Multimodal management of malignant pleural mesothelioma: where are we today?

Abstract

The prognosis of patients with malignant pleural mesothelioma remains poor and although it is clear that multimodal therapy is necessary to improve long-term results, precise treatment schemes have not yet been unequivocally established. Single-modality therapy does not have a major impact on long-term survival and combined-modality therapies are being further evaluated. However, the relative contributions of chemotherapy, radiotherapy and surgery have not been clearly determined at the present time. Moreover, the extent of resection and precise surgical procedure remain a highly debated topic. To better compare and combine results from different institutions and trials, uniform definitions of surgical procedures including extrapleural pneumonectomy and different forms of pleurectomy have recently been introduced. Due to the relatively higher morbidity and mortality of extrapleural pneumonectomy, there is currently a shift towards pleurectomy/decortication when a macroscopic complete resection of all tumour can be obtained by this procedure. In most recent trials, induction chemotherapy was administered to improve surgical resection rates but pathological complete responses are infrequently observed. The role of post-operative radiotherapy has to be further elucidated.Further treatment options that are currently explored include hyperthermic intrapleural chemotherapy, immunotherapy, gene therapy and photodynamic therapy. However, no randomised comparisons are available yet. @ERSpublications Treatment of malignant pleural mesothelioma remains controversial

Malignant mesothelioma as an oxidative stress-induced cancer: An update

“…A study based on the WHO mortality database reported a death toll of 92,253 from MM within 1994-2008 in 83 countries [2] and global cases of MM are projected to be on the rise for decades to come [3]. Although not as common as other types of human cancer, this tumor is nevertheless very aggressive in nature and is usually in the advance stage when diagnosed, resulting in a short median survival ( $ 9 to 12 months) [4,5]. Development of MM is closely related to exposure to fibrous particles, the most widely known of which are the asbestos fibers (Group 1, definite carcinogen to humans by International Agency of Research on Cancer [IARC], World Health Organization).…”

Radio-immunotherapy and chemo-immunotherapy as a novel treatment paradigm in malignant pleural mesothelioma

“…IMPRINT delivers 50. 4 Gy of radiation to the entire hemithorax in 28 fractions. SMART consists in delivering 25 Gy in 5 fractions with a boost of 5 Gy to the area of gross disease detected on the CT scan or PET scan.…”

“…The efficacy of current therapies including surgery, chemotherapy and radiation is limited. Therefore, a large number of studies have focused on multimodality approaches for the treatment of this disease (3,4). Nowadays, combination of multimodality treatment with immunotherapy has been evaluated in pre-clinical studies and is entering clinical trials (5)(6)(7)(8)(9).…”

A new prognostic index for overall survival in malignant pleural mesothelioma: the rPHS (regimen, PS, histology or stage) index

“…Above all, these PIs are based on clinical trial data and may not be applicable to the clinical setting. Further, they do not incorporate information regarding pemetrexed, which can improve overall survival (OS), and does not incorporate recent advancements in supportive care (3,(12)(13)(14). Therefore, while existing PIs might be useful for researchers in deciding which patients to include in clinical trials, these systems are less useful for clinicians who need to discuss prognoses with their MPM patients.…”

“…Despite recent advancements in treatment, surgery, radiotherapy and chemotherapy (CTx) or multimodality therapy has not been proven to be curative (2)(3)(4). For the majority of patients, treatment options are limited to palliative chemotherapy and best supportive care (BSC) (5).…”