Mesothelioma - Update on management

摘要

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