Epidemiology and Clinical Aspects of Malignant Pleural Mesothelioma

Abstract

Mesothelioma is a cancer predominantly of the pleural cavity. There is a clear association of exposure to asbestos with a dose dependent risk of mesothelioma. The incidence of mesothelioma in different countries reflect the historical patterns of commercial asbestos utilisation in the last century and predominant occupational exposures mean that mesothelioma is mostly seen in males. Modern imaging techniques and advances in immunohistochemical staining have contributed to an improved diagnosis of mesothelioma. There have also been recent advances in immune checkpoint inhibition, however, mesothelioma remains very challenging to manage, especially considering its limited response to conventional systemic anticancer therapy and that no cure exists. Palliative interventions and support remain paramount with a median survival of 9–12 months after diagnosis. The epidemiology and diagnosis of mesothelioma has been debated over previous decades, due to a number of factors, such as the long latent period following asbestos exposure and disease occurrence, the different potencies of the various forms of asbestos used commercially, the occurrence of mesothelioma in the peritoneal cavity and its heterogeneous pathological and cytological appearances. This review will describe the contemporary knowledge on the epidemiology of mesothelioma and provide an overview of the best clinical practice including diagnostic approaches and management.

Analysis of the correlation between Zeste enhancer homolog 2 (EZH2) mRNA expression and the prognosis of mesothelioma patients and immune infiltration

“…Malignant mesothelioma is a rare primary cancer with survival of less than 1 year 1 . A trimodality treatment approach in combination of surgery, chemotherapy, and sequential radiation therapy (RT) represents the mainstream of current mesothelioma treatment options 17 . While the survival still remains unimproved, urgently requiring the prognostic biomarkers to guide clinical decision-making.…”

Molecular Alterations in Malignant Pleural Mesothelioma: A Hope for Effective Treatment by Targeting YAP

“…Malignant pleural mesothelioma (MPM) is a rare (prevalence 8–30 cases/million/year) and aggressive neoplasm, originating from the mesothelium lining the pleural surface of the lungs [ 1 ], which has been largely attributed to environmental/occupational exposure to asbestos fibers (83% of cases) [ 2 , 3 ]. However, despite the ban of using asbestos in many countries for over 20 years, the incidence of MPM has failed to decline worldwide, with a total of 250,000 deaths anticipated for the next 30 years [ 4 , 5 ] because of the following reasons: (i) a significant lag between first-time exposure to asbestos and the onset of symptoms in an aging, genetically susceptible population (≥ 30–60 years) [ 6 , 7 ]; (ii) on-going use of asbestos in middle-income and low-income countries [ 8 ]; (iii) presence of other risk factors of MPM’s pathogenesis, including refractory ceramic fibers [ 9 ], hormonal factors [ 10 , 11 ], and some mineral (erionite, fluoro-edenite) or chemical exposures [ 12 – 15 ] such as ionizing radiation [ 16 – 18 ].…”

“…Although MPM's etiology is rather well consolidated, only little progress has been made in MPM diagnosis and treatment. Over the past 20 years, the morphological analysis of the three histological subtypes, including epithelioid, biphasic also called mixed, and sarcomatoid forms, has been the primary indicator for therapeutic decision making at an advanced disease stage [5,19,20]. In daily practice, only a few effective biomarkers have been recommended for MPM [21], whereas an invasive biopsy followed by first-line systematic chemotherapy with cisplatin plus pemetrexed, with or without bevacizumab, are still the main treatment options [22][23][24].…”

An Examination of the Anti-Cancer Properties of Plant Cannabinoids in Preclinical Models of Mesothelioma

“…Malignant mesothelioma is an aggressive cancer with a poor response to current therapies and, consequently, has a very grim prognosis. The median survival for malignant mesothelioma is only approximately 12 months and the 5-year survival rate is less than 10% [ 1 , 2 ]. Worldwide, over 38,000 people die each year from mesothelioma [ 3 ] with asbestos exposure linked to approximately 80% of all cases [ 4 ].…”