Title:Mesothelioma - Update on Management
VOLUME: 10 ISSUE: 4
Author(s):Patricia Tai, Kurian Joseph, Avi Assouline, Joseph Au and Edward Yu
Affiliation:Department of Radiation Oncology, Allan Blair Cancer Center, Regina, Canada.
Keywords:Biomarkers, clinical outcome, clinical trial, immunotherapy, mesothelin, mesothelioma,
radiotherapy.
Abstract:Mesothelioma is an often fatal cancer arising from the lining of pleura, peritoneum, pericardium
and tunica vaginalis (of the testis). In the past decade, investigators have met with limited or minimal success
in demonstrating improvements in survival compared to supportive care or observation. Radical surgery such
as extrapulmonary pleurectomy is associated with perioperative mortality rates of 6-30% by different
institutions, compared to 3% with extended pleurectomy and decortication. Talc pleurodesis is preferred over
video-assisted thorascopic partial pleurectomy in the setting of pleural effusion due to fewer complications
and shorter hospital stay. To spare normal tissues, radiotherapy with IMRT (intensity-modulated radiation
therapy) technique should be used in all cases. Reirradiation with proton particles for recurrent disease is
being investigated. The ongoing PIT (Prophylactic Irradiation of Tracts) study will explore the effectiveness
of radiotherapy to prevent or delay recurrent nodules on the chest wall following invasive chest wall
intervention. The literature on this question is varied and inconclusive. Pemetrexed-cisplatin is currently the
standard as first line therapy for malignant pleural mesothelioma in accordance with a phase III study
showing improved quality of life and survival. In 2012, a new promising biomarker, fibulin-3 was reported in
all mesothelioma sites. Fibulin-3 is a superior prognosticator compared with mesothelin and can be used to
monitor tumor response. Mesothelin, the cell-surface glycoprotein, has become the primary target for
immunotherapy. SS1P is a recombinant antimesothelin immunotoxin which induces a durable response in all
mesotheliomas.
