Mesothelioma And Therapy Induced Changes In Tumor Uptakes
An interesting study is called, Early Response Evaluation in Malignant Pleural Mesothelioma
by Positron Emission Tomography With [18F] Fluorodeoxyglucose by
Giovanni L. Ceresoli, Arturo Chiti, Paolo A. Zucali, Marcello Rodari, Romano F. Lutman, Silvia Salamina, Matteo Incarbone, Marco Alloisio, Armando Santoro -
Journal of Clinical Oncology, Vol 24, No 28 (October 1), 2006: pp. 4587-4593 American Society of Clinical Oncology. Here is an excerpt: ABSTRACT - PURPOSE: Response evaluation with conventional criteria based on computed tomography (CT) is particularly challenging in malignant pleural mesothelioma (MPM) due to its diffuse pattern of growth. There is growing evidence that therapy-induced changes in tumor [18F]fluorodeoxyglucose (FDG) uptake as measured by positron emission tomography (PET) may predict response and patient outcome early in the course of treatment.
PATIENTS AND METHODS: Patients with histologically proven MPM, not candidates to curative surgery, scheduled to undergo palliative chemotherapy with a pemetrexed-based regimen were eligible for this study. Patients were evaluated by FDG-PET and CT at baseline and after two cycles of therapy. A decrease of 25% or more in tumor FDG uptake as measured by standardized uptake value was defined as a metabolic response (MR). Best overall response from CT scans was determined according to previously published criteria.
RESULTS: Twenty-two patients were included in the study, and 20 were assessable for early metabolic response with FDG-PET. Of these, eight were classified as responders (40%) and 12 as nonresponders (60%). Early MR was significantly correlated to median time-to-tumor progression (TTP) with a median TTP for metabolic responders of 14 months versus 7 months for nonresponders (P = .02). No correlation was found between TTP and radiologic response evaluated by CT. Patients with a MR had a trend toward longer overall survival.
CONCLUSION: The use of MR evaluated by FDG-PET in the assessment of treatment efficacy in MPM appears promising. Our observations need to be validated in a larger prospective series.
Another interesting study is called, Immunoreactivity for p53 protein in malignant mesothelioma and non-neoplastic mesothelium by Dr. Marc Ramael, Greet Lemmens, Christa Eerdekens, Corinne Buysse, Ivo Deblier, Werner Jacobs, Eric Van Marck - The Journal of Pathology Volume 168, Issue 4, pages 371375, December 1992. Here is an excerpt: Abstract - The presence of p53 protein in non-neoplastic pleural mesothelium (40 cases) and in human malignant mesothelioma (36 cases) was assessed immunohistochemically using the antibodies DO7, CM-1 and PAb240. In a quarter of the malignant mesotheliomas, there was nuclear immunoreactivity for p53 protein with both the DO7 and CM-1 antibodies. There were no statistically significant differences between the various mesothelioma subtypes (P>005). No immunoreactivity was found with the PAb240 antibody, suggesting absence of mutant-type p53 protein. Non- neoplastic mesothelium was not immunoreactive with any of the antibodies. We conclude that there is immunoreactivity for p53 protein in some mesotheliomas. p53 protein immunoreactivity could be used to discriminate between neoplastic and reactive mesothelium.
Another interesting study is called, Concentration of hyaluronan in the serum of untreated cancer patients with special reference to patients with Mesothelioma by Inger Marie S. Dahl MD, Torvard C. Laurent MD Cancer Volume 62, Issue 2, pages 326330, 15 July 1988. Here is an excerpt: Abstract - The concentration of hyaluronan was measured in the serum from patients with tumors. The patients were divided into nine groups: two control groups, i.e., those with benign tumors and those having undergone radical surgery; and seven groups of patients with untreated malignant conditions, i.e., mesotheliomas, sarcomas, lymphomas, breast carcinomas, brain tumors, bronchial carcinomas, and a group of various malignancies. As an additional control group, subjects with benign pulmonary diseases were investigated. The control groups and all the groups with malignant tumors except the mesotheliomas had serum hyaluronan values equal to or only slightly higher than those of healthy volunteers of the same age. The patients with mesotheliomas had significantly elevated hyaluronan levels (287 282 [Standard deviation] g/l; n = 35; P < 0.001) compared with healthy volunteers (54 28 g/l in the age group of 51 to 60 years). Patients with asbestosis do not exhibit increased serum hyaluronan. The analysis of serum hyaluronan should therefore be of value in the diagnosis of mesothelioma.
We all owe a debt of gratitude to these fine researchers for their work. If you found any of these excerpts helpful, please read the studies in their entirety.
by: Mont Wrobleski
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