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Malignant pleural mesothelioma: current concepts in treatment

Nature Clinical Practice Oncology volume 4, pages 344–352 (2007)Cite this article

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).

Key Points

  • Malignant pleural mesothelioma (MPM) is a major social and epidemiological issue because of its increasing worldwide prevalence

  • The multimodal approach has demonstrated favorable outcomes and will be the cornerstone for future treatment of MPM, but the optimum combination of treatment options has not yet been identified

  • The role of surgery has yet to be defined, and it is unknown whether radical surgery offers benefit in MPM because of the morbidity and mortality associated with extrapleural pneumonectomy, and the complex disease etiology

  • The effect of radiotherapy on quality of life needs to be assessed

  • Pemetrexed is the chemotherapeutic agent that will be the basis of the best antineoplastic regimens in the future

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Figure 1: Regional difference in prevalence of malignant pleural mesothelioma

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Author information

Authors and Affiliations

  1. and RK Walesby is a Consultant Cardiothoracic Surgeon in the Departments of Cardiothoracic Surgery at the Royal Free Hospital and University College London Hospital, A Tsiouris is a Senior House Officer in General and Transplantation Surgery at the Royal Free Hospital, London, UK.,

    Athanasios Tsiouris & Robin K Walesby

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  2. Robin K Walesby
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Correspondence to Athanasios Tsiouris.

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The authors declare no competing financial interests.

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Tsiouris, A., Walesby, R. Malignant pleural mesothelioma: current concepts in treatment. Nat Rev Clin Oncol 4, 344–352 (2007). https://doi.org/10.1038/ncponc0839

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