Management Of Malignant Pleural Mesothelioma Research Articles

Three-dimensional printing of the human lung pleural cavity model for PDT malignant mesothelioma

ObjectiveThe primary aim was to investigate emerging 3D printing and optical acquisition technologies to refine and enhance photodynamic therapy (PDT) dosimetry in the management of malignant pleural mesothelioma (MPM). Materials and methodsA rigorous digital reconstruction of the pleural lung cavity was conducted utilizing 3D printing and optical scanning methodologies. These reconstructions were systematically assessed against CT-derived data to ascertain their accuracy in representing critical anatomic features and post-resection topographical variations. ResultsThe resulting reconstructions excelled in their anatomical precision, proving instrumental translation for precise dosimetry calculations for PDT. Validation against CT data confirmed the utility of these models not only for enhancing therapeutic planning but also as critical tools for educational and calibration purposes. ConclusionThe research outlined a successful protocol for the precise calculation of light distribution within the complex environment of the pleural cavity, marking a substantive advance in the application of PDT for MPM. This work holds significant promise for individualizing patient care, minimizing collateral radiation exposure, and improving the overall efficiency of MPM treatments.

Updates in Management of Malignant Pleural Mesothelioma.

Malignant pleural mesothelioma (MPM) is an aggressive asbestos-associated thoracic malignancy that is usually incurable. As demonstrated in the landmark MARS2 trial, surgical resection does not improve survival outcomes and its role in managing MPM is limited. Whilst platinum-pemetrexed chemotherapy in combination with bevacizumab was the standard first-lineapproach for unresectable disease, landmark phase 3 trials have now established the role of immune checkpoint inhibitors (CPIs) in the upfront management of unresectable disease: either nivolumab-ipilimumab or carboplatin-pemetrexed-pembrolizumab. Patient selection for optimal strategy remains an ongoing question. For relapsed disease novel genomic-based therapies targeting a range of aberrations including losses of the tumour suppressor genes BAP1, CDKN2A and NF2, are being evaluated. Nonetheless, the future of MPM therapeutics holds promise. Here we overview current treatment strategies in the management of MPM.

Pembrolizumab (Anti-PD-1) in the management of malignant pleural mesothelioma: A systematic review of the current literature

Malignant pleural mesothelioma is an infrequent and aggressive type of cancer that is difficult to treat, and standard therapies have shown limited effectiveness. There have been recent advances in the development of targeted therapies for malignant pleural mesothelioma, including immunotherapy with pembrolizumab. This is a systematic review of the current role of pembrolizumab in the treatment of this disease. A systematic search was conducted through the databases and search engines. The eligible studies to be included were those that primarily focused on the outcomes of treating this disease with pembrolizumab, regardless of study design, line of therapy, mode of therapy, and ECOG performance status. After the initial and full-text screenings, 15 studies were reviewed. The number of cases was 454 with a mean age of 68.13 years, of which males (79.7%) were the predominant gender. Most of the cases were affected by epithelioid mesothelioma (76.7%). Pembrolizumab had been used as the first line of treatment in 62 (13.7%) cases. In 92.73% of cases, the therapy mode was pembrolizumab monotherapy. A total of 68 different adverse events were recorded. The most commonly associated adverse events were fatigue (14.8%), pruritis/rash (13.7%), and diarrhea (9.7%). Two patients died due to adverse events. The overall objective response was 17.8%, stable disease was 35.7%, progression-free survival was about 47.6% with a mean of 4.73 months, and 117 cases (25.8%) could reach treatment-related survival. Pembrolizumab can serve as a viable alternative in the management of malignant pleural mesothelioma, offering satisfactory outcomes and acceptable safety profiles

Hyperthermic Intrathoracic Chemotherapy (HITOC) Improves Malignant Pleural Mesothelioma Control Through a Tumor Specific Cytotoxic Immune Response

Abstract Background The management of malignant pleural mesothelioma (MPM) remains challenging with poor patient survival. Local therapies such as hyperthermic intrathoracic cisplatin (HITOC) have shown good tumor control in selected patients. HITOC was shown to increase MPM drug exposure while limiting systemic side effects but alternative mechanisms for HITOC are still lacking. Aims We hypothesized that HITOC induces an immune response directed against MPM which decreases cancer related mortality. Methods A perfusion circuit was downsized to administer cisplatin in the thoracic cavity of MPM bearing mice at normo (37°C, ITOC) or hyperthermic (39°C, HITOC) conditions for 30 minutes. Tumor platinum content and distribution were determined by inductively coupled plasma mass spectrometry (ICP-MS) and by laser ablation ICP-MS respectively. The impact of (H)ITOC on the MPM immune microenvironment was questioned using flow cytometry and immunohistochemistry. Tumor growth and survival was assessed in immunocompetent and T-cell deficient mice. Finally, the combination of HITOC with anti-CTLA-4 and anti-PD-1 antibodies was evaluated in immunocompetent animals. Results MPM tumor control and mouse survival were significantly improved by HITOC compared to controls (ITOC, saline 37 and 39°C). This correlated with higher tumor platinum content that was mainly located at the surface of tumors. Furthermore, HITOC enhanced MPM infiltration by cytotoxic T-cells and decreased the level of protumor (M2-like) macrophages at day 7. The beneficial impact of HITOC on tumor control and mice survival was lost in immunocompromised animals. Interestingly, HITOC significantly induced PD-1 and CTLA-4 immune checkpoint molecules expression and administration of dual immune checkpoint blockade after HITOC increased of almost two fold the median survival of the animals. Conclusions HITOC improves MPM control through a T lymphocyte immune mediated response. The potentiation of the immune checkpoint blockade response by HITOC opens new perspectives for the combination of immune checkpoint inhibitors with HITOC in clinic.

Caregivers of patients with malignant pleural mesothelioma: who provides care, what care do they provide and what burden do they experience?

There are limited data on the impact of caregiving for patients with malignant pleural mesothelioma (MPM) on the caregiver. We aimed to identify the demographic characteristics of these caregivers, the caregiving activities they perform and how caregiving burden impacts their work productivity and overall activity. This cross-sectional study collected data from caregivers of patients with MPM across France, Italy, Spain and the United Kingdom January-June 2019. Caregiver demographics, daily caregiving tasks and the impact of caregiving on physical health was collected via questionnaire. The Zarit Burden Interview (ZBI) was used to assess caregiver burden and the Work Productivity and Activity Impairment questionnaire (WPAI) assessed impairment at work and during daily activities. Analyses were descriptive. Overall, 291 caregivers provided data. Caregivers were mostly female (83%), living with the patient (82%) and their partner/spouse (71%). Caregivers provided over five hours of daily emotional/physical support to patients. ZBI scores indicated 74% of caregivers were at risk of developing depression. Employed caregivers had missed 12% of work in the past seven days, with considerable presenteeism (25%) and overall work impairment (33%) observed. Overall, the mean activity impairment was 40%. Caregivers provide essential care for those with MPM. We show caregiving for patients with MPM involves a range of burdensome tasks that impact caregivers' emotional health and work reflected in ZBI and WPAI scores. Innovations in the management of MPM must account for how caregivers may be impacted and can be supported to carry out this important role.

Abstract 6399: Hyperthermic intrathoracic chemotherapy (HITOC) improves malignant pleural mesothelioma control through a tumor specific cytotoxic immune response

Abstract Introduction: The management of malignant pleural mesothelioma (MPM) remains challenging with poor patient survival. Local therapies such as hyperthermic intrathoracic cisplatin (HITOC) have shown good tumor control in selected patients. HITOC was shown to increase MPM drug exposure while limiting systemic side effects but alternative mechanisms for HITOC are still lacking. Here, we hypothesized that HITOC induces an immune response directed against MPM which decreases cancer related mortality. Methods: We implanted AB12-luc MPM cells in the pleural cavity of BALB/c mice. A chemotherapy perfusion circuit was downsized to administer cisplatin (80mg/m2 equivalent dose) in the thoracic cavity at normo (37°C, ITOC) or hyperthermic (39°C, HITOC) conditions for 30 minutes. Tumor growth (visualized by bioluminescence) and mouse survival were then assessed. We determined tumor platinum content and distribution by inductively coupled plasma mass spectrometry (ICP-MS) and by laser ablation ICP-MS (LA-ICP-MS) respectively. We also questioned the impact of (H)ITOC on the MPM immune microenvironment (innate and adaptive immune cells, activity and checkpoint expression) by 16-colour flow cytometry and immunohistochemistry. Finally, tumor response to (H)ITOC was assessed in BALB/c athymic mice implanted with AB12-luc cells. Results: MPM tumor control and mouse survival were significantly improved by HITOC compared to controls (ITOC, saline 37 and 39°C). Tumor platinum content was significantly higher in HITOC compared to ITOC but was majorly located at the surface of tumors. HITOC enhanced MPM infiltration by CD8+Granzyme B+ T-cells and decreased the levels of MCHII−/CD80− (M2-like) macrophages compared to controls at day 7. Interestingly, immune checkpoint expression of PD1 and CTLA4 was significantly enhanced in CD8+ lymphocytes in HITOC treated MPM compared to controls at day 7. Finally, the lack of T lymphocytes (BALB/c athymic mice) abrogated the impact of HITOC on MPM control and mouse survival. Conclusion: HITOC improves MPM control through a T lymphocyte immune mediated response. The enhanced immune checkpoint (PD1/CTLA4) expression in CD8+ lymphocytes opens perspectives for the combination of HITOC with immune checkpoint inhibitors. Citation Format: Yameng Hao, Aspasia Gkasti, Louis-Emmanuel Chriqui, Damien Marie, Michel Gonzalez, Thorsten Krueger, Solange Peters, Paul J. Dyson, Etienne Meylan, Johanna Joyce, Sabrina Cavin, Jean Y. Perentes. Hyperthermic intrathoracic chemotherapy (HITOC) improves malignant pleural mesothelioma control through a tumor specific cytotoxic immune response. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 6399.

The Evolving Role of Immune-Checkpoint Inhibitors in Malignant Pleural Mesothelioma.

Malignant pleural mesothelioma (MPM) is a rare cancer usually caused by asbestos exposure and associated with a very poor prognosis. After more than a decade without new therapeutic options, immune checkpoint inhibitors (ICIs) demonstrated superiority over standard chemotherapy, with improved overall survival in the first and later-line settings. However, a significant proportion of patients still do not derive benefit from ICIs, highlighting the need for new treatment strategies and predictive biomarkers of response. Combinations with chemo-immunotherapy or ICIs and anti-VEGF are currently being evaluated in clinical trials and might change the standard of care in the near future. Alternatively, some non-ICI immunotherapeutic approaches, such as mesothelin targeted CAR-T cells or denditric-cells vaccines, have shown promising results in early phases of trials and are still in development. Finally, immunotherapy with ICIs is also being evaluated in the peri-operative setting, in the minority of patients presenting with resectable disease. The goal of this review is to discuss the current role of immunotherapy in the management of malignant pleural mesothelioma, as well as promising future therapeutic directions.

Tislelizumab combined with anlotinib in the second-line treatment of malignant pleural mesothelioma.

Malignant pleural mesothelioma (MPM) is a malevolent tumor originated from pleura and often leads to poor prognosis. Chemotherapy of pemetrexed and cisplatin combined with antiangiogenic therapy of bevacizumab is recommended as the first-line regimen by guidelines. However, there are few sustainable second-line anti-tumor theraies that bring distinct survival benefit after the occurrence of drug resistance as the reported mPFS (median progression-free survival) scarcely exceeds 6 months. Immune checkpoint inhibitors are extensively investigated in pan-cancer, and dual immunotherapy has been listed in the first-line recommendation of MPM in several guidelines, while MPM patients benefit modestly from immune checkpoint inhibitors combination or monotherapy in second-line practice. We report a 59-year-old male patient who was diagnosed with unresectable MPM in April 2021. He received firstly pemetrexed combined with platinum and bevacizumab, which barely curbed disease progression; When the first line treatment failed, he was switched to tislelizumab combined with anlotinib. Tislelizumab combined with anlotinib significantly relieved his clinical symptoms, and imaging examination further validated the improvement. Until present, the second-line treatment PFS is more than 10 months. The case firstly demonstrated the efficacy of tislelizumab combined with anlotinib in the second-line management of MPM. Thus, immunotherapy combined with small-molecule multi-target anti-angiogenic medication may be alternative for the second-line schemes of MPM.

A glimpse into the role of debulking surgery and hyperthermic intrathoracic chemotherapy (HITHOC) in the management of malignant pleural mesothelioma

A glimpse into the role of debulking surgery and hyperthermic intrathoracic chemotherapy (HITHOC) in the management of malignant pleural mesothelioma

EP07.03-006 Feasibility of TTFields with Pemetrexed and Platinum-Based Chemotherapy for Unresectable Malignant Pleural Mesothelioma: Real-World Data

Management of malignant pleural mesothelioma (MPM) is challenging as patients frequently present with unresectable advanced disease and the response rates with systemic therapy alone remain low. Tumor Treating Fields (TTFields) is an antimitotic locoregional treatment comprising of low-intensity, alternating electric fields delivered through a portable medical device to the chest. Given the paucity of effective therapies for MPM, TTFields treatment was made available for use under an FDA-approved Humanitarian Device Exemption (HDE) protocol in 2019, but no real-world data beyond the initial trial have been published to date.

External Validation of a Breath-Based Prediction Model for Malignant Pleural Mesothelioma

Simple SummaryMalignant pleural mesothelioma (MPM) is an incurable asbestos-related thoracic cancer for which early-stage diagnosis remains a major challenge. Volatile organic compounds (VOCs), which are metabolites present in exhaled breath, have proven to be promising non-invasive biomarkers for MPM. However, without the necessary validation in an independent group of individuals, clinical implementation is hampered. Therefore, we performed external validation of a VOC-based prediction model for MPM, which initially revealed a poor performance and thus poor generalisability of the model. However, subsequent updating of the model improved its performance in the validation cohort, resulting in a more generalisable model with a screening potential, which could significantly impact MPM management.During the past decade, volatile organic compounds (VOCs) in exhaled breath have emerged as promising biomarkers for malignant pleural mesothelioma (MPM). However, as these biomarkers lack external validation, no breath test for MPM has been implemented in clinical practice. To address this issue, we performed the first external validation of a VOC-based prediction model for MPM. The external validation cohort was prospectively recruited, consisting of 47 MPM patients and 76 asbestos-exposed (AEx) controls. The predictive performance of the previously developed model was assessed by determining the degree of agreement between the predicted and actual outcome of the participants (patient/control). Additionally, to optimise the performance, the model was updated by refitting it to the validation cohort. External validation revealed a poor performance of the original model as the accuracy was estimated at only 41%, indicating poor generalisability. However, subsequent updating of the model improved the differentiation between MPM patients and AEx controls significantly (73% accuracy, 92% sensitivity, and 92% negative predictive value), substantiating the validity of the original predictors. This updated model will be more generalisable to the target population and exhibits key characteristics of a potential screening test for MPM, which could significantly impact MPM management.

Current State of Pleural-Directed Adjuncts Against Malignant Pleural Mesothelioma.

Multimodality therapy including surgical resection is the current paradigm in treating malignant pleural mesothelioma (MPM), a thoracic surface cancer without cure. The main limitation of all surgical approaches is the lack of long-term durability because macroscopic complete resection (R1 resection) commonly predisposes to locoregional relapse. Over the years, there have been many studies that describe various intrapleural strategies that aim to extend the effect of surgical resection. The majority of these approaches are intraoperative adjuvants. Broadly, there are three therapeutic classes that employ diverse agents. The most common, widely used group of adjuvants are comprised of direct therapeutics such as intracavitary chemotherapy (± hyperthermia). By comparison, the least commonly employed intrathoracic adjuvant is the class comprised of drug-device combinations like photodynamic therapy (PDT). But the most rapidly evolving (new) class with much potential for improved efficacy are therapeutics delivered by specialized drug vehicles such as a fibrin gel containing cisplatin. This review provides an updated perspective on pleural-directed adjuncts in the management of MPM as well as highlighting the most promising near-term technology breakthroughs.

Immunothérapie et autres stratégies dans le traitement du mésothéliome pleural: Immunotherapy and other strategies in the treatment of pleural mesothelioma

Management of malignant pleural mesothelioma (MPM), a rare tumor, usually due to previous asbestos exposure, with a globally poor prognosis and no validated curative treatment to date, is highly evolving. Recent major improvements in a better knowledge of MPM pathogenesis stimulate the search of new treatments, strategies and biomarkers to drive precision medicine in the future. Multimodal treatment and surgery with curative intent, included was well as radiotherapy, are highly discussed and restrained to selected patients, even if these indications could change with the combination of immunotherapies. As front line treatment, standard chemotherapy doing quite poorly, even if slightly improved by addition of bevacizumab, is now highly challenged by an immunotherapy combining nivolumab + ipilimumab. Therapeutic options beyond first line treatment are limited even if anti-PD-1/PD-L1 ± anti-CTLA-4 antibodies also exhibited promising results in phase II and III trials. Thus the search of new treatments, strategies and biomarkers is a crucial goal, and recruitment of patients in clinical trials is strongly encouraged. Other immunotherapies alone or combined with standard treatments and/or targeted therapies, multimodal strategies including intrapleural therapy are currently assessed.In France, the national cancer institute INCa labelled the national network of expert centers for MPM NETMESO (combining MESOCLIN and MESOPATH) and requests that to all patients should be discussed during regional (± national) NETMESO multidisciplinary board MPM at least at the time of diagnosis, in order to propose them an optimal management and to join clinical research studies.© 2022 SPLF. Published by Elsevier Masson SAS. All rights reserved.

20 years managing malignant pleural mesothelioma: a review of our experience and the quest for the optimal prognostic marker

Introduction: Malignant pleural mesothelioma (MPM) is a rare, but aggressive incurable cancer. A variety of prognostic tools have been developed to guide clinicians and patients in the management of MPM regarding the most appropriate therapy and survival time. Objectives: To evaluate the usefulness of the Brims’ decision tree analysis, the EORTC prognostic score, the CALGB prognostic groups, the modified Glasgow Prognostic Score (mGPS), and the LENT prognostic score in our MPM patients. Methods: Local retrospective database analysis of patients with MPM diagnosed between 2000 and 2020. The different prognostic scores were applied and MPM group risks’ evolution was analyzed. Statistical analysis was performed with IBM® SPSS® Statistics 25. Results: A total of 67 patients were evaluated (55 males, 82.1%). Epithelioid MPM was the commonest histological type (51 patients, 76.1%). Median overall survival (OS) was 11 months (IQR 23) and median progression free-survival (PFS) was 7 months (IQR 12.5). Survival distributions were statistically significantly different for the Brims’ and the mGPS’ groups (respectively, χ2 = 7.188, p = .027, and χ2 = 6.46, p = .04). For EORTC, CALGB and LENT score, there were not statistically significant differences in survival distributions (respectively, χ2 =.57, p = .811; χ2 = 7.978, p = .157; and χ2 = 1.23, p = .267). Brims’ model and mGPS statistically significantly predicted OS (respectively, F(1,57) = 11.1, p < 0.01, and F(1,32) = 6.846, p = .01). EORTC, CALGB and LENT failed to statistically significantly predict OS (respectively, F(1,44) = .003, p = .955; F(1.43) = .722, p = 0.4; and F(1,14) = 1.193, p = .293). Conclusion: The small number of patients included and missing data for some parameters are limitations of our analysis. However, to our knowledge, this was the first study and the largest cohort to address MPM prognostic scores in our country. In our cohort, the Brims’ model and mGPS were useful in predicting survival. Both are simple tools with easily accessible parameters and should be considered for clinical practice.

[Recommendations for the management of malignant pleural mesothelioma].

恶性胸膜间皮瘤（MPM）是一种少见、侵袭性强、预后差的恶性肿瘤。近年，关于MPM的临床研究进展迅速，新的治疗药物和临床试验结果不断涌现，本文对MPM的最新研究进展进行解读，力求推动临床更好地诊断和治疗MPM。.

P37.02 Improving Outcomes in Malignant Pleural Mesothelioma in an Integrated Health System

Malignant pleural mesothelioma (MPM) is a rare and aggressive tumor with an associated poor prognosis, median overall survival (OS) is 1 year, despite advances in treatment practices.1-4 NCCN guidelines recommend patients with MPM should be managed by a multidisciplinary team with experience in MPM management.5 Although there is no agreement on which surgical intervention is best,6-8 guidelines are consistent in recommending that surgeries be performed by skilled surgeons at high-volume centers.1 Improved outcomes due to regionalization of surgeries for patients with NSCLC has been demonstrated,9 but further evaluation of centralization of MPM surgeries has yet to be determined. Electronic medical records of 369 adult patients with MPM from 1/1/2009 to 12/31/2020 were reviewed and compared before (2009-2014) and after (2015-2020) MPM surgeries were regionalized to specialized surgeons and multidisciplinary review of MPM patient treatment options. We used the Kaplan-Meier method and log-rank tests to compare survival rates by period, by treatment type, and by stage. Patients were followed from cancer diagnosis date until they died or end of study follow-up, whichever occurred first. We also conducted Cox proportional hazards regression model to examine the overall survival with adjustments for age, gender, histology, stage, and Charlson Comorbidity Index (CCI). Despite similar staging, more patients received any MPM directed treatment from 2015-2020 (n=127, 65%) compared with those patients from 2009-2014 (n=77, 45%) (p<0.0001). Specifically, there was an increase in patients who received pleurectomy/decortication (PD) from 2015-2020 (n=42, 21%) compared to those who received PD in 2009-2014 (n=6, 3.5%) (p=0.0001). Median survival in patients who received multi-modality treatment (surgery, systemic therapy, +/- radiation) during 2009-2014 was 16.7 months (95% confidence interval (CI), 10.8-34.8) compared to 5.7 months (95% CI, 4.0-9.2) in patients who received no treatment. From 2015-2020, median OS for patients who received multi-modality therapy was 23.5 months compared to median survival of 4.3 months in those who received no treatment. Landmark analysis showed a significant survival benefit in patients with early stage MPM from 2015-2020 compared to the 2009-2014 cohort with a median OS 20.7 months and 12.8 months, respectively (HR, 1.58; 95% CI, 1.01-2.47; p = 0.042) (Figure 1); while patients with advanced stage MPM showed no difference in survival between 2009-2014 and 2015-2020 cohorts (HR, 0.97; 95% CI, 0.71-1.32). Consolidating mesothelioma surgery to specialized surgeons and regular multidisciplinary review of MPM cases to determine appropriate multimodality therapy improves OS in patients with MPM.

GOECP/SEOR clinical guidelines on radiotherapy for malignant pleural mesothelioma.

Malignant pleural mesothelioma (MPM) is a rare tumor with poor prognosis and rising incidence. Palliative care is common in MPM as radical treatment with curative intent is often not possible due to metastasis or extensive locoregional involvement. Numerous therapeutic advances have been made in recent years, including the use of less aggressive surgical techniques associated with lower morbidity and mortality (e.g., pleurectomy/decortication), technological advancements in the field of radiotherapy (intensity-modulated radiotherapy, image-guided radiotherapy, stereotactic body radiotherapy, proton therapy), and developments in systemic therapies (chemotherapy and immunotherapy). These improvements have had as yet only a modest effect on local control and survival. Advances in the management of MPM and standardization of care are hampered by the evidence to date, limited by high heterogeneity among studies and small sample sizes. In this clinical guideline prepared by the oncological group for the study of lung cancer of the Spanish Society of Radiation Oncology, we review clinical, histologic, and therapeutic aspects of MPM, with a particular focus on all aspects relating to radiotherapy, including the current evidence base, associations with chemotherapy and surgery, treatment volumes and planning, technological advances, and reradiation.

Integrating data from multidisciplinary Management of Malignant Pleural Mesothelioma: a cohort study

BackgroundMalignant pleural mesothelioma (MPM) is a rare and aggressive malignancy that most commonly affects the pleural layers. MPM has a strong association with asbestos, mainly caused by exposure to its biopersistent fibers in at least 80% of cases. Individuals with a chronic exposure to asbestos might develop disease with a 20–40-year latency with few or no symptoms. Such has been the case in the Italian regions of Piedmont and Lombardy, where industrial production of materials laden with asbestos, mainly cements, has been responsible for the onset of a large epidemic. Since 2018, a multidisciplinary team at San Matteo hospital in Pavia has been collecting data on over 100 patients with MPM. The main goal of this project is to define and describe an integrated profile for each MPM case at diagnosis by using data mining and partition analysis.MethodsHere we bring together exhaustive epidemiologic, histologic and radiologic data of 88 MPM patients that came to our observation and draw correlations with predictive and prognostic significance.ResultsThe median overall survival (OS) was 15.6 months. Most patients presented with pleural effusion, irrespective of disease stage. Quite unexpectedly, no statistically significant association was demonstrated between OS and TNM disease stage at diagnosis. Although average OS is similar in male and female patients, partition analysis of data underlined a significant differential hierarchy of predictor categories based on patient gender. In females with no smoking history, full chemotherapeutic regimens are associated with better outcomes. Moreover, concerning second line treatments, vinorelbine emerged as the most advantageous choice for female patients, whereas in the male subgroup no statistically significant difference resulted between gemcitabine and vinorelbine.ConclusionA multidisciplinary approach to MPM is mandatory to define better therapeutic approaches, personalize the management and improve patient outcomes.

Tract metastasis in patients with long-term pleural catheter-computed tomography diagnosis and longitudinal assessment.

Long-term indwelling pleural catheters (IPC), used for the management of malignant pleural mesothelioma (MPM), may lead to catheter tract metastasis (CTM). While computed tomography (CT) is valuable for diagnosis, no studies have assessed CT manifestations of CTM. Our goal is to describe the incidence, CT appearances, and temporal evolution of CTM in MPM. A retrospective review of CT of 90 consecutive patients with MPM and IPC. In patients with CTM, a longitudinal assessment was performed for CT appearance at diagnosis and over time, interval from insertion to diagnosis and rate of progression. The incidence of CTM was 26% (23/90), in 22 men (54-83 years, mean 73 years). CTM manifested with focal lesion (3 to 60 mm, mean 25 mm) in the subcutaneous tissue at the insertion site. Abnormalities of sub-adjacent skin and fat stranding were present in 16/24 (66%) and 11/24 (46%), respectively, enlargement of chest wall musculature in 11/24 (46%), and dilated subcutaneous vessels in 4/24 (17%) patients. On follow-up, 53% had enlargement of focal lesion. The average rate of progression was 3.5 mm/month, compared to 0.79 mm/month for pleural thickening (p = 0.03). The time between IPC insertion and CTM diagnosis varied from 58 to 1375 days (median 408 days); 83% occurred after IPC removal. Reporting radiologists described focal abnormality at the insertion site in only 9/23 (39%) patients. CTM is commonly overlooked and underreported by radiologists. CT invariably demonstrates focal subcutaneous lesion in the procedure tract, most commonly after IPC removal. Ancillary findings, notably serratus or latissimus dorsi muscle enlargement, are novel finding that can assist in CT detection and diagnosis. • Catheter tract metastasis (CTM), resulting from indwelling pleural catheter to manage malignant pleural mesothelioma, invariably manifested on CT as a focal subcutaneous lesion at the site of insertion, more commonly after catheter removal. • Ipsilateral muscle enlargement is a newly described CT finding that can assist in the detection and diagnosis. • Catheter tract metastasis was commonly overlooked by radiologists, reported in only 39% of cases.

197P Development of a core outcome set for clinical studies of the invasive management of malignant pleural mesothelioma: The COSi-meso initiative

197P Development of a core outcome set for clinical studies of the invasive management of malignant pleural mesothelioma: The COSi-meso initiative