Patterns of metastases in malignant pleural mesothelioma in the modern era: Redefining the spread of an old disease.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 8556-8556 ◽  
Author(s):  
Dearbhaile Catherine Collins ◽  
Anastasia Constantinidou ◽  
Raghav Sundar ◽  
Maxime Chenard-Poirier ◽  
Timothy Anthony Yap ◽  
...  
Keyword(s):  
Bone Metastases ◽  
Malignant Pleural Mesothelioma ◽  
Survival Data ◽  
Lung Metastases ◽  
Case Reports ◽  
Pleural Mesothelioma ◽  
Clinical Workflow ◽  
Trial Protocols ◽  
Type Pattern ◽  
Metastatic Patterns

8556 Background: Malignant pleural mesothelioma (MPM) has been historically documented as a locally infiltrative disease in large series from the early 1980s. With the changing landscape of cancer diagnosis and treatment, increased areas of unusual metastases have been published as case reports. With no standard second-line therapies for MPM, referral to early phase trial units is common. We report the metastatic patterns of a large cohort of MPM patients treated at the Royal Marsden Drug Development Unit (DDU). Methods: Clinical data was gathered for MPM patients referred to the DDU from 1992 to 2016. Radiographic details were collected from CT, bone scan and FDG PET imaging. Prior treatment, response, somatic mutations, clinical trial and survival data was obtained from medical records. Results: From the database, 165 evaluable patients with MPM were identified. Median age at diagnosis was 64 years (range 37–90) and 76% were male. Epithelioid MPM comprised 81% and 65% were right sided. Bone metastases were reported in 20%, with the majority lytic in nature ( Table). Peritoneal and omental disease was evident in 24% with ascites in 16%. In 11% of cases lung metastases presented as diffuse miliary-type pattern. Visceral metastases (15%) were predominantly liver (78%), but also occurred in adrenals, spleen and kidneys. Symptomatic brain metastases were recorded in 3%. Median overall survival was 24.2 months (95% CI: 20.8 - 29.2). Conclusions: This large study documents the metastatic patterns of advanced MPM in the 21st century and highlights an increased frequency of traditionally unexpected sites of metastases. Higher than expected incidence of lytic bone metastases (20%) suggests consideration of bone imaging in advanced MPM clinical workflow and trial protocols. [Table: see text]

scholarly journals Radiological evaluation of malignant pleural mesothelioma - defining distant metastatic disease

BMC Cancer ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Dearbhaile Catherine Collins ◽  
Raghav Sundar ◽  
Anastasia Constantidinou ◽  
David Dolling ◽  
Timothy Anthony Yap ◽  
...  
Keyword(s):  
Malignant Pleural Mesothelioma ◽  
Metastatic Disease ◽  
Distant Metastases ◽  
Peritoneal Metastases ◽  
Pleural Mesothelioma ◽  
Clinical Workflow ◽  
Distant Metastatic Disease ◽  
High Incidence ◽  
Trial Protocols ◽  
Metastatic Sites

Abstract Background Malignant pleural mesothelioma (MPM) is traditionally characterized by local destructive spread of the pleura and surrounding tissues. Patient outcomes in MPM with distant metastatic dissemination are lacking. Methods In this retrospective study, we reviewed a cohort of 164 MPM patients referred to a Phase I trials unit, aiming to describe identified metastatic sites, and correlate with clinical outcomes. Results 67% of patients were diagnosed with distant metastatic disease with a high incidence of bone (19%), visceral (14%), contralateral lung (35%) and peritoneal metastases (22%). Peritoneal metastases were more likely in epithelioid versus biphasic/ sarcomatoid MPM (p = 0.015). Overall survival was 23.8 months with no statistical difference in survival between those with distant metastases and those without. Conclusions This report highlights the frequency of distant metastases and encourages further radiological investigations in the presence of symptoms. In particular, given the relatively high incidence of bone metastases, bone imaging should be considered in advanced MPM clinical workflow and trial protocols. The presence of distant metastases does not appear to have prognostic implications under existing treatment paradigms. This cohort of MPM patients gives an indication of patterns of metastatic spread that are likely to become prevalent as prognosis improves with emerging treatment paradigms.

scholarly journals Radiological evaluation of malignant pleural mesothelioma - defining distant metastatic disease

2020 ◽  
Author(s):  
Dearbhaile Catherine Collins ◽  
Raghav Sundar ◽  
Anastasia Constantidinou ◽  
David Dolling ◽  
Timothy Anthony Yap ◽  
...  
Keyword(s):  
Malignant Pleural Mesothelioma ◽  
Metastatic Disease ◽  
Distant Metastases ◽  
Peritoneal Metastases ◽  
Pleural Mesothelioma ◽  
Clinical Workflow ◽  
Distant Metastatic Disease ◽  
High Incidence ◽  
Trial Protocols ◽  
Metastatic Sites

Abstract BackgroundMalignant pleural mesothelioma (MPM) is traditionally characterized by local destructive spread of the pleura and surrounding tissues. Patient outcomes in MPM with distant metastatic dissemination are lacking. MethodsIn this retrospective study, we reviewed a cohort of 164 MPM patients referred to a Phase I trials unit, aiming to describe identified metastatic sites, and correlate with clinical outcomes. Results67% of patients were diagnosed with distant metastatic disease with a high incidence of bone (19%), visceral (14%), contralateral lung (35%) and peritoneal metastases (22%). Peritoneal metastases were more likely in epithelioid versus biphasic/ sarcomatoid MPM (p=0.015). Overall survival was 23.8 months with no statistical difference in survival between those with distant metastases and those without.ConclusionsThis report highlights the frequency of distant metastases and encourages further radiological investigations in the presence of symptoms. In particular, given the relatively high incidence of bone metastases, bone imaging should be considered in advanced MPM clinical workflow and trial protocols. The presence of distant metastases does not appear to have prognostic implications under existing treatment paradigms. This cohort of MPM patients gives an indication of patterns of metastatic spread that are likely to become prevalent as prognosis improves with emerging treatment paradigms.

scholarly journals Radiological evaluation of malignant pleural mesothelioma - defining distant metastatic disease

2020 ◽  
Author(s):  
Dearbhaile Catherine Collins ◽  
Raghav Sundar ◽  
Anastasia Constantidinou ◽  
David Dolling ◽  
Timothy Anthony Yap ◽  
...  
Keyword(s):  
Malignant Pleural Mesothelioma ◽  
Metastatic Disease ◽  
Distant Metastases ◽  
Peritoneal Metastases ◽  
Pleural Mesothelioma ◽  
Clinical Workflow ◽  
Distant Metastatic Disease ◽  
High Incidence ◽  
Trial Protocols ◽  
Metastatic Sites

Abstract Background Malignant pleural mesothelioma (MPM) is traditionally characterized by local destructive spread of the pleura and surrounding tissues. Patient outcomes in MPM with distant metastatic dissemination are lacking. Methods In this retrospective study, we reviewed a cohort of 164 MPM patients referred to a Phase I trials unit, describe identified metastatic sites, and correlate with clinical outcomes. Results 67% of patients were diagnosed with distant metastatic disease with a high incidence of bone (19%), visceral (14%), contralateral lung (35%) and peritoneal metastases (22%). Peritoneal metastases were more likely in epithelioid versus biphasic/ sarcomatoid MPM (p = 0.015). Overall survival was 23.8 months with no statistical difference in survival between those with distant metastases and those without. Conclusions This report highlights the frequency of distant metastases and encourages further radiological investigations in the presence of symptoms. In particular, given the relatively high incidence of bone metastases, bone imaging should be considered in advanced MPM clinical workflow and trial protocols. The presence of distant metastases does not appear to have prognostic implications under existing treatment paradigms. This cohort of MPM patients gives an indication of patterns of metastatic spread that are likely to become prevalent as prognosis improves with emerging treatment paradigms.

scholarly journals Radiological evaluation of malignant pleural mesothelioma - defining distant metastatic disease

2020 ◽  
Author(s):  
Dearbhaile Catherine Collins ◽  
Raghav Sundar ◽  
Anastasia Constantidinou ◽  
David Dolling ◽  
Timothy Anthony Yap ◽  
...  
Keyword(s):  
Malignant Pleural Mesothelioma ◽  
Metastatic Disease ◽  
Distant Metastases ◽  
Peritoneal Metastases ◽  
Pleural Mesothelioma ◽  
Clinical Workflow ◽  
Distant Metastatic Disease ◽  
High Incidence ◽  
Trial Protocols ◽  
Metastatic Sites

Abstract BackgroundMalignant pleural mesothelioma (MPM) is traditionally characterized by local destructive spread of the pleura and surrounding tissues. Patient outcomes in MPM with distant metastatic dissemination are lacking.MethodsIn this retrospective study, we reviewed a cohort of 164 MPM patients referred to a Phase I trials unit, aiming to describe identified metastatic sites, and correlate with clinical outcomes. Results67% of patients were diagnosed with distant metastatic disease with a high incidence of bone (19%), visceral (14%), contralateral lung (35%) and peritoneal metastases (22%). Peritoneal metastases were more likely in epithelioid versus biphasic/ sarcomatoid MPM (p=0.015). Overall survival was 23.8 months with no statistical difference in survival between those with distant metastases and those without.ConclusionsThis report highlights the frequency of distant metastases and encourages further radiological investigations in the presence of symptoms. In particular, given the relatively high incidence of bone metastases, bone imaging should be considered in advanced MPM clinical workflow and trial protocols. The presence of distant metastases does not appear to have prognostic implications under existing treatment paradigms. This cohort of MPM patients gives an indication of patterns of metastatic spread that are likely to become prevalent as prognosis improves with emerging treatment paradigms.

Treatment outcomes in malignant pleural mesothelioma: A single center experience of systemic therapies and biomarkers.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e20070-e20070
Author(s):  
Adithya Balasubramanian ◽  
Adrian Pick ◽  
Beena Kumar ◽  
Zdenka Prodanovic ◽  
Prashant Joshi ◽  
...  
Keyword(s):  
Malignant Pleural Mesothelioma ◽  
Survival Data ◽  
Immune Checkpoint ◽  
Immune Checkpoint Inhibitors ◽  
Checkpoint Inhibitors ◽  
Asbestos Exposure ◽  
Case Series ◽  
Stage Iv ◽  
Pleural Mesothelioma ◽  
Retrospective Audit

e20070 Background: Malignant Pleural Mesothelioma (MPM) is a rare but fatal disease related to asbestos exposure, with historic survival in the order of 9 to 17 months. Chemotherapy is associated with only a modest benefit. The advent of immunotherapy has heralded significantly improved outcomes using checkpoint inhibitors in an as yet ill-defined cohort. We aim to identify predictive and prognostic biomarkers in a series of patients (pts) with MPM and describe survival data. Methods: A retrospective audit was undertaken of pts with MPM diagnosed between 2013 and 2017 at a single tertiary centre in Melbourne, Australia (Monash Health). Data relating to patient outcomes and clinicopathological features were obtained through medical reports. Further immunostains are being performed on archived tissue for PDL-1 status. Results: 65 pts were identified, of whom 52 (80.0%) were male. Median age was 73 years (range 44-90). 52 pts were noted to be ECOG 0-1. 42 pts (64.6%) were noted to have suspected asbestos exposure. Epithelioid MPM was the most common subtype, noted in 41 pts (63.1%) (table 1). 8 pts (12.3%) presented with stage IV disease. 16 pts (24.6%) received checkpoint inhibitor therapy, with 10 (63 %) in the second/third line setting. Median overall survival (OS) was 19.8 months (95% CI 13.3-26.3) in the whole cohort.Patient characteristics associated with poor OS were: presence of weight loss (P = 0.001), chest pain (p = 0.08) and ECOG 2 (p = 0.04). Pts with sarcomatoid histology who received immune checkpoint inhibitors in any line of treatment had significantly prolonged OS compared to other histologies. 3-year survival was 80% in this group while median OS was not reached (p = 0.04). This difference was not seen with other histologies. Conclusions: The evolving landscape of treatment in MPM appears to show promise in improving OS. In this unselected case series, our data is consistent with historic controls in terms of survival and prognostic factors. The finding of significantly improved survival with immune checkpoint inhibitors in the sarcomatoid histology is exciting and warrants further exploration. Further data on PDL1 status will be presented.

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