TY - JOUR
T1 - Leveraging the pleural space for anticancer therapies in pleural mesothelioma
AU - Blyth, Kevin G.
AU - Adusumilli, Prasad S.
AU - Astoul, Philippe
AU - Darlison, Liz
AU - Lee, Y. C.Gary
AU - Mansfield, Aaron S.
AU - Marciniak, Stefan J.
AU - Maskell, Nick
AU - Panou, Vasiliki
AU - Peikert, Tobias
AU - Rahman, Najib M.
AU - Zauderer, Marjorie G.
AU - Sterman, Daniel
AU - Fennell, Dean A.
N1 - Publisher Copyright:
© 2024 Elsevier Ltd
PY - 2024/6
Y1 - 2024/6
N2 - Most patients with pleural mesothelioma (PM) present with symptomatic pleural effusion. In some patients, PM is only detectable on the pleural surfaces, providing a strong rationale for intrapleural anticancer therapy. In modern prospective studies involving expert radiological staging and specialist multidisciplinary teams, the population incidence of stage I PM (an approximate surrogate of pleura-only PM) is higher than in historical retrospective series. In this Viewpoint, we advocate for the expansion of intrapleural trials to serve these patients, given the paucity of data supporting licensed systemic therapies in this setting and the uncertainties involved in surgical therapy. We begin by reviewing the unique anatomical and physiological features of the PM-bearing pleural space, before critically appraising the evidence for systemic therapies in stage I PM and previous intrapleural PM trials. We conclude with a summary of key challenges and potential solutions, including optimal trial designs, repurposing of indwelling pleural catheters, and new technologies.
AB - Most patients with pleural mesothelioma (PM) present with symptomatic pleural effusion. In some patients, PM is only detectable on the pleural surfaces, providing a strong rationale for intrapleural anticancer therapy. In modern prospective studies involving expert radiological staging and specialist multidisciplinary teams, the population incidence of stage I PM (an approximate surrogate of pleura-only PM) is higher than in historical retrospective series. In this Viewpoint, we advocate for the expansion of intrapleural trials to serve these patients, given the paucity of data supporting licensed systemic therapies in this setting and the uncertainties involved in surgical therapy. We begin by reviewing the unique anatomical and physiological features of the PM-bearing pleural space, before critically appraising the evidence for systemic therapies in stage I PM and previous intrapleural PM trials. We conclude with a summary of key challenges and potential solutions, including optimal trial designs, repurposing of indwelling pleural catheters, and new technologies.
UR - http://www.scopus.com/inward/record.url?scp=85193834463&partnerID=8YFLogxK
U2 - 10.1016/S2213-2600(24)00111-5
DO - 10.1016/S2213-2600(24)00111-5
M3 - Review article
C2 - 38740045
AN - SCOPUS:85193834463
SN - 2213-2600
VL - 12
SP - 476
EP - 483
JO - The Lancet Respiratory Medicine
JF - The Lancet Respiratory Medicine
IS - 6
ER -