A narrative review of current treatment strategies and emerging therapies in malignant pleural mesothelioma (original) (raw)
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Multimodal management of malignant pleural mesothelioma: where are we today?
European Respiratory Journal, 2014
The prognosis of patients with malignant pleural mesothelioma remains poor and although it is clear that multimodal therapy is necessary to improve long-term results, precise treatment schemes have not yet been unequivocally established. Single-modality therapy does not have a major impact on long-term survival and combined-modality therapies are being further evaluated. However, the relative contributions of chemotherapy, radiotherapy and surgery have not been clearly determined at the present time. Moreover, the extent of resection and precise surgical procedure remain a highly debated topic. To better compare and combine results from different institutions and trials, uniform definitions of surgical procedures including extrapleural pneumonectomy and different forms of pleurectomy have recently been introduced. Due to the relatively higher morbidity and mortality of extrapleural pneumonectomy, there is currently a shift towards pleurectomy/decortication when a macroscopic complete resection of all tumour can be obtained by this procedure. In most recent trials, induction chemotherapy was administered to improve surgical resection rates but pathological complete responses are infrequently observed. The role of post-operative radiotherapy has to be further elucidated.
Cancer Management and Research, 2015
Malignant pleural mesothelioma (MPM) is a rare tumor that is challenging to control. Despite some benefit from using the multimodality-approach (surgery, combination chemotherapy and radiation), survival remains poor. However, current research produced a list of potential therapies. Here, we summarize significant new preclinical and early clinical developments in treatment of MPM, which include mesothelin specific antibody and toxin therapies, interleukin-4 (IL-4) receptor toxins, dendritic cell vaccines, immune checkpoint inhibitors, and gene-based therapies. In addition, several local modalities such as photodynamic therapy, postoperative lavage using betadine, and cryotherapy for local recurrence, have also shown to be effective for local control of disease.
Journal of Cancer Metastasis and Treatment, 2021
Patients with unresectable malignant pleural mesothelioma (MPM) have historically poor outcomes and treatment, and their treatments have been limited to palliative chemotherapy. Recent efforts to improve prognosis for these patients by adding angiogenesis inhibitors to chemotherapy led to significant benefits. However, the emergence of immunotherapy combinations for the front-line treatment has upended the standard of care and has led to the first new FDA approvals for the treatment of MPM in nearly two decades. This review aims to cover the main clinical trials in unresectable MPM with VEGF inhibitors and immunotherapy which have led to paradigm shifts in current practice. Ongoing clinical trials exploring the combination of chemo and immunotherapies show a great deal of promise, and continued support for ambitious, large-scale well-designed trials remain vital for defining the future outcomes of patients diagnosed with MPM.
Progress in the Management of Malignant Pleural Mesothelioma in 2017
Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, 2018
Malignant pleural mesothelioma (MPM) is an uncommon, almost universally fatal, asbestos-induced malignancy. New and effective strategies for diagnosis, prognostication, and treatment are urgently needed. Herein we review the advances in MPM achieved in 2017. Whereas recent epidemiological data demonstrated that the incidence of MPM-related death continued to increase in United States between 2009 and 2015, new insight into the molecular pathogenesis and the immunological tumor microenvironment of MPM, for example, regarding the role of BRCA1 associated protein 1 and the expression programmed death receptor ligand 1, are highlighting new potential therapeutic strategies. Furthermore, there continues to be an ever-expanding number of clinical studies investigating systemic therapies for MPM. These trials are primarily focused on immunotherapy using immune checkpoint inhibitors alone or in combination with other immunotherapies and nonimmunotherapies. In addition, other promising targe...
Chemotherapy for malignant pleural mesothelioma
Current Opinion in Oncology, 2003
Purpose of Review This paper aims to propose an update on therapeutic medical options for malignant pleural mesothelioma (MPM). Recent Findings For 13 years, the standard of care in MPM patients has been cisplatin/pemetrexed chemotherapy. Recently, the Cis/Pem/bevacizumab triplet emerged as a new option for MPM patients eligible for bevacizumab, and not as a candidate for multimodality therapy trials, as validated by the last NCCN and French guidelines. Immunotherapy is also emerging as a promising option on its own or in combination with first-line Cis/Pem, or even as a valuable alternative to chemotherapy, radical surgery, and multimodality strategies. Summary Targeted therapies and immunotherapy are new promising treatments in MPM as single agents or in combination with chemotherapy. However, the key challenge remains to find reliable predictive biomarkers for these innovative, exciting, and expensive treatments to select the best patients for each strategy. After years of nihilism and negative trials, numerous therapeutic strategies can now be offered to mesothelioma patients and the future looks brighter.
Neoadjuvant and Intrapleural Therapies for Malignant Pleural Mesothelioma
Clinical Lung Cancer, 2009
Historically, malignant pleural mesothelioma patients with potentially resectable disease have been treated with surgery and radiation alone. With improvements in systemic and intrapleural treatment options, a movement toward multi-modality therapy has become more common. Systemic treatment options largely consist of neoadjuvant chemotherapy with platinum doublets and most recently novel targeted agents, such as dasatinib. Intrapleural strategies have included injecting chemotherapy, chemotherapy with hyperthermic perfusion, gene therapy, and immunotherapy. The following review discusses the latest results in neoadjuvant and intrapleural therapies in malignant pleural mesothelioma.
Interactive cardiovascular and thoracic surgery, 2013
Malignant pleural mesothelioma (MPM) remains an aggressive thoracic malignancy associated with poor prognosis. There is no standard treatment regimen, and particularly, the impact of radical surgery remains controversial. The main goal of our retrospective single-centre study was to evaluate the surgical and non-surgical treatment modalities applied at our division regarding their effect on the patient's survival. During the last decade, 82 patients with histologically confirmed MPM were treated at our division. The complete clinical records of 61 patients were eligible for statistical evaluation. There were 14 women (23%) and 47 men (77%) with a mean age of 63.7 years. Epitheloid subtype was found in 48 patients (78.7%), sarcomatoid in 3 (4.9%) and biphasic in 10 (16%). Surgery as the first treatment modality was performed in 44 patients (72.1%). Pleurectomy/decortication was done in 28 cases (45.9%), extended pleurectomy/decortication was performed in 13 (21.3%) and extrapleur...
The Role of Surgery in Malignant Pleural Mesothelioma
The Journal of OncoPathology, 2015
Malignant pleural mesothelioma (MPM) is a fatal malignancy associated with asbestos exposure. Although various therapies have been used in the past, including surgery, chemotherapy, radiotherapy, immunotherapy, and more recently targeted therapy, prognosis still remains poor. Radical surgery including extrapleural pneumonectomy (EPP) or pleurectomy/decortication (P/D) is being offered to obtain maximal cytoreduction in the context of multimodality therapy in patients with MPM. Growing evidence suggests that EPP might be detrimental, while recent reports suggest that P/D is better tolerated, producing low mortality and morbidity and allowing patients to receive adjuvant therapies in the form of either chemotherapy alone, or combined chemoradiotherapy. Many now believe that P/D should be the default procedure in multimodality regimens, although this remains to be proven in a large randomized trial. Apart from its therapeutic role, surgery has also an important role to play in pleural mesothelioma in establishing or refining diagnosis and in controlling symptoms and improving quality of life in many patients whose life expectancy is limited. Recent progress in molecular analyses and biomarkers should help with patient selection for surgery, immunotherapy and systemic therapies in the near future.
Molecular and Clinical Oncology, 2022
Malignant pleural mesothelioma (MPM) is considered a relatively uncommon disease but its incidence is increasing worldwide. Patients affected by MPM have a very severe prognosis and have been often occupationally and environmentally exposed to asbestos. In recent years, checkpoint inhibitors have dramatically revolutionized the paradigm for the treatment of several malignancies. Several efforts have also been made to improve the survival outcomes of patients with MPM and after decades, the standard-of-care systemic treatment for unresectable MPM, based on first-line combination chemotherapy with cisplatin and pemetrexed, has changed. In addition to checkpoint inhibitors, other types of treatments, such as molecularly targeted therapy have been evaluated. However, to date, the results of these investigations are not very encouraging. The aim of the present review is to provide a comprehensive overview of the most relevant data of clinical trials regarding recent treatment strategies of MPM with a particular focus on immunotherapeutic and targeted approaches. Contents 1. Introduction 2. Malignant pleural mesothelioma (MPM) 3. Immunotherapy 4. Targeted agents in MPM 5. Conclusion