Leveraging the pleural space for anticancer therapies in pleural mesothelioma

Kevin G Blyth; Prasad S Adusumilli; Philippe Astoul; Liz Darlison; Y C Gary Lee; Aaron S Mansfield; Stefan J Marciniak; Nick Maskell; Vasiliki Panou; Tobias Peikert; Najib M Rahman; Marjorie G Zauderer; Daniel Sterman; Dean A Fennell

doi:10.1016/S2213-2600(24)00111-5

Leveraging the pleural space for anticancer therapies in pleural mesothelioma

Lancet Respir Med. 2024 May 10:S2213-2600(24)00111-5. doi: 10.1016/S2213-2600(24)00111-5. Online ahead of print.

Authors

Affiliations

¹ School of Cancer Sciences, University of Glasgow, Glasgow, UK; Queen Elizabeth University Hospital, Glasgow, UK; Cancer Research UK Scotland Centre, Glasgow, UK. Electronic address: kevin.blyth@glasgow.ac.uk.
² Department of Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Cellular Therapeutics Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Center for Cell Engineering, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
³ Thoracic Oncology Department, Hôpital NORD, Aix-Marseille University, Marseille, France.
⁴ Mesothelioma UK, Leicester, UK.
⁵ University of Western Australia, Perth, WA, Australia; Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia.
⁶ Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA.
⁷ Cambridge Institute for Medical Research, University of Cambridge, Cambridge, UK.
⁸ Academic Respiratory Unit, University of Bristol, Bristol, UK; Department of Respiratory Medicine, Southmead Hospital, Bristol, UK.
⁹ Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark; Odense Respiratory Research Unit, University of Southern Denmark, Odense, Denmark; Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark.
¹⁰ Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
¹¹ Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, UK; Nuffield Department of Medicine, University of Oxford, Oxford, UK.
¹² Cellular Therapeutics Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Thoracic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
¹³ New York University School of Medicine, New York, NY, USA.
¹⁴ University of Leicester, Leicester, UK; University Hospitals of Leicester NHS Trust, Leicester, UK.

PMID: 38740045
DOI: 10.1016/S2213-2600(24)00111-5

Abstract

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.

Publication types

Review