical Genetics Feb 2024Malignant pleural mesothelioma (MPM) is a rare and aggressive neoplasm of the pleural tissue that lines the lungs and is mainly associated with long latency from... (Meta-Analysis)
Meta-Analysis
Malignant pleural mesothelioma (MPM) is a rare and aggressive neoplasm of the pleural tissue that lines the lungs and is mainly associated with long latency from asbestos exposure. This tumor has no effective therapeutic opportunities nowadays and has a very low five-year survival rate. In this sense, identifying molecular events that trigger the development and progression of this tumor is highly important to establish new and potentially effective treatments. We conducted a meta-analysis of genome-wide expression studies publicly available at the Gene Expression Omnibus (GEO) and ArrayExpress databases. The differentially expressed genes (DEGs) were identified, and we performed functional enrichment analysis and protein-protein interaction networks (PPINs) to gain insight into the biological mechanisms underlying these genes. Additionally, we constructed survival prediction models for selected DEGs and predicted the minimum drug inhibition concentration of anticancer drugs for MPM. In total, 115 MPM tumor transcriptomes and 26 pleural tissue controls were analyzed. We identified 1046 upregulated DEGs in the MPM samples. Cellular signaling categories in tumor samples were associated with the TNF, PI3K-Akt, and AMPK pathways. The inflammatory response, regulation of cell migration, and regulation of angiogenesis were overrepresented biological processes. Expression of SOX17 and TACC1 were associated with reduced survival rates. This meta-analysis identified a list of DEGs in MPM tumors, cancer-related signaling pathways, and biological processes that were overrepresented in MPM samples. Some therapeutic targets to treat MPM are suggested, and the prognostic potential of key genes is shown.
Topics: Humans; Mesothelioma, Malignant; Mesothelioma; Phosphatidylinositol 3-Kinases; Pleural Neoplasms; Lung Neoplasms
PubMed: 37347449
DOI: 10.1007/s10528-023-10426-5