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Malignant Peritoneal Mesothelioma: An In-Depth and Up-to-Date Review of Pathogenesis, Diagnosis, Management and
Josh B Karpes1,2, Raphael Shamavonian1,2, Suzannah Dewhurst1,2
1Hepatobiliary and Surgical Oncology Unit, Department of Surgery, St George Hospital, Kogarah, NSW 2217, Australia.
Abstract:
Malignant peritoneal mesothelioma (MPM) is an extremely rare malignancy usually confined to the abdominal cavity. With an aggressive natural history, morbidity and mortality are consequences of progressive locoregional effects within the peritoneal cavity. The first reported case was in the early 20th century, however, due to the rare nature of the disease and a large gap in understanding of the clinicopathological effects, the next reported MPM cases were only published half a decade later. Since then, there has been exponential growth in our understanding of the disease, however, there are no prospective data and a paucity of literature regarding management. Traditionally, patients were treated with systemic therapy and the outcomes were very poor, with a median survival of less than one year. However, with the advent of cytoreductive surgery and locoregional chemotherapy, there have been significant improvements in survival. Even more recently, with an improved understanding of the molecular pathogenesis of MPM, there have been reports of improved outcomes with novel therapies. Given the disastrous natural history of MPM, the limited data, and the lack of universal treatment guidelines, an in-depth review of the past, present, and future of MPM is critical to improve treatment regimens and, subsequently, patient outcomes.
Insights
Malignant peritoneal mesothelioma (MPM) is a rare cancer. Advances in surgery and chemotherapy have improved survival, with novel therapies showing promise for better patient outcomes.
Area of Science:
- Oncology
- Surgical Oncology
- Medical Oncology
Background:
- Malignant peritoneal mesothelioma (MPM) is an extremely rare abdominal malignancy with a poor prognosis.
- Historically, treatment involved systemic therapy with limited success, resulting in median survival under one year.
Purpose of the Study:
- To review the historical context, current management strategies, and future directions for malignant peritoneal mesothelioma.
- To highlight the need for improved treatment regimens and guidelines due to the limited data and aggressive nature of MPM.
Main Methods:
- Literature review of malignant peritoneal mesothelioma cases and treatment outcomes.
- Analysis of historical treatment modalities versus modern surgical and chemotherapeutic approaches.
Main Results:
- Traditional systemic therapy yielded poor outcomes for MPM.
- Cytoreductive surgery combined with locoregional chemotherapy has significantly improved survival rates.
- Emerging novel therapies, informed by molecular pathogenesis, show potential for further outcome improvement.
Conclusions:
- Significant progress has been made in MPM management, moving from poor-prognosis systemic therapy to more effective multimodal approaches.
- Continued research into novel therapies and the establishment of universal treatment guidelines are crucial for advancing MPM patient care and survival.
