Module Abstract

Novel Developments in the Treatment of Malignant Mesothelioma

Abstract

Malignant mesothelioma is a cancer that arises from the lining cells (mesothelium) of several sites, including the pleural and peritoneal cavities, but also the pericardium and the tunica vaginalis. The exact prevalence is unknown, but it is estimated that mesotheliomas represent less than 1% of all cancers. Malignant pleural mesothelioma (MPM) is the most common form of mesothelioma, and most cases are attributable to asbestos fibers. It is a rare, aggressive, and deadly malignancy affecting approximately 3000 people in the United States per year; worldwide incidence continues to rise. Difficulties in MPM diagnosis and staging, especially of early disease, have thwarted the development of a universally accepted therapeutic approach. Single-modality therapies (surgery, radiotherapy, chemotherapy) alone have failed to significantly prolong patient survival. Multimodality treatment regimens have been developed that have shown greater promise. Radical surgery with extrapleural pneumonectomy and adjuvant treatment has become the preferred option in early stages of the disease. In unresectable disease, combination chemotherapy with pemetrexed and cisplatin or gemcitabine and cisplatin is currently the preferred option for treatment, but median survival with these regimens in phase II and III trials is less than 1 year. Novel agents and combinations are currently being tested in this setting. In this CME-certified learning module, Marcelo C. DaSilva, MD, FACS, FCCP, and David J. Sugarbaker, MD, provide an in-depth review of malignant mesothelioma, including an analysis of the pathophysiology, histology, diagnosis, staging, and prognosis of the disease as well as a discussion on the latest developments in the clinical management of patients with malignant mesothelioma.