bims-mesote 2024-10-27 papers

Issue of 2024‒10‒27
four papers selected by
Laura Mannarino, Humanitas Research

Cureus. 2024 Sep;16(9): e69966

A Case of Malignant Pleural Mesothelioma With Unknown Asbestos Exposure.

Ani Paremuzyan, Ewele Onwubuya, John Mathews.

Malignant pleural mesothelioma (MPM) is a rare, locally invasive tumor that develops from mesothelial cells lining the lung's pleura. It is mostly associated with prolonged asbestos exposure. The long latency period between asbestos exposure and clinical symptoms makes diagnosing MPM challenging. This report describes a 57-year-old Hispanic female who presented with a persistent nonproductive cough and was ultimately diagnosed with advanced-stage pleural mesothelioma after extensive work-up. It highlights the difficulties in diagnosing MPM in patients without apparent asbestos exposure independent of age or gender.

Keywords: asbestos; effusion; exudate; lung; malignant; mesothelioma; plaques; pleural; screening; thoracotomy

DOI: https://doi.org/10.7759/cureus.69966

Ann Thorac Surg. 2024 Oct 22. pii: S0003-4975(24)00875-0. [Epub ahead of print]

Characteristics of long-term survivors with malignant pleural mesothelioma.

Isabelle Opitz, Olivia Lauk, Raphael Werner, Alessandra Matter, Monika Hebeisen, Bianca Battilana, Hasan Batirel, Harvey Pass, Raja Flores, Andrea Wolf, Marc de Perrot, Mir Alireza Hoda, Walter Klepetko, Thomas Klikovits, Masaki Hashimoto, Seiki Hasegawa, William G Richards, Raphael Bueno.

BACKGROUND: Pleural mesothelioma (PM) is a cancer with usually a dismal prognosis. However, long-term survivors do exist. Herein, we analyzed long-term survivors (>5 years after surgery) from high-volume centres around the world.METHODS: This is a multicenter retrospective descriptive analysis of long-term survivors (overall survival ≥ 5 years from surgery) treated within a multimodality therapy approach including macroscopic complete resection. Overall survival was calculated with Kaplan Meier analysis and cases were matched by center and surgery year and compared with a control group of short-term survivors (<2 years) in a conditional logistic regression analysis.
RESULTS: There were 276 long-term survivors, most were male (n=166, 63%) with a median age of 59 (range 21-83) years at time of diagnosis. The histology for 246 was epithelioid and non-epithelioid for 30 patients. The disease was on the right side in 58% of the patients. As of this analysis, 148 patients were dead, 104 were alive and 10 were lost to follow-up. Pathological tumor stages were: pT1 (n=50), pT2 (n=63), pT3 (n=90) or pT4 (n=16), pN0 (n=150), pN1 (n=20) and pN2 (n=39). The matched control dataset included 333 patients, 95 cases and 238 controls. Comparing short- with long-term survivors, there was moderate evidence that a low white blood cell (WBC) count before surgery was more often observed in long-term survivors.
CONCLUSIONS: The data show that long-term survival in PM is possible in a subgroup of surgically treated patients; histological subtype and WBC count seem to be prognosticators for longer survival.

Keywords: Long-term survivor; macroscopic complete resection; malignant pleural mesothelioma; multimodality therapy approach; prognosticator

DOI: https://doi.org/10.1016/j.athoracsur.2024.10.004

Transl Lung Cancer Res. 2024 Sep 30. 13(9): 2448-2452

Double immune checkpoint inhibitor therapy for unresectable pleural mesothelioma rarely induces hyperprogressive disease: a case report.

Gaspard Naulleau, Isabelle Monnet, Gaëlle Rousseau-Bussac, Florent Vinas, Gilles Mangiapan, Laurence Jabot, Amel Boudjemaa, Christos Chouaïd, Jean-Bernard Auliac, Jean-Baptiste Assié.

Background: Use of immune checkpoint inhibitors (ICIs) is associated with new response types, such as hyperprogressive disease (HPD), whose definition is still being discussed. Some authors use dynamic indexes to define HPD. However, since the Checkmate-743 study, ICIs have been a first-line therapy for pleural mesothelioma (PM), thereby making use of dynamic indexes less appropriate. The aim of this study is to describe two cases of HPD and then discuss its definitions and implications.Case Description: Herein, we report two cases of PM HPD on first-line ICI therapy. A 67-year-old man with right unresectable epithelioid PM, without BAP1 or CDKN2A losses, high neutrophil/lymphocyte ratio and rapid-onset pulmonary and mediastinal HPD after two ICI cycles, died of respiratory failure 1 month after starting treatment. A 40-year-old woman with left unresectable epithelioid PM had HPD at first assessment after 4 ICI infusions with jugular thrombosis, liver metastases and more dismal biological parameters. There are multiple different ways to describe HPD, some not applicable to PM. Suspected mechanisms include macrophage reprogramming to M2 cells. There are no known predictive factors of HPD, and future works should focus on identifying them.
Conclusions: HPD is a mode of progression for ICI-treated PM patients. Further investigation is needed to better define and anticipate HPD in these patients.

Keywords: Case report; hyperprogressive disease (HPD); immune checkpoint inhibitors (ICIs); pleural mesothelioma (PM)

DOI: https://doi.org/10.21037/tlcr-24-382

Toxicol Ind Health. 2024 Oct 24. 7482337241293201

An evaluation of trends for mesothelioma mortality in American women: Addressing the content of a recent Morbidity and Mortality Weekly Report (MMWR).

Michael E Stevens, Brett P Tuttle, David W Brew, Dennis J Paustenbach.

Mesothelioma is a fatal disease that has historically been associated with exposure to airborne asbestos. Because occupational asbestos exposures dropped dramatically in the late 1960s and early 1970s, far fewer cases of mesothelioma today are due to these fibers but, instead, are usually a result of the aging process or genetic predisposition. In May of 2022, a Morbidity and Mortality Weekly Report (MMWR) was issued by the Centers for Disease Control and Prevention (CDC) regarding malignant mesothelioma incidence in women from 1999 to 2020. While this MMWR alerted citizens to the continued presence of the disease, after reading this article one might have thought that the CDC was suggesting that the disease was increasing in women due to asbestos exposures (which it is not). In the present analysis, we investigate several factors related to the interpretation of epidemiological data for mesothelioma, including the role of asbestos as a risk factor over time. The authors conducted a review of the scientific community's understanding of mesothelioma incidence and asbestos exposures amongst women, as well as an investigation of the methods and references in the MMWR article. Although various articles have recently discussed the incidence of both peritoneal and pleural mesothelioma in women, it is fortunate that the age-adjusted rates for mesothelioma have remained flat (neither increased nor decreased significantly) in women for the past 50 years. Incredibly few women in the U. S. have had appreciable cumulative exposures to any type of asbestos (chrysotile, amosite, or crocidolite) in the workplace or from the ambient environment, especially since about 1965-1970. In this paper, we highlight six factors that should be considered when evaluating the incidence of mesothelioma amongst American women in the current era. Without sufficient consideration of these factors, improper conclusions have been drawn over the past several years.

Keywords: Age-adjusted incidence; asbestos; background disease rates; epidemiology; mesothelioma; women

DOI: https://doi.org/10.1177/07482337241293201