| | | |

New Test May Help Doctors Choose the Best Mesothelioma Surgery

ByAlex Strauss

best mesothelioma surgeryA new predictive model may make it easier for cancer doctors to choose the best mesothelioma surgery for each pleural mesothelioma patient. 

There are two major surgical approaches for pleural mesothelioma. One involves removal of a lung and the other does not. 

Right now, the choice about which surgery to have is based on patient demographics, symptoms, and lab values. Which surgery is most common at the institution may also play a role. Many surgeons have strong opinions about which is the best mesothelioma surgery.  

But Harvard researchers say the new predictive model they tested is a better way to stratify mesothelioma patients. Their study suggests that this approach may lead to better treatment outcomes and more accurate clinical trials. 

Surgical Treatment of Pleural Mesothelioma

EPP and PD are the two main surgical treatments for pleural mesothelioma. Extrapleural pneumonectomy is the most radical approach. It involves removing one of the lungs along with the pleural lining where the mesothelioma tumor started. Other at-risk tissues in the chest are also removed. The goal is to keep new tumors from forming. 

The other type of mesothelioma surgery is pleurectomy with decortication (PD). PD surgery leaves the lungs in place. Surgeons remove the pleural membrane and other at-risk tissues. They also scrape away any visible cancer from the surface of the lungs. 

Surgeons around the world are divided over which is the best mesothelioma surgery. Some patients live longer after EPP. Others have better survival odds with PD. The Harvard study sheds some light on why this is and how the understanding could improve outcomes. 

The Best Mesothelioma Surgery May Hinge on Molecular Factors

The Harvard research team used a variety of tests that focus on the mesothelioma tumor tissue. The tissue came from nearly 400 patients who underwent either EPP or PD between 2007 and 2014.

“The Mesothelioma Prognostic Test (MPT) and molecular subtype based on Claudin-15 to Vimentin (C/V) expression ratio are molecular signatures associated with survival,” writes Beow Yeap, whose name appears first on the paper. 

The team combined these tests with measurements of tumor volume (TV) and a white blood cell test called the neutrophil-to-lymphocyte ratio (NLR). The result was a more accurate predictive model for each type of mesothelioma surgery. 

“MPT, molecular subtype, TV, and NLR were independently prognostic in EPP patients,” writes Dr. Yeap. “In the PD cohort (N=193), MPT poor risk combined with TV>200 cc was associated with triple the risk compared to other subgroups…”

Both the EPP and PD models were more accurate than current predictive tests. 

Source:

Yeap, B, et al, “Mesothelioma Risk Score: A New Prognostic Pretreatment, Clinical-Molecular Algorithm for Malignant Pleural Mesothelioma”, July 6, 2021, Journal of Thoracic Oncology, Online ahead of print, https://www.jto.org/article/S1556-0864(21)02255-3/pdf

Similar Posts

  • | |

    Doctors Describe "Concrete Therapeutic Approach" for Mesothelioma

    ByAlex Strauss

    A team of medical researchers in Italy have achieved what they are calling “excellent” tumor control and survival results in malignant pleural mesothelioma patients using a combination of surgery, chemotherapy, and radiotherapy. Caused by exposure to asbestos, mesothelioma typically spreads quickly across the lung-encasing membrane called the pleura. There is no known cure but treatments are improving. In the current prospective study, 20 malignant pleural mesothelioma patients underwent radical pleurectomy/decortication followed by high doses of radiation. After surgeons removed as much of the visible mesothelioma tumor and surrounding tissue as possible, patients received 50Gy of radiation to the effected side of their chest, delivered in 25 fractions. Regions of particular concern for mesothelioma regrowth got an extra radiation “boost” to…

  • | |

    Does Radiotherapy Reduce Mesothelioma Pain?

    ByAlex Strauss

    A new study says there is not enough evidence to support the use of radiotherapy for the treatment of pain associated with malignant pleural mesothelioma. Researchers at the University of Edinburgh in Scotland reviewed a range of past studies on mesothelioma pain and radiotherapy by searching databases that date back as far as 1974. To be eligible to be included in their review, the study had to focus on malignant pleural mesothelioma and radiotherapy given “with the intent of improving pain”. The study also had to report doses and fractionation of the radiotherapy and how the pain responded. In all, the researchers found eight studies on mesothelioma pain and radiotherapy that met the criteria. Two of the studies were prospective…

  • |

    Ape Virus Shrinks Mesothelioma Tumors in Lab

    ByAlex Strauss

    A virus that causes leukemia in gibbon apes may have the power to help fight malignant mesothelioma in people. Gibbon ape leukemia virus (GALV) has been tested for years as a viral vector, a carrier of therapeutic genetic information, in the treatment of various human illnesses, including cancer. A new study in Japan compared GALV with a leukemia virus derived from mice to see which carrier communicated most efficiently with mesothelioma cells. While both types of viruses replicated in most of the mesothelioma cell lines tested, the mouse-derived virus was not effective in a mesothelioma cell line called ACC-MESO-1. In this cell line, only the GALV spread efficiently both in culture and in mice that had been given human mesothelioma…

  • | |

    Radiotherapy for Mesothelioma: Better But Still Limited

    ByAlex Strauss

    A form of highly-targeted radiation therapy for mesothelioma is better than it used to be, but is still risky. That is the message of a recent article on intensity-modulated radiation therapy (IMRT) in Seminars in Thoracic and Cardiovascular Surgery. Author Kenneth E. Rosenzweig, MD, a Radiation Oncologist with Mount Sinai Hospital in New York, reviewed recent studies on IMRT and mesothelioma. He concludes that, while the “troubling toxicity” associated with IMRT when it was first introduced has not been entirely eliminated, the fact that clinicians now have more experience with it is making a positive difference for mesothelioma patients. Before targeted therapies like IMRT were available, high-dose radiation was not usually a feasible option for mesothelioma since the irregular shape…

  • | |

    A Second-Line Option for Mesothelioma?

    ByAlex Strauss

    Although survival was not significantly extended, the chemotherapy drug vinorelbine might be a treatment option for mesothelioma patients whose cancer has returned after first-line chemotherapy with pemetrexed. A new study on vinorelbine as a second-line treatment finds that the drug is “moderately active” in mesothelioma patients who were initially treated with pemetrexed-based chemotherapy. Pemetrexed (Alimta), along with a platinum-based drug like cisplatin, is the primary first-line drug therapy for mesothelioma. But vinorelbine is gaining attention as a possible option for mesothelioma, in part because it is available in a less expensive generic form. In “Vinorelbine in pemetrexed-pretreated patients with malignant pleural mesothelioma”, the Italian authors detail the results of their study on 59 patients with unresectable pleural mesothelioma.  These patients…

  • | |

    Repeat HIPEC Improves Mesothelioma Survival

    ByAlex Strauss

    If one cytoreductive surgery and HIPEC procedure for mesothelioma is good, subsequent treatments may be even better. That is the central message of research conducted at the Moffitt Cancer Center in Florida. The study’s aim was to assess overall survival among peritoneal mesothelioma patients who had not just one, but two or more rounds of heated intraperitoneal chemotherapy (HIPEC) after cytoreductive surgery. The cytoreduction/HIPEC approach has become popular for peritoneal mesothelioma, a treatment-resistant cancer of abdominal membranes caused by asbestos. Cytoreductive surgery involves removing as much of the mesothelioma tumor as possible from the abdomen. Because the shape and spreading pattern of mesothelioma tumors make complete cytoreduction difficult, the surgery is often followed by a rinse with a heated solution…