bims-mesote 2025-05-04 papers

Issue of 2025–05–04
three papers selected by
Laura Mannarino, Humanitas Research

Medicina (Kaunas). 2025 Mar 31. pii: 638. [Epub ahead of print]61(4):

Efficacy of Immunotherapy Versus Chemotherapy in Advanced Pleural Mesothelioma: A Turkish Oncology Group (TOG) Study.

Ziya Kalkan, Senar Ebinc, Murat Arcagok, Ahmet Bilici, Ozcan Yildiz, Saadettin Kilickap, Deniz Can Guven, Ali Murat Tatli, Ahmet Taner Sumbul, Nil Molinas Mandel, Akin Ozturk, Murat Bardakci, Serdar Karakaya, Muhammet Ali Kaplan.

Background and Objectives: This study aimed to evaluate the effectiveness of immunotherapy compared to chemotherapy across different treatment lines in patients with pleural mesothelioma. It also sought to identify factors influencing the success of immunotherapy, such as histological subtype, PD-L1 expression, type of asbestos exposure, and metastatic status. Materials and Methods: A retrospective analysis was conducted with 60 patients diagnosed with pleural mesothelioma. Data on age, gender, histological subtype, and asbestos exposure were collected for all patients and PD-L1 expression was assessed in a subset of patients. Patients received either chemotherapy or immunotherapy as first-, second-, and third-line treatments, and progression-free survival (PFS) and treatment responses were evaluated. Results: Among the 60 patients, 35 (58.3%) were male and the median age was 59 years. The majority (71.7%) had epithelioid histology and 28.3% had distant metastases. Asbestos exposure was documented in 65% of the cases. PD-L1 expression of ≥1% was found in 13 of 17 patients tested. First-line treatments included immunotherapy for 11 patients and chemotherapy for the others, with immunotherapy achieving median PFS of 9 months versus 6 months for chemotherapy, although the difference was not statistically significant. In third-line treatments, immunotherapy significantly outperformed chemotherapy with median PFS of 6 months compared to 3 months (p = 0.048). Absence of metastasis and prior asbestos exposure in an endemic region were linked to better immunotherapy outcomes. Conclusion: Immunotherapy shows increased efficacy in later treatment lines for pleural mesothelioma, especially for patients without metastases or with prior endemic asbestos exposure. Tailored therapeutic strategies should be further explored in prospective studies.

Keywords: immunotherapy; pleural mesothelioma; real-world data

DOI: https://doi.org/10.3390/medicina61040638

Cancers (Basel). 2025 Apr 20. pii: 1371. [Epub ahead of print]17(8):

The Mesothelioma Systemic Inflammation Score Is Independently Associated with Overall Survival and Predicts Benefit of Multimodality Treatment in Pleural Mesothelioma.

BACKGROUND/OBJECTIVES: Malignant pleural mesothelioma (MPM) remains challenging to treat, with a poor prognosis. As controversy about clinical management continues, predictive biomarkers for patient selection to indicate the benefit of treatment modalities are urgently needed.
METHODS: In a retrospective analysis of 195 patients between 1994 and 2020 at the Department of Thoracic Surgery, Medical University of Vienna, Austria, the Mesothelioma Systemic Inflammation Score (MSIS)-consisting of pretreatment neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), C-reactive protein (CRP), and fibrinogen-was tested for its prognostic and predictive significance. The prognostic impact of MSIS was subsequently validated in an independent cohort of 80 patients treated at the Department of Thoracic Surgery, Karl Landsteiner Institute for Clinical and Translational Thoracic Surgery Research, Clinic Floridsdorf, Vienna, Austria.
RESULTS: Median overall survival (OS) was 14 months for the entire cohort (95% CI: 11.4-16.6). Patients undergoing multimodality treatment including macroscopic complete resection had a longer OS (22.3 months, 95% CI: 18.6-26.0; p < 0.001). In multivariable analysis, MSIS (p < 0.001), disease stage (p = 0.001), and the type of treatment (p = 0.004) were confirmed as independent predictors for OS. Higher MSIS was associated with shorter OS (p < 0.001). Significant survival benefit of multimodality regimens including surgery was limited to patients with low MSIS. Among patients with low (≤ 2) MSIS, multimodality therapy was associated with significantly prolonged OS when compared with chemo- and/or radiotherapy alone (25.8 months [95% CI: 16.4-35.3] vs. 14.4 months [95% CI: 10.4-18.4], p < 0.001). In contrast, among patients with elevated MSIS, no survival benefit was achieved by surgery over conservative treatment (11.8 months [95% CI: 8.3-15.3] vs. 8.2 months [95% CI: 5.2-11.3], p = 0.233). The ability of MSIS to predict survival was equivalent between the baseline and the independent validation cohort (p < 0.001).
CONCLUSIONS: The Mesothelioma Systemic Inflammation Score was found to be an independent prognostic score in pleural mesothelioma, predicting benefit from macroscopic complete resection as part of multimodality treatment in distinct patients.

Keywords: biomarkers; malignant pleural mesothelioma; predictive score; prognostic score; systemic inflammation score

DOI: https://doi.org/10.3390/cancers17081371

Cureus. 2025 Mar;17(3): e81473

A Rare Case of Sarcomatoid-Type Localized Pleural Mesothelioma Derived From Visceral Pleura.

Takayuki Kosaka, Seshiru Nakazawa, Rikuo Ushikubo, Takashi Ibe, Ken Shirabe.

A man in his 80s presented with shortness of breath. Chest CT scan showed pleural effusion and a mass in the right lower lobe. He had high inflammatory reaction and was diagnosed as having pulmonary suppuration with empyema. After three weeks of antibiotic treatment, the lesion grew and he was referred to our department for surgical intervention. A complete resection of the right lower lobe was planned to control infection. Intraoperative findings showed that the lower lobe became a large mass and was judged unresectable. The procedure was converted to drainage of the abscess cavity. Pathological examination, combined with clinical and radiological findings, led to the diagnosis of localized sarcoma-type malignant pleural mesothelioma. Localized malignant pleural mesothelioma is a rare disease and most cases have been reported as epithelial type, deriving from the parietal pleura. Our case is quite rare because it was a sarcoma-type, deriving from the visceral pleura.

Keywords: localized pleural mesothelioma; lung cancer; mesothelioma; pleural mesothelioma; sarcomatoid-type pleural mesothelioma

DOI: https://doi.org/10.7759/cureus.81473