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Published on: December 21, 2019
Malignant pleural mesothelioma: current concepts in treatment
Athanasios Tsiouris1, Robin K Walesby
1General and Transplantation Surgery at the Royal Free Hospital, London, UK. athtsiouris@hotmail.com
Abstract:
Malignant pleural mesothelioma (MPM) is a primary and locally aggressive tumor of the pleura. A well defined causal relationship with asbestos exposure, and an overwhelming media interest in the use of asbestos in industrialized countries after World War II, has produced a high level of awareness of this disease. With a peak incidence of MPM expected in Europe, Australia, and the US within the next 15 years, and the failure of current treatment approaches to offer long-term survival and improve quality of life, new therapeutic regimens are warranted. The effects of surgery in terms of survival and symptomatic relief have yet to be defined because of a lack of randomized trials. The role of radiotherapy in the treatment of MPM remains controversial, as the radiosensitivity of malignant mesothelial cells is modest. MPM response to chemotherapy is comparatively poor. The combination of pemetrexed and cisplatin chemotherapy has achieved the best objective responses. Presently, a multimodal approach is considered to be the cornerstone of treatment of MPM. Important ongoing international and national trials are addressing the roles of chemotherapy (e.g. the EAP and MS01 trial), radical surgery (e.g. the MARS trial) and radiotherapy (e.g. the SAKK group phase III study).
Insights
Malignant pleural mesothelioma (MPM) is an aggressive cancer linked to asbestos. New treatments are needed as current options offer limited survival and quality of life improvements for this asbestos-related disease.
Area of Science:
- Oncology
- Thoracic Surgery
- Medical Oncology
Background:
- Malignant pleural mesothelioma (MPM) is a locally aggressive cancer of the pleura.
- A strong link exists between MPM and asbestos exposure, with rising incidence expected.
- Current treatments fail to provide long-term survival or improve quality of life.
Purpose of the Study:
- To review the current therapeutic landscape for malignant pleural mesothelioma.
- To highlight the need for novel treatment strategies due to poor outcomes.
- To discuss ongoing clinical trials investigating chemotherapy, surgery, and radiotherapy.
Main Methods:
- Literature review of current MPM treatment modalities.
- Analysis of the efficacy of chemotherapy, surgery, and radiotherapy.
- Overview of ongoing major clinical trials (EAP, MS01, MARS, SAKK).
Main Results:
- Pemetrexed and cisplatin combination shows the best objective responses in chemotherapy.
- The role of surgery and radiotherapy in MPM treatment remains uncertain due to limited data.
- A multimodal approach is currently considered the standard of care.
Conclusions:
- New therapeutic regimens are urgently required for malignant pleural mesothelioma.
- Multicenter trials are crucial to define the roles of chemotherapy, surgery, and radiotherapy.
- Optimizing MPM treatment necessitates a comprehensive, evidence-based approach.
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