Treatment of Malignant Pleural Mesothelioma: American Society of Clinical Oncology Clinical Practice Guideline

Abstract

Purpose To provide evidence-based recommendations to practicing physicians and others on the management of malignant pleural mesothelioma. Methods ASCO convened an Expert Panel of medical oncology, thoracic surgery, radiation oncology, pulmonary, pathology, imaging, and advocacy experts to conduct a literature search, which included systematic reviews, meta-analyses, randomized controlled trials, and prospective and retrospective comparative observational studies published from 1990 through 2017. Outcomes of interest included survival, disease-free or recurrence-free survival, and quality of life. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations. Results The literature search identified 222 relevant studies to inform the evidence base for this guideline. Recommendations Evidence-based recommendations were developed for diagnosis, staging, chemotherapy, surgical cytoreduction, radiation therapy, and multimodality therapy in patients with malignant pleural mesothelioma. Additional information is available at www.asco.org/thoracic-cancer-guidelines and www.asco.org/guidelineswiki .

Diagnostic yield of pleural fluid cytology in malignant effusions: an Australian tertiary centre experience

“…Cytological diagnosis of mesothelioma is feasible for MPE, with a study from Western Australia, a region with the highest per capita incidence of malignant mesothelioma worldwide, reporting 73% accuracy for diagnosis of mesothelioma with an experienced laboratory and cytopathologist. 6,27,28 Our findings suggest that one pleural fluid sample is adequate for detecting MPE due to lung adenocarcinoma, but repeated samples may increase sensitivity for detection of other cancer types. 15,24 Another study which included over 1200 cases of epithelioid mesothelioma demonstrated no difference in survival between those diagnosed by cytology versus those with histologic-derived diagnosis.…”

“…Nonadenocarcinoma NSCLC (NSCLC not specified, NSCLC with neuroendocrine differentiation and squamous cell carcinoma) also demonstrated high sensitivity; however, with only five cases in our cohort this should be interpreted with caution. 26,27 Repeated cytological analysis with a second sample only modestly improved the accuracy (by 4.3% to 90.2%) and sensitivity (by 7.7% to 75.4%) of pleural fluid cytology for MPE diagnosis, with most cases diagnosed on a second sample being less common tumour types. 23 Our finding regarding sensitivity is consistent with other studies reporting significantly lower sensitivity for detection of mesothelioma (range 27-48%).…”

Therapeutic efficacy evaluation of radioimmunotherapy with 90Y‐labeled anti‐podoplanin antibody NZ‐12 for mesothelioma

“…Median overall survival in patients with malignant mesothelioma is 7 months . Surgical resection may be offered to patients with early‐stage disease, and systemic chemotherapy is the main treatment for patients with advanced‐stage disease . Most malignant mesothelioma patients receive chemotherapy, however, because the disease is often diagnosed at the advanced stage .…”

The management of malignant pleural mesothelioma in the USA 2004-13—a decade of lost opportunity?

“…Whilst the British Thoracic Society (19) has adopted a typically conservative attitude when they recommend radical surgery only as part of a clinical trial and boldly declare no role for EPP (on the basis of one small feasibility study). In contrast the American Society of Clinical Oncology strongly recommended that in selected patients with early-stage disease (node negative, epithelioid) a maximal surgical cytoreduction should be performed (20). Furthermore, it is strongly recommended that patients with ipsilateral histologically confirmed mediastinal lymph node involvement should undergo maximal surgical cytoreduction in the context of multimodality therapy (neoadjuvant or adjuvant chemotherapy).…”