Mesothelioma - Update on Management

Publisher： Bentham Science Publishers

E-ISSN： 1875-6387 |10|4|206-220

ISSN： 1573-398x

Source： Current Respiratory Medicine Reviews, Vol.10, Iss.4, 2015-05, pp. : 206-220

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Abstract

Mesothelioma is an often fatal cancer arising from the lining of pleura, peritoneum, pericardiumand tunica vaginalis (of the testis). In the past decade, investigators have met with limited or minimal successin demonstrating improvements in survival compared to supportive care or observation. Radical surgery suchas extrapulmonary pleurectomy is associated with perioperative mortality rates of 6-30% by differentinstitutions, compared to 3% with extended pleurectomy and decortication. Talc pleurodesis is preferred overvideo-assisted thorascopic partial pleurectomy in the setting of pleural effusion due to fewer complicationsand shorter hospital stay. To spare normal tissues, radiotherapy with IMRT (intensity-modulated radiationtherapy) technique should be used in all cases. Reirradiation with proton particles for recurrent disease isbeing investigated. The ongoing PIT (Prophylactic Irradiation of Tracts) study will explore the effectivenessof radiotherapy to prevent or delay recurrent nodules on the chest wall following invasive chest wallintervention. The literature on this question is varied and inconclusive. Pemetrexed-cisplatin is currently thestandard as first line therapy for malignant pleural mesothelioma in accordance with a phase III studyshowing improved quality of life and survival. In 2012, a new promising biomarker, fibulin-3 was reported inall mesothelioma sites. Fibulin-3 is a superior prognosticator compared with mesothelin and can be used tomonitor tumor response. Mesothelin, the cell-surface glycoprotein, has become the primary target forimmunotherapy. SS1P is a recombinant antimesothelin immunotoxin which induces a durable response in allmesotheliomas.

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