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Mesothelioma

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Lung Cancer

Part of the book series: Current Clinical Oncology ((CCO))

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Abstract

Mesothelioma is a rare but devastating malignancy originating from mesothelial cells lining serosal surfaces of the pleura, peritoneum, pericardium, and tunica vaginalis. This chapter focuses on malignant pleural mesothelioma (MPM). In the United States, the incidence of MPM is declining; however, the worldwide incidence of MPM is expected to increase over the next decade, particularly in Europe, Asia, and Australia. Development of MPM is characterized by disease manifestation several decades following asbestos exposure, accounting for the lag between asbestos regulation and peak incidence of MPM in developed countries. In vitro, malignant transformation of normal mesothelial cells by asbestos fibers may be influenced by DNA damage following cell cycle perturbation caused by disruption of mitotic spindles and reactive oxygen species plus altered signal transduction leading to activation of proto-oncogene expression. MPM is predominantly a locoregional, diffuse, aggressive disease with median survival of 9-17 months regardless of the stage of the disease. Multimodality therapy is becoming the standard treatment for resectable MPM. Extrapleural pneumonectomy (EPP) and pleurectomy/decortication (P/D) have been used to manage localized disease. To date, radiotherapy is the only treatment modality that has been shown to reduce locoregional recurrence following resection of MPM. Radiotherapy is used to prevent tract seeding by the malignant mesothelial cells following pleural intervention, to improve locoregional disease control postoperatively, and to palliate symptoms in unresectable patients. Improvements in chemotherapy, especially use of cisplatin and pemetrexed, have yielded survival benefit in these patients. Combination of surgery, radiotherapy, and chemotherapy has resulted in median survival of 20-28 months in the most favorable patients. Given these discouraging results, there is clearly a need to improve therapeutic outcomes in MPM. Ongoing studies are investigating novel targeted biologic agents alone and in combination with standard treatments to increase MPM patient survival.

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  1. The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA

    Mary Frances McAleer, Reza J. Mehran & Anne Tsao

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  1. Mary Frances McAleer
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  2. Reza J. Mehran
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Correspondence to Mary Frances McAleer .

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  1. M. D. Anderson Cancer Center, University of Texas, Holcombe Blvd. 1515, Houston, 77030, U.S.A.

    David J. Stewart

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McAleer, M.F., Mehran, R.J., Tsao, A. (2010). Mesothelioma. In: Stewart, D. (eds) Lung Cancer. Current Clinical Oncology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60761-524-8_17

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