TY - JOUR
T1 - ERS/ESTS/EACTS/ESTRO guidelines for the management of malignant pleural mesothelioma
AU - Opitz, Isabelle
AU - Scherpereel, Arnaud
AU - Berghmans, Thierry
AU - Psallidas, Ioannis
AU - Glatzer, Markus
AU - Rigau, David
AU - Astoul, Philippe
AU - Boeluekbas, Servet
AU - Boyd, Jeanette
AU - Coolen, Johan
AU - De Bondt, Charlotte
AU - De Ruysscher, Dirk
AU - Durieux, Valerie
AU - Faivre-Finn, Corinne
AU - Fennell, Dean A.
AU - Galateau-Salle, Francoise
AU - Greillier, Laurent
AU - Hoda, Mir Ali
AU - Klepetko, Walter
AU - Lacourt, Aude
AU - McElnay, Phil
AU - Maskell, Nick A.
AU - Mutti, Luciano
AU - Pairon, Jean-Claude
AU - Van Schil, Paul
AU - van Meerbeeck, Jan P.
AU - Waller, David
AU - Weder, Walter
AU - Putora, Paul Martin
AU - Cardillo, Giuseppe
N1 - Funding Information:
The authors would like to thank Patrick Brochard and Justine Gallet (University Bordeaux, Bordeaux, France) and Eric Wasielewski (CHU Lille, Lille, France) for their help. Prof Corinne Faivre-Finn was supported by the NIHR Manchester Biomedical Research Centre.
Funding Information:
Conflict of interest: Arnaud Scherpereel reports personal fees for advisory board work from AstraZeneca, BMS, MSD, Roche and Janssen, non-financial support for meeting attendance from BMS, MSD and Roche, institutional support for clinical trial participation from Astra-Zeneca/MedImmune, BMS, Verastem and Bayer, grants from BMS, outside the submitted work. Ioannis Psallidas works as a Medical Science Director for AstraZeneca, outside the submitted work; membership of the task force was resigned when this position became effective. David Rigau works as methodologist for the European Respiratory Society. Jeanette Boyd is an employee of the European Respiratory Society. Dirk De Ruysscher reports grants from Bristol-Myers-Squibb AstraZeneca, Celgene, Roche/Genentech and Merck/Pfizer, outside the submitted work. Dean Fennell reports personal fees and non-financial support from BMS and MSD, nonfinancial support from Eli Lilly, Clovis, Bergen Bio and Pierre Fabre, grants, personal fees and non-financial support from Roche-Genentech, personal fees from Aldeyra, during the conduct of the study. Laurent Greillier reports grants, personal fees and nonfinancial support from Roche and Novartis, personal fees and nonfinancial support from Pfizer, Bristol-Myers Squibb, Boehringer Ingelheim, AstraZeneca, Abbvie and MSD, outside the submitted work. Phil McElnay was employed by GlaxoSmithKline, outside the submitted work. Jean-Claude Pairon reports grants from Santé Publique France Agency and French National Health Insurance (CNAM-TS), outside the submitted work. Walter Weder reports personal fees from AstraZeneca for advisory board work and lectures, grants and personal fees for lectures from Covidien, outside the submitted work. Paul Martin Putora reports grants from AstraZeneca and Celgene, outside the submitted work. All other authors declared no conflict of interest.
Funding Information:
This work was supported by the European Respiratory Society, European Society of Thoracic Surgeons, European Association for Cardio-Thoracic Surgery and the European Society for Radiotherapy and Oncology. Funding information for this article has been deposited with the Crossref Funder Registry.
Publisher Copyright:
© 2020 The article has been co-published with permission in the European Journal of Cardio-Thoracic Surgery and the European Respiratory Journal. All rights reserved in respect of European Journal of Cardio-Thoracic Surgery,
PY - 2020/7
Y1 - 2020/7
N2 - The European Respiratory Society (ERS)/European Society of Thoracic Surgeons (ESTS)/European Association for Cardio-Thoracic Surgery (EACTS)/European Society for Radiotherapy and Oncology (ESTRO) task force brought together experts to update previous 2009 ERS/ESTS guidelines on management of malignant pleural mesothelioma (MPM), a rare cancer with globally poor outcome, after a systematic review of the 2009-2018 literature. The evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluation approach. The evidence syntheses were discussed and recommendations formulated by this multidisciplinary group of experts. Diagnosis: pleural biopsies remain the gold standard to confirm the diagnosis, usually obtained by thoracoscopy but occasionally via image-guided percutaneous needle biopsy in cases of pleural symphysis or poor performance status. Pathology: standard staining procedures are insufficient in similar to 10% of cases, justifying the use of specific markers, including BAP-1 and CDKN2A (p16) for the separation of atypical mesothelial proliferation from MPM. Staging: in the absence of a uniform, robust and validated staging system, we advise using the most recent 2016 8th TNM (tumour, node, metastasis) classification, with an algorithm for pretherapeutic assessment. Monitoring: patient's performance status, histological subtype and tumour volume are the main prognostic factors of clinical importance in routine MPM management. Other potential parameters should be recorded at baseline and reported in clinical trials. Treatment: (chemo)therapy has limited efficacy in MPM patients and only selected patients are candidates for radical surgery. New promising targeted therapies, immunotherapies and strategies have been reviewed. Because of limited data on the best combination treatment, we emphasize that patients who are considered candidates for a multimodal approach, including radical surgery, should be treated as part of clinical trials in MPM-dedicated centres.
AB - The European Respiratory Society (ERS)/European Society of Thoracic Surgeons (ESTS)/European Association for Cardio-Thoracic Surgery (EACTS)/European Society for Radiotherapy and Oncology (ESTRO) task force brought together experts to update previous 2009 ERS/ESTS guidelines on management of malignant pleural mesothelioma (MPM), a rare cancer with globally poor outcome, after a systematic review of the 2009-2018 literature. The evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluation approach. The evidence syntheses were discussed and recommendations formulated by this multidisciplinary group of experts. Diagnosis: pleural biopsies remain the gold standard to confirm the diagnosis, usually obtained by thoracoscopy but occasionally via image-guided percutaneous needle biopsy in cases of pleural symphysis or poor performance status. Pathology: standard staining procedures are insufficient in similar to 10% of cases, justifying the use of specific markers, including BAP-1 and CDKN2A (p16) for the separation of atypical mesothelial proliferation from MPM. Staging: in the absence of a uniform, robust and validated staging system, we advise using the most recent 2016 8th TNM (tumour, node, metastasis) classification, with an algorithm for pretherapeutic assessment. Monitoring: patient's performance status, histological subtype and tumour volume are the main prognostic factors of clinical importance in routine MPM management. Other potential parameters should be recorded at baseline and reported in clinical trials. Treatment: (chemo)therapy has limited efficacy in MPM patients and only selected patients are candidates for radical surgery. New promising targeted therapies, immunotherapies and strategies have been reviewed. Because of limited data on the best combination treatment, we emphasize that patients who are considered candidates for a multimodal approach, including radical surgery, should be treated as part of clinical trials in MPM-dedicated centres.
KW - MPM
KW - Guidelines
KW - Multimodality
KW - Surgery
KW - Chemotherapy
KW - Radiotherapy
KW - PHASE-II TRIAL
KW - GERMLINE BAP1 MUTATIONS
KW - OCCUPATIONAL ASBESTOS EXPOSURE
KW - STAGING PROJECT PROPOSALS
KW - FORTHCOMING 8TH EDITION
KW - PALLIATIVE RADIATION-THERAPY
KW - PEGYLATED ARGININE DEIMINASE
KW - FLUORO-EDENITIC COMPOSITION
KW - WORLD-HEALTH-ORGANIZATION
KW - PROGRESSION-FREE SURVIVAL
U2 - 10.1093/ejcts/ezaa158
DO - 10.1093/ejcts/ezaa158
M3 - Article
C2 - 32448904
SN - 1010-7940
VL - 58
SP - 1
EP - 24
JO - European Journal of Cardio-Thoracic Surgery
JF - European Journal of Cardio-Thoracic Surgery
IS - 1
ER -