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Malignant Pleural Mesothelioma

H. Kindler
Published 2000 · Medicine

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Opinion statementDespite innumerable trials of surgery, radiotherapy, and countless chemotherapeutic drugs, it is unclear whether any intervention has had a significant impact on more than a few highly selected patients with malignant pleural mesothelioma. Because most patients die of respiratory failure from extensive disease progression in the thorax, treatment usually includes attempts at local control. Unfortunately, radiotherapy is associated with significant complications in pleural mesothelioma, and surgery is feasible in only a small percentage of patients. Although there have been several single-institution reports of combined-modality therapy with extrapleural pneumonectomy, postoperative radiation, and chemotherapy in which prolonged survival has been observed, most patients with malignant pleural mesothelioma have locally advanced disease, advanced age, or comorbid medical illnesses that preclude aggressive surgery. Therefore, the use of a systemic anticancer agent is the only treatment option for most patients with malignant pleural mesothelioma.Evaluation of effective chemotherapy regimens for this disease has been hampered by many factors. Because mesothelioma is an uncommon malignancy, most studies have enrolled small numbers of patients, and few trials have been randomized. The disease is heterogenous, yet until recently there was no single staging system that could reliably predict survival, nor is there a universally accepted set of prognostic criteria for selecting a uniform group of patients. Response assessment has been limited by the inherent difficulties of reproducibly measuring pleural-based disease. The real impact of systemic chemotherapy on the natural history of malignant mesothelioma is still uncertain because phase III trials comparing chemotherapy with best supportive care have not yet been completed.Although nearly every class of cytotoxic agent has been evaluated in mesothelioma, response rates of greater than 20% have not been consistently demonstrated for any drug. The most active drug classes are the antifolates, the anthracyclines, and the platinums. Doxorubicin has historically been considered the gold-standard chemotherapy, although its true response rate is likely only 15%. The most active commercially available drug for mesothelioma so far appears to be gemcitabine. Although gemcitabine has a limited role as a single agent, it is quite active in combination with a platinating agent. The impressive 48% response rate reported for the combination of gemcitabine with cisplatin in a single phase II study has made this regimen the new standard of care for off-protocol treatment of this disease, although this trial still requires validation.With the recent introduction of several new agents with definite activity in this disease, the therapeutic nihilism previously associated with malignant pleural mesothelioma is gradually being replaced by a cautious optimism. Early trials of angiogenesis inhibitors, gene therapy, and vaccines offer additional avenues for treatment. As we begin to incorporate these active new drugs with each other and in adjuvant and neoadjuvant treatment regimens, there is reason to believe that superior results for patients with malignant pleural mesothelioma can be achieved in the near future.
This paper references
Malignant pleural mesothelioma.
P. Baas (1998)
Simian virus 40-like DNA sequences in human pleural mesothelioma.
M. Carbone (1994)
The importance of surgical staging in the treatment of malignant pleural mesothelioma.
V. Rusch (1996)
Multimodality management of malignant pleural mesothelioma.
D. Sugarbaker (1998)
Malignant mesothelioma. The eastern cooperative oncology group (ECOG) experience
H. Lerner (1983)
Good symptom relief with palliative MVP (mitomycin-C, vinblastine and cisplatin) chemotherapy in malignant mesothelioma.
George W. Middleton (1998)
Carboplatin and gemcitabine chemotherapy for malignant pleural mesothelioma: a phase II study of the GSTPV.
S. Aversa (1999)
Cisplatin and gemcitabine treatment for malignant mesothelioma: a phase II study.
M. Byrne (1999)
Phase II trial of mitomycin in malignant mesothelioma.
D. Bajorin (1987)
Chemotherapy in malignant pleural mesothelioma. A review.
S. T. Ong (1996)
Induction of tumor antigen-specific immunity in vivo by a novel vaccinia vector encoding safety-modified simian virus 40 T antigen.
Y. C. Xie (1999)
Randomized phase II trial of cisplatin with mitomycin or doxorubicin for malignant mesothelioma by the Cancer and Leukemia Group B.
A. Chahinian (1993)
Thoracoscopy in pleural malignant mesothelioma: A prospective study of 188 consecutive patients. Part 2: Prognosis and staging
C. Boutin (1993)
Gemcitabine for malignant mesothelioma: A phase II trial by the Cancer and Leukemia Group B.
H. Kindler (2001)
A proposed new international TNM staging system for malignant pleural mesothelioma. From the International Mesothelioma Interest Group.
V. Rusch (1995)
Clinical and pharmacokinetic phase I study of multitargeted antifolate (LY231514) in combination with cisplatin.
R. Thödtmann (1999)
VEGF and VEGF type C play an important role in angiogenesis and lymphangiogenesis in human malignant mesothelioma tumours
Y. Ohta (1999)
High-dose methotrexate in the treatment of malignant mesothelioma of the pleura. A phase II study.
O. Solheim (1992)
Thoracoscopy in pleural malignant mesothelioma: A prospective study of 188 consecutive patients. Part 1: Diagnosis
C. Boutin (1993)
Node status has prognostic significance in the multimodality therapy of diffuse, malignant mesothelioma.
D. Sugarbaker (1993)
Cisplatin in combination with irinotecan in the treatment of patients with malignant pleural mesothelioma
T. Nakano (1999)
Phase I, dose-finding, and pharmacokinetic study of raltitrexed combined with oxaliplatin in patients with advanced cancer.
K. Fizazi (2000)
Phase II trial of carboplatin in the management of malignant mesothelioma.
D. Raghavan (1990)
S. Kumar-Singh (1997)
High-dose paclitaxel plus G-CSF for malignant mesothelioma: CALGB phase II study 9234.
N. Vogelzang (1999)
Carboplatin and gemcitabine chemotherapy for malignant pleural mesothelioma: a phase II study of the GSTPV.
S. Aversa (1999)
Factors predictive of survival among 337 patients with mesothelioma treated between 1984 and 1994 by the Cancer and Leukemia Group B.
J. Herndon (1998)
A phase II study of gemcitabine in patients with malignant pleural mesothelioma
J. van Meerbeeck (1999)
Paclitaxel for malignant pleural mesothelioma: a phase II study of the EORTC Lung Cancer Cooperative Group.
J. Van Meerbeeck (1996)
Prevention of malignant seeding after invasive diagnostic procedures in patients with pleural mesothelioma. A randomized trial of local radiotherapy.
C. Boutin (1995)

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S. Matsumoto (2014)
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N. C. Cheng (2014)
Pemetrexed alone and in combination with platinum compounds in the management of malignant mesothelioma.
Harit Suwanrusme (2004)
Uncommon Thoracic Tumors
R. Rengan (2011)
Molecular profiling of malignant pleural mesothelioma and pulmonary fibrosis
P. Lindholm (2009)
Malign peritoneal mesothelioma with nephrotic syndrome.
M. Doğan (2012)
Chapter 46 – Uncommon Thoracic Tumors
J. Zeng (2016)
Emerging insights into the biology and therapy of malignant mesothelioma.
N. Vogelzang (2002)
Critical Analysis of Electromagnetic Hyperthermia Randomized Trials: Dubious Effect and Multiple Biases
Sergey V Roussakow (2013)
Photodynamic therapy for mesothelioma
S. Hahn (2001)
Pre-trained deep convolutional neural networks for the segmentation of malignant pleural mesothelioma tumor on CT scans
E. Gudmundsson (2019)
CD 157 enhances malignant pleural mesothelioma aggressiveness and predicts poor clinical outcome
E. Ortolan (2014)
Pemetrexed (Alimta, MTA, multitargeted antifolate, LY231514) for malignant pleural mesothelioma.
C. Manegold (2003)
Transient but Not Stable ZEB1 Knockdown Dramatically Inhibits Growth of Malignant Pleural Mesothelioma Cells
Mihoko Horio (2011)
Highly efficient tumor transduction and antitumor efficacy in experimental human malignant mesothelioma using replicating gibbon ape leukemia virus
S. Kubo (2013)
Novel combinations using pemetrexed in malignant mesothelioma.
S. Gadgeel (2004)
New pyrazolo[3,4-d]pyrimidine SRC inhibitors induce apoptosis in mesothelioma cell lines through p27 nuclear stabilization
P. Indovina (2012)
Biphasic Malignant Mesothelioma with Brain Metastasis
Amitabha Sengupta (2012)
Mesothelioma at era of helical tomotherapy: results of two institutions in combining chemotherapy, surgery and radiotherapy.
A. Sylvestre (2011)
Integration of multimodality approaches in the management of malignant pleural mesothelioma.
Derlis Martino (2004)
Immunoregulation by hepatocyte growth factor in malignant mesothelioma
Nathan Luke Meredith Cook (2008)
Clinical Trials for Unresectable Malignant Pleural Mesothelioma
Kazuya Fukuoka (2009)
Interaction and cross-resistance of cisplatin and pemetrexed in malignant pleural mesothelioma cell lines.
Miyako Kitazono-Saitoh (2012)
Pemetrexed , Vitamin B 12 , and Thoracic Tumors : The Times , They Are A-Changin ’
Paolo Bironzo (2018)
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S. Cilla (2010)
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G. Utkan (2013)
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Obtaining an upper estimate of the survival benefit associated with surgery for mesothelioma.
M. Utley (2010)
Metastatic pleural mesothelioma presenting in a breast fine needle aspiration specimen
P. Shield (2017)
Malignant pleural mesothelioma: surgical roles and novel therapies.
H. Pass (2001)
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