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Study: Pleurectomy/Decortication Effective in Multimodal Therapy for Mesothelioma

Thursday, May 14, 2009

Source: : Multimodality Therapy for Malignant Pleural Mesothelioma: Pleurectomy/Decortication Followed by Chemotherapy With Cisplatin/Pemetrexed and Radiotherapy. Abstract 151PD

One of the great questions in contemporary mesothelioma treatment is whether pleurectomy/decortication or extrapleural pneumonectomy is the more effective surgical arm for patients with malignant mesothelioma. Different surgeons hold conflicting opinions on this question, but definitive guidance is still not available to recommend one procedure over the other. In light of this situation, physicians in Germany conducted a study to investigate the specific efficacy of pleurectomy/decortication in multimodality therapy and their results compare favorably with prior studies on the efficacy of EPP and multimodal therapy.

The physicians enrolled 35 patients with histologically-confirmed pleural mesothelioma. The staging breakdown was as follow: ten patients with Stage I disease, 6 with Stage II, 17 with Stage III and 2 patients with Stage IV. 25 Patients presented with epithelioid mesothelioma.

The treatment plan of the study stipulated pleurectomy/decortication as the surgical modality, followed by four cycles of pemetrexed and cisplatin. Radiation therapy to the chest wall and mediastinum commenced four to six weeks after surgery. Of the 35 patients who started the study, 33 completed the full treatment plan. One patient died as a result of the surgery and one died as a result of chemotherapy toxicity.

The study results demonstrated overall median survival at 33.2 months. The 1-year survival rate was reported at 75%, the 2-year survival rate at 61% and the 3-year survival was reported as 43%. Due to these excellent results, the physicians concluded that pleurectomy/decortication is effective in multimodal treatments and they call for large, multi-center studies on this treatment.

The physicians presented their findings on May 3, 2009 at the 2009 European Multidisciplinary Conference in Thoracic Oncology (EMCTO).

Labels: mesothelioma, pleuralmesothelioma, surgery, treatments

posted by Joseph DiCastro at 11:35 AM
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Osteopontin Isoforms as Diagnostic Markers for Mesothelioma

Wednesday, May 6, 2009

Prior research has identified osteopontin (SPP1) as a potential tumor marker for malignant mesothelioma, as well as for other cancers, but little is understood about the biological activity responsible for this function. Molecular analysis of osteopontin has identified three specific isoforms of the protein, which are known as SPP1-A, SPP1-B and SPP1-C, but the relationship between these isoforms and carcinogenesis is also poorly understood. To learn more about these relationships, researchers from New York University’s School of Medicine conducted a study on tissue samples extracted from the resected tissue of patients with malignant mesothelioma and then compared their findings to a control group of healthy tissue. The researchers found that all of the isoforms of SPP1 were present in normal tissues, but that SPP1-A and SPP1-B were significantly up-regulated in the mesothelioma tissue, but SPP1-C was not. This was also the case when the researchers compared cases of primary mesothelioma to cases of recurrent mesothelioma, which led the researchers to conclude that SPP1-A and SPP1-B may be useful serum markers for mesothelioma diagnosis.

The researchers also looked at the tumorigenic activity of osteopontin and found that both SPP1-A and SPP1-B were associated with pro-tumorigenic activity, while SPP1-C was not. The researchers hypothesize that because the only structural difference between SPP1-A and SPP1-C is an exon that encodes an oligopeptide, future research may be able to develop a specific inhibitor to SPP1-A’s pro-tumorigenic activity. Such a development could be very beneficial to improving the efficacy of mesothelioma treatments.

This study was published in Biochemical and Biophysical Research Communications, under the title of “Tumorigenic properties of alternative osteopontin isoforms in mesothelioma.”

Labels: diagnosis, mesothelioma

posted by Joseph DiCastro at 2:26 PM
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Gene Expression and Treatment Prognosis in Malignant Mesothelioma

Friday, May 1, 2009

Even as recent advances in the treatment of malignant mesothelioma have led to a better long-term prognosis for some patients, physicians have not been able to definitely determine which patient classes have the best overall chances at long-term survival. Early diagnosis and epitheloid histology are typically seen as the best prognostic factors, but variations even exist among patients with these factors. In an attempt to learn more this question, physicians and researchers at Boston’s Brigham and Woman’s Hospital have conducted a number of retrospective gene expression studies using tissue samples from prior patients and the results of a recent prospective study involving 120 patients have confirmed many of their previous findings.

The physicians were able to isolate the relationships among four genes (TM4SF1/PKM2, TM4SF1/ARHGDIA, and COBLL1/ARHGDIA) to determine which patients were the likeliest to experience a better prognosis and which were likeliest to experience a more limited one. The authors report their testing predicted both overall survival and cancer-specific survival and the combination of the gene expression tests with traditional prognostic factors allowed them to create separate classifications of a high-risk group and low-risk group with significant accuracy.

The results of this research are quite promising for mesothelioma treatment and the authors call for more study of their testing methodology to determine its regular applicability to mesothelioma patients.

Labels: mesothelioma, treatments

posted by Joseph DiCastro at 12:41 PM
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