Surgical Management of Malignant Pleural Mesothelioma: An Update of Clinical Evidence

Cao, Christopher; Akhunji, Zakir; Fu, Ben; Wilcox, C.; Novis, Elan; Tian, David H.; Yan, Tristan D.

doi:10.1053/j.semtcvs.2015.02.007

Cited by 5 publications

(4 citation statements)

References 19 publications

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“…The operative reports were reviewed to assure correct surgical classification based on the definitions as follows: extrapleural pneumonectomy (13): en bloc resection of the lung and pleura to remove all gross tumor with resection of the diaphragm and/or pericardium as required; radical pleurectomy and decortication: parietal and visceral pleurectomy to remove all gross tumor with resection of the diaphragm and/or pericardium as required; complete pleurectomy and decortication (CPD): parietal and visceral pleurectomy to remove all gross tumor without resection of diaphragm or pericardium. These surgical definitions are widely accepted (14). NAC patients received the standard regimen of pemetrexed and cisplatin.…”

Section: Duke Cohort: Patient Selectionmentioning

confidence: 99%

The Role of Neoadjuvant Chemotherapy in Patients With Resectable Malignant Pleural Mesothelioma—An Institutional and National Analysis

Voigt

Raman

Jawitz

et al. 2020

JNCI: Journal of the National Cancer Institute

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Background There is no standard of care with respect to the use of neoadjuvant chemotherapy (NAC) in resectable malignant pleural mesothelioma (MPM). We performed an intention-to-treat analysis with data from a single institution and the National Cancer Database (NCDB) to identify whether the use of NAC impacts survival in resectable MPM. Methods Patients with MPM who had surgery with curative intent at Duke University from 1995 to 2017 were selected, and the 2004–2015 NCDB was used to identify MPM patients with clinical stage I–IIIB who underwent definitive surgery. For both cohorts, patients were stratified by receipt of NAC. Primary outcomes were overall survival and postresection survival (RS), which were estimated using Kaplan-Meier and multivariable Cox proportional hazards models. Results A total of 257 patients met inclusion criteria in the Duke cohort. Compared with immediate resection (IR), NAC was associated with similar overall survival but an increased risk for postresection mortality in both unmatched (adjusted hazard ratio [HR] = 1.85, 95% confidence interval [CI] = 1.21 to 2.83) and propensity-matched (HR = 1.62, 95% CI = 1.03 to 2.55) cohorts. A total of 1949 NCDB patients were included: 1597 (81.9%) IR and 352 (18.1%) NAC. RS was worse for patients undergoing NAC in both unmatched (HR = 1.85, 95% CI = 1.21 to 2.83) and propensity-matched (HR = 1.29, 95% CI = 1.06 to 1.57) analyses compared with patients receiving IR. Conclusions In this intention-to-treat study, NAC was associated with worse RS compared with IR in patients with MPM. The risks and benefits of induction therapy should be weighed before offering it to patients with resectable MPM.

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Section: Duke Cohort: Patient Selectionmentioning

confidence: 99%

The Role of Neoadjuvant Chemotherapy in Patients With Resectable Malignant Pleural Mesothelioma—An Institutional and National Analysis

Voigt

Raman

Jawitz

et al. 2020

JNCI: Journal of the National Cancer Institute

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“…Such a dismal prospect is confirmed by our selected population of 102 MPMs resected with curative intent, whose survival is by far the worst among all RTC. New evidence on this interesting issue could be generated by the on-going MARS 2 trial [35]. In conclusion, the long-term survival reported in our unselected RTCs series, demonstrates that a careful preoperative evaluation combined with specific expertise in complex surgical resections and a multidisciplinary management provide the best chance cure, especially for primary mediastinal germ-cell tumours, thymomas and sarcomas.…”

Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Outcome of complex surgical resection and reconstruction for rare thoracic cancers: the clinical value of a predictive score

Pastorino

Leuzzi

Sabia

et al. 2022

Preprint

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BackgroundComplex surgical resection and reconstruction for rare thoracic cancers (RTCs) represent a major challenge, given their very low frequency, extreme variability of presentation, multi-modality treatment options and inadequate outcome prediction. We reported the experience of a tertiary referral centre on a consecutive series of RTC patients, to predict outcome by disease and complexity of surgical procedures.MethodsFrom Jan 2003 to Dec 2018, 1122 surgical procedures were performed with curative intent on 952 RTC patients. Study endpoints were: post-operative hospital stay (Pod), 30-day and 90-day mortality, 5-year and 10-year survival (OS). The follow-up was closed at June 2020.ResultsMedian Pod was 8 days, with a 2% 30-day and 3.9% 90-day mortality. Overall survival (OS) was 85.7% at 1 year, 61.7% at 5 years and 50.7% at 10 years. Ten-year OS was 64.8% in low, 58.8% in intermediate, and 42.4% in high complexity score (Log-rank tests p<0.0001); 64.4% in patients with 1 or 2 reconstructions and 32.8% in patients with 3 or more reconstructions; 44.5% with vascular and 48% with chest wall reconstruction; 71.8% in germ cell tumors and 0% in mesothelioma.ConclusionComplex surgical resection and reconstruction was associated with acceptable 90-day mortality and good 10-year survival in all RTCs but mesothelioma.A predictive score based on surgical complexity and cancer type can help the clinical decision making.

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“…Surgical intervention is difficult to perform, since achieving negative margins when extracting thin areas of pleura is difficult to accomplish and is associated with a significant level of risk, requiring a high level of familiarity and expertise with the procedure [ 32 ]. Two main surgical interventions are currently in use, pleurectomy/decorti-cation (P/D) and Extrapleural Pneumonectomy (EPP) [ 29 ]. As illustrated in the MARS trial, EPP, an invasive aggressive debulking procedure showed no benefit when added to chemotherapy/radiation, being associated with a worse median survival when compared with no surgical intervention, and may actually cause harm [ 33 , 34 ].…”

Section: Current Therapiesmentioning

confidence: 99%

Current and Emerging Therapy for Malignant Pleural Mesothelioma: Focus on CD26/Dipeptidyl Peptidase IV as a Therapeutic Target

Doonan

Ohnuma

Dang

et al. 2017

CCTR

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Background: Malignant mesothelioma is a largely incurable disease that is refractory to current therapies. CD26 is a multifunctional cell surface protein involved in autoimmune disease, diabetes, and cancer. It has a role in T cell function, extracellu-lar protein modification, as a prognostic factor for cancer, and as a therapeutic target for malignant mesothelioma. New treatment strategies are urgently needed for malig-nant pleural mesothelioma (MPM), and CD26-targeted therapy represents a novel ap-proach.Outline: In this review, the most current and up-to-date literature available was reviewed and the current state of malignant mesothelioma treatment is described. Throughout the review the need for new therapeutic approaches is highlighted in the shortcomings of current therapy. CD26 is a target that is fit to take on these shortcom-ings. In this review we discuss the structure and function of CD26, its role in malignant mesothelioma and the future of anti-CD26 therapy as a versatile immunotherapeutic option.Conclusion: This review highlights the areas of most promise in treating MPM, these in-clude immune checkpoint blockade, passive immunization, and based on our recently published data, targeting of CD26 with its specific mAb. Finally we describe how the an-ti-CD26 mAb YS110 was recently evaluated in the first-in-human phase I clinical trial, showing prolonged disease stabilization and a favorable side effect profile. Through better understanding of CD26, new pathways to treating and potentially curing malig-nant mesothelioma may be discovered.

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Surgical Management of Malignant Pleural Mesothelioma: An Update of Clinical Evidence

Cited by 5 publications

References 19 publications

The Role of Neoadjuvant Chemotherapy in Patients With Resectable Malignant Pleural Mesothelioma—An Institutional and National Analysis

The Role of Neoadjuvant Chemotherapy in Patients With Resectable Malignant Pleural Mesothelioma—An Institutional and National Analysis

Outcome of complex surgical resection and reconstruction for rare thoracic cancers: the clinical value of a predictive score

Current and Emerging Therapy for Malignant Pleural Mesothelioma: Focus on CD26/Dipeptidyl Peptidase IV as a Therapeutic Target

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