Mesothelioma Navy Mesothelioma Diagnosis & Treatment 3 — Questions and Answers
Question 1: Which chemotherapy doublet is FDA-approved as first-line treatment for unresectable pleural mesothelioma?
- Carboplatin + paclitaxel
- Cisplatin + pemetrexed (Correct answer)
- Gemcitabine + oxaliplatin
- 5-FU + leucovorin
Correct answer: Cisplatin + pemetrexed
The combination of cisplatin and pemetrexed (an antifolate) is the standard first-line regimen for pleural mesothelioma approved by the FDA.
Question 2: Before receiving pemetrexed, mesothelioma patients are given folic acid and vitamin B12. What is the primary reason for this supplementation?
- To enhance antitumor efficacy of the drug
- To reduce hematologic and gastrointestinal toxicity (Correct answer)
- To prevent drug resistance from developing
- To improve renal clearance of cisplatin
Correct answer: To reduce hematologic and gastrointestinal toxicity
Folic acid and B12 supplementation significantly reduces the risk of severe neutropenia and mucositis associated with pemetrexed treatment.
Question 3: Which surgical procedure removes the entire lung, pleura, pericardium, and diaphragm in selected mesothelioma patients?
- Pleurectomy/decortication (P/D)
- Extrapleural pneumonectomy (EPP) (Correct answer)
- Video-assisted thoracoscopic surgery (VATS)
- Wedge resection
Correct answer: Extrapleural pneumonectomy (EPP)
Extrapleural pneumonectomy (EPP) is the most radical surgery for mesothelioma, removing the lung and all surrounding involved structures.
Question 4: What is the key advantage of pleurectomy/decortication (P/D) over extrapleural pneumonectomy (EPP) for mesothelioma?
- Higher cure rates in all patient groups
- Preservation of the underlying lung with potentially lower perioperative mortality (Correct answer)
- Ability to treat Stage IV disease
- Shorter duration of surgery
Correct answer: Preservation of the underlying lung with potentially lower perioperative mortality
P/D preserves the lung, which is associated with lower operative mortality compared to EPP, while still achieving significant cytoreduction.
Question 5: Immunotherapy with nivolumab plus ipilimumab was approved for which mesothelioma patient population?
- Patients who progressed after cisplatin + pemetrexed
- Previously untreated unresectable pleural mesothelioma (first-line) (Correct answer)
- Only sarcomatoid subtype regardless of line
- Peritoneal mesothelioma exclusively
Correct answer: Previously untreated unresectable pleural mesothelioma (first-line)
The FDA approved nivolumab plus ipilimumab (CheckMate 743 trial) as first-line treatment for unresectable pleural mesothelioma in 2020.
Question 6: In the context of mesothelioma, what does 'cytoreductive surgery with HIPEC' refer to for peritoneal disease?
- Removing peritoneal tumors followed by heated intraperitoneal chemotherapy perfusion (Correct answer)
- Cooling the abdomen during surgery to reduce blood loss
- Freezing peritoneal implants using cryotherapy
- Injecting immunotherapy directly into the peritoneum under heat
Correct answer: Removing peritoneal tumors followed by heated intraperitoneal chemotherapy perfusion
Cytoreductive surgery removes visible peritoneal tumor deposits, and HIPEC (hyperthermic intraperitoneal chemotherapy) then bathes the abdominal cavity in heated chemotherapy to eliminate microscopic disease.
Question 7: Which histological subtype of mesothelioma has the WORST prognosis and the poorest response to standard chemotherapy?
- Epithelioid
- Biphasic with >50% epithelioid component
- Sarcomatoid (Correct answer)
- Desmoplastic (a sarcomatoid variant)
Correct answer: Sarcomatoid
Sarcomatoid mesothelioma is the most aggressive subtype, with a median survival often under 6 months and limited response to chemotherapy or surgery.
Mesothelioma Navy Mesothelioma Diagnosis & Treatment 3
Which chemotherapy doublet is FDA-approved as first-line treatment for unresectable pleural mesothelioma?