Integrating Data from Multidisciplinary Management of Malignant Pleural Mesothelioma: A Cohort Study

Abstract

Background. Malignant pleural mesothelioma (MPM) is a rare and aggressive malignancy that most commonly affects the pleural lining of the lungs. MPM has a strong association with asbestos being at least 80% of cases caused by exposure to its biopersistent fibers. Individuals with a chronic exposure to asbestos might refer a 20-40-year latency with no or few symptoms. Such has been the case of Piedmont and Lombardy regions of Italy where industrial production of materials laden with asbestos, mainly cements, has created a large epidemic. Since 2018 in Pavia San Matteo hospital, a multidisciplinary team has been collecting data on over 100 patients with MPM. The main goal of this project is to define and describe an integrated profile for each MPM case at diagnosis by using data mining and partition analysis. Methods. Here we bring together exhaustive epidemiologic, histologic, radiologic data of 88 MPM patients that came to our observation to draw correlations with predictive and prognostic significance. Results. Overall, the median survival (OS) was of 15.6 months. Most patients presented with pleural effusion, irrespective of disease stage. Quite unexpectedly, no statistically significant association had been demonstrated between OS and TNM disease stage at diagnosis. Although average OS is similar in male and female patients, partition analysis of data underlined a significant differential hierarchy of predictor categories based on patient gender. In never smoker female patients, full chemotherapeutic regimens are associated to better outcomes. Moreover, within respect to second line treatments, vinorelbine emerged as the most advantageous choice but only in females, whereas in the male subgroup no statistically significant differences resulted between gemcitabine and vinorelbine. Conclusions. Multidisciplinary approach to MPM is thus mandatory to define better therapeutic approaches, personalize the management and improve patient outcomes.

Feasibility and safety of extended pleurectomy/decortication for malignant pleural mesothelioma. A single group experience

“…Within 3 years of the study, overall we evaluated 52 novel diagnoses; of these 19 entered the present project, whereas the remaining 43 patients harbored advanced disease. Each case was evaluated and discussed by a multidisciplinary team, based on the AIOM (Associazione Italiana di Oncologia Medica—Linee Guida AIOM 2019 Mesotelioma pleurico) and NCCN (National Comprehensive Cancer Network, website at Guidelines Detail (nccn.org]) guidelines and the local PDTA (Percorso Diagnostico Terapeutico e Assistenziale – Territorial Diagnostic, Therapeutic and Assistance Planning) for MPM, active since 2014 and defined within the Provincial Oncology Intercompany Department (DIPO) of Pavia 3 . It is clearly recommended by the national and international guidelines that MPM patients susceptible to multimodal approaches encompassing surgery, should be referred to specialized centers and evaluated by multidisciplinary teams to assess the best optimal treatment sequence in a personalized manner.…”

“…The management of malignant pleural mesothelioma (MPM) consists of a multidisciplinary approach with chemotherapy, surgery, and radiotherapy in selected cases 1–3 …”

Unprecedented long‐term survival in a patient with malignant pleural mesothelioma treated with subsequent systemic chemo‐ and immunotherapeutic regimens

“…Epithelioid PM represents more than half of the pleural mesothelioma diagnoses, with median patient survival of 14 months, whereas the biphasic and sarcomatoid histology account overall for 30%–40% of cases and are associated with a shorter survival time of less than 10 months 3 . At present, surgery is recommended only in carefully selected patients with localized disease and within a multimodal treatment approach 4,5 . Specifically, in a retrospective study, conservative surgery through pleurectomy/decortication was proven to prolong median survival mainly in epithelioid mesothelioma patients up to 19 months 3 …”