Malignant Pleural Mesothelioma

Rolf A. Stahel; Emanuela Felley-Bosco; Isabelle Opitz; Walter Weder


Future Oncol. 2009;5(3):391-402. 

In This Article

Abstract and Epidemiology


Malignant pleural mesothelioma continues to be a challenge. The diagnosis and treatment of patients with malignant pleural mesothelioma requires a multidisciplinary approach. The diagnosis is best made by thoracoscopic biopsy and the aid of immunohistochemistry. Molecular studies identified inactivation of the neurofibromatosis-2 gene and INK4α/ARF to be key events in tumorigenesis. Based on the results of a Phase III trial, the combination of cisplatin with pemetrexed has become the preferred choice for chemotherapy, although there is suggestive evidence for the activity of other platin combinations based on Phase II studies. The optimal second-line chemotherapy remains to be defined. Surgical interventions ranging from pleurectomy/decortication to extrapleural pneumonectomy are increasingly offered in specialized centers, and the results of multimodality approaches with neoadjuvant or adjuvant chemotherapy and extrapleural pneumonectomy are encouraging. Ongoing investigations are defining the role of postoperative radiotherapy and the clinical activity of tyrosine kinase inhibitors targeting VEGFR2, histone deacetylase inhibitors and proteosome inhibitors.


Malignant pleural mesothelioma continues to be a challenge. The disease is associated with asbestos exposure and its incidence will continue to increase for some years to come in regions where the commercial use of asbestos has been banned, and is certain to continue to contribute to cancer mortality in regions of the word lacking worker protection and persisting with its commercial use. In Europe, where commercial use of asbestos is banned, a first analysis predicted that male mesothelioma deaths would continue to increase and peak in the year 2020,[1] whereas more recent models suggested the increase to level off and the peak to occur earlier, around 2015.[2,3] These estimates have taken into consideration a certain latency period and the ban of commercial asbestos exposure in the early nineties. However, recent data from the Italian Mesothelioma Registry demonstrated a longer latency than expected. The median latency was 44.6 years and increasing over time in a linear fashion.[4] Environmental asbestos exposure is common in some villages of Turkey. Here, the rate of mesothelioma mortality can be over hundred-fold higher than in control villages.[5]


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