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Title

Treatment of Malignant Pleural Mesothelioma

Authoring Organization

Publication Month/Year

January 18, 2018

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

The purpose of this guideline is to provide recommendations for the management of patients with malignant pleural mesothelioma (MPM), an aggressive tumor with a poor prognosis. 

This clinical practice guideline also aims to outline the management of patients with MPM, including diagnosis, pathologic confirmation, and surgical and medical management.

Target Patient Population

Patients with malignant pleural mesothelioma

Target Provider Population

Medical, surgical, and radiation oncologists; oncology nurses and physician assistants; pulmonologists; radiologists; pathologists

Inclusion Criteria

Female, Male, Adolescent, Adult, Child, Older adult

Health Care Settings

Ambulatory, Hospital, Outpatient, Radiology services

Scope

Assessment and screening, Diagnosis, Management

Keywords

mesothelioma, Malignant Pleural Mesothelioma

Source Citation

DOI: 10.1200/JCO.2017.76.6394 Journal of Clinical Oncology 36, no. 13 (May 01, 2018) 1343-1373.

Supplemental Methodology Resources

Data Supplement, Methodology Supplement

Methodology

Number of Source Documents
222
Literature Search Start Date
January 1, 1990
Literature Search End Date
December 31, 2017
Description of External Review Process
The ASCO Clinical Practice Guidelines Committee (CPGC) convened an Expert Panel with multidisciplinary representation in medical oncology, nuclear and radiation oncology, surgical oncology, pulmonology, pathology, community oncology, patient/advocacy representation, and guideline implementation. Members of the Expert Panel were responsible for reviewing and approving the penultimate version of the guideline, which was then circulated for external review and submitted to Journal of Clinical Oncology for editorial review and consideration for publication. No date mentioned.
Specialties Involved
Family Medicine, Internal Medicine General, Oncology, Pathology, Pulmonology, Radiology, Medical Oncology, Surgical Oncology, Radiation Oncology, Oncology, Oncology, Oncology
Description of Systematic Review
The recommendations were developed by an Expert Panel with multidisciplinary representation using a systematic review (1990 to 2016), which included systematic reviews, meta-analyses, randomized controlled trials (RCTs), prospective and retrospective comparative observational studies, and clinical experience.
List of Questions
This clinical practice guideline addresses five overarching clinical questions: (1) What is the optimal approach to obtain an accurate diagnosis of mesothelioma? (2) What initial assessment is recommended before initiating any therapy for mesothelioma? (3) What is the appropriate first- and second-line systemic treatment of patients with mesothelioma? (4) What is the appropriate role of surgical cytoreduction in the management of mesothelioma? (5) When should radiation be recommended for mesothelioma?
Description of Study Criteria
Articles were selected for inclusion in the systematic review of the evidence based on the following criteria: •Population: Patients diagnosed with MPM. •Interventions that focused on diagnosis, staging, imaging, chemotherapy, radiation, and surgical cytoreduction of patients with MPM. •Study designs included were systematic reviews, meta-analyses, RCTs, and prospective and retrospective comparative observational studies. Some phase II studies were included to address some of the clinical questions for chemotherapy management. •A minimum sample size of 20. Articles were excluded from the systematic review if they were meeting abstracts not subsequently published in peer-reviewed journals; editorials, commentaries, letters, news articles, case reports, or narrative reviews; or published in a non-English language.
Description of Search Strategy
PubMed and the Cochrane Collaboration Library electronic databases (± meeting abstracts) were searched for evidence reporting on outcomes of interest. Refer to the Data Supplement for details.
Description of Study Selection
Literature search results were reviewed and deemed appropriate for full text review by two ASCO staff reviewers in consultation with the Expert Panel Co-Chairs. Data were extracted by two staff reviewers and subsequently checked for accuracy through an audit of the data by another ASCO staff member. Disagreements were resolved through discussion and consultation with the Co-Chairs if necessary. Evidence tables are provided in the manuscript and/or in Data Supplements 1.
Description of Evidence Analysis Methods
The guideline recommendations were crafted, in part, using the principles of the GuideLines Into DEcision Support (GLIDES) methodology.
Description of Evidence Grading
High: High confidence that the available evidence reflects the true magnitude and direction of the net effect (i.e., balance of benefits v harms) and that further research is very unlikely to change either the magnitude or direction of this net effect. Intermediate: Moderate confidence that the available evidence reflects the true magnitude and direction of the net effect. Further research is unlikely to alter the direction of the net effect; however, it might alter the magnitude of the net effect. Low: Low confidence that the available evidence reflects the true magnitude and direction of the net effect. Further research may change either the magnitude and/or direction this net effect. Insufficient: Evidence is insufficient to discern the true magnitude and direction of the net effect. Further research may better inform the topic. The use of the consensus opinion of experts is reasonable to inform outcomes related to the topic.
Description of Recommendation Grading
Evidence Based: There was sufficient evidence from published studies to inform a recommendation to guide clinical practice. Formal Consensus: The available evidence was deemed insufficient to inform a recommendation to guide clinical practice. Therefore, the Expert Panel used a formal consensus process to reach this recommendation, which is considered the best current guidance for practice. The Panel may choose to provide a rating for the strength of the recommendation (i.e., "strong," "moderate," or "weak"). The results of the formal consensus process are summarized in the guideline and reported in the Data Supplement (see the Supporting Documents" field). Informal Consensus: The available evidence was deemed insufficient to inform a recommendation to guide clinical practice. The recommendation is considered the best current guidance for practice, based on informal consensus of the Expert Panel. The Panel agreed that a formal consensus process was not necessary for reasons described in the literature review and discussion. The Panel may choose to provide a rating for the strength of the recommendation (i.e., "strong," "moderate," or "weak"). No recommendation: There is insufficient evidence, confidence, or agreement to provide a recommendation to guide clinical practice at this time. The Panel deemed the available evidence as insufficient and concluded it was unlikely that a formal consensus process would achieve the level of agreement needed for a recommendation.
Description of Funding Source
ASCO provides funding for Guideline Development.
Company/Author Disclosures
Author Disclosures of Potential Conflicts of Interest are documented in the Guideline.
Percentage of Authors Reporting COI
100
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