Oral Anlotinib Maintenance Therapy for an Advanced Malignant Peritoneal Mesothelioma Diagnosed by Laparoscopy After Initial Misdiagnosis to Obtain Longer Progression-Free Survival: Case Report and Literature Review

Abstract

Malignant peritoneal mesothelioma (MPeM) is a rare and highly invasive malignant tumor with a lack of specificity in clinical manifestations, which can easily lead to misdiagnosis and missed diagnosis. Due to the difficulty of early diagnosis, most patients are already in the advanced stage when diagnosed, and the prognosis is poor. At present, there is no standard treatment strategy, and the existing treatment methods are not effective, the duration of remission is short, which cannot meet the clinical needs. Here we describe a patient with advanced MPeM, initially misdiagnosed as ovarian cancer, who responded to treatment with bevacizumab in combination with albumin-bound paclitaxel and cisplatin. In preparation for cytoreductive surgery (CRS), MPeM was confirmed by laparoscopic peritoneal nodule biopsy combined with histological and immunohistochemical results. Subsequently, due to intolerable neurotoxicity after chemotherapy, she received oral anlotinib therapy on April 25, 2022, and remained stable disease (SD) with the medication, having achieved more than 14 months of progression-free survival (PFS) as of the date of our manuscript submission. The patient’s total treatment time was over 19 months. These treatments delayed tumor progression, reduced drug side effects, maintained a good quality of life, and further extended overall survival (OS). Our experience is that on the one hand, it is necessary to increase the clinician’s understanding of the disease, and make full use of tissue samples and immunohistochemical staining to reduce the occurrence of misdiagnosis. On the other hand, based on preliminary evidence, we found that oral anlotinib offers a viable maintenance treatment strategy for patients with advanced mesothelioma, which needs to be further explored in future studies.

Keywords:

• MPeM
• misdiagnosis
• anlotinib
• maintenance therapy
• progression-free survival

Abbreviations

MPeM, Malignant peritoneal mesothelioma; CRS, cytoreductive surgery; SD, stable disease; PFS, progress free survival; OS, overall survival; HIPEC, hyperthermic intraperitoneal chemotherapy; MPlM, malignant pleural mesothelioma; immune checkpoint inhibitors (ICIs); MM, malignant mesothelioma; CT, Computed tomography; PR, partial remission; PS, Performance status; TKIs, tyrosine kinase inhibitors; VEGF, vascular endothelial growth factor; VEGFR-2, vascular endothelial growth factor receptor-2; FGFR, fibroblast growth factor receptor; PDGFR, platelet-derived growth factor receptor; RCC, renal cell carcinoma.

Data Sharing Statement

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Ethics Approval and Consent to Participate

This study was approved by the Ethics Committee of Affiliated Dalian Third People’s Hospital of Dalian Medical University.Informed consent was obtained prior to each treatment in this case report. Written informed consent has been obtained from the patient for the release of relevant clinical and imaging data from their cases, included consent for the publication of the case details.

Acknowledgments

The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).

Author Contributions

The authors listed in this article have made significant contributions to the work of the report, whether in concept, research design, execution, data acquisition, analysis and interpretation, or in all of these areas, and meet the following criteria. All authors participated in drafting or writing, or substantially revised or critically reviewed the article, and have agreed on the journal in which the article will be submitted. Finally, all authors agree to take responsibility and be accountable for the contents of the article.

Disclosure

The authors declare that there are no conflicts of interest regarding the publication of this paper.

Additional information

Funding

No funding was received for this study.