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Mésothéliome Pleural Malin : La Chimiothérapie Est-elle La Seule Option Thérapeutique ?

A. Scherpereel, X. Dhalluin
Published 2014 · Medicine

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Resume Le mesotheliome pleural malin (MPM) est un cancer de mauvais pronostic et rare mais d’incidence croissante, secondaire classiquement a une exposition a l’amiante. Il n’y a pas a ce jour de traitement curatif du MPM. Le MPM presente une forte resistance a la chimiotherapie, meme si celle-ci est le traitement de reference actuel de premiere ligne (platine et pemetrexed) pour les recommandations internationales, et peu de patients sont des candidats potentiels a une « chirurgie radicale » telle qu’envisagee precedemment (pneumonectomie extrapleurale) et non validee. Cependant, devant les resultats tres limites de la chimiotherapie, il est explore d’autres voies therapeutiques que celle-ci (immunotherapie…) ou des strategies combinant la chimiotherapie a d’autres traitements : therapies ciblees, radiotherapie, approche multimodale incluant une pleurectomie/decortication etendue (eP/D), une chirurgie d’exerese tumorale maximale macroscopique du MPM, de morbi-mortalite moindre mais non curative sauf a un stade tres precoce et rare. C’est pourquoi il a ete suggere que l’eP/D pourrait etre interessante si elle etait combinee avec un traitement intrapleural (chimiotherapie, therapie photodynamique…). Ces traitements innovants, resumes ici, doivent etre valides par des essais cliniques prospectifs multicentriques, avec en France l’aide du reseau des centres experts du MPM (« MESOCLIN ») pour faciliter l’inclusion des patients.
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