Case 13.8

Asbestos Exposure ◽

The United States ◽

Parietal Pleura ◽

Pleural Mesothelioma ◽

Pleural Plaques ◽

Abnormal Chest ◽

Left Pleura ◽

Histologic Subtypes

62-year-old man with shortness of breath and an abnormal chest CT Axial 3D SPGR postgadolinium images (Figure 13.8.1) demonstrate diffuse thickening and enhancement of the left pleura, with a few minimally enhancing, focal right-sided pleural plaques. Malignant pleural mesothelioma Malignant pleural mesothelioma is a rare neoplasm that originates from the mesothelial cells lining the visceral and parietal pleura. The incidence of malignant pleural mesothelioma in the United States is 15 cases per million; there is a strong correlation with asbestos exposure. Malignant pleural mesothelioma is divided into 3 histologic subtypes: epithelial (55%-65%), sarcomatoid (10%-15%), and mixed (20%-35%). Patients with epithelial malignant pleural mesothelioma have the best prognosis, and among those with limited disease who undergo extrapleural pneumonectomy (removal of the pleura, lung, hemidiaphragm, and part of the pericardium), survival is longer (5-year survival, 39%) than among all patients (median survival, 8-18 months after diagnosis)....

Pleural Plaques and Malignant Pleural Mesothelioma in a Patient With Previous Asbestos Exposure

Pleural Diseases ◽

10.1016/b978-0-323-79541-8.00002-3 ◽

2022 ◽

pp. 15-22

Author(s):

Marchetti Giampietro ◽

Sorino Claudio ◽

Feller-Kopman David

Keyword(s):

Asbestos Exposure ◽

Pleural Mesothelioma ◽

Pleural Plaques

Multimodality treatment of malignant pleural mesothelioma

F1000Research ◽

10.12688/f1000research.15796.1 ◽

2018 ◽

Vol 7 ◽

pp. 1681 ◽

Cited By ~ 6

Author(s):

Lawek Berzenji ◽

Paul Van Schil

Keyword(s):

Asbestos Exposure ◽

Multimodality Treatment ◽

Treatment Modalities ◽

Surgical Approaches ◽

Pleural Mesothelioma ◽

Treatment Approaches ◽

Definitive Answer ◽

Platinum Based Chemotherapy

Malignant pleural mesothelioma (MPM) is a rare disease of the pleura and is largely related to asbestos exposure. Despite recent advancements in technologies and a greater understanding of the disease, the prognosis of MPM remains poor; the median overall survival rate is about 6 to 9 months in untreated patients. The main therapeutic strategies for MPM are surgery, chemotherapy, and radiation therapy (RT). The two main surgical approaches for MPM are extrapleural pneumonectomy (EPP), in which the lung is removed en bloc, and pleurectomy/decortication, in which the lung stays in situ. Chemotherapy usually consists of a platinum-based chemotherapy, such as cisplatin, often combined with a folate antimetabolite, such as pemetrexed. More recently, immunotherapy has emerged as a possible therapeutic strategy for MPM. Evidence suggests that single-modality treatments are not an effective therapeutic approach for MPM. Therefore, researchers have started to explore different multimodality treatment approaches, in which often combinations of surgery, chemotherapy, immunotherapy, and RT are investigated. There is still no definitive answer to the question of which multimodality treatment combinations are most effective in improving the poor prognosis of MPM. Research into the effects of trimodality treatment approaches have found that radical approaches such as EPP and hemithoracic RT post-EPP are less effective than was previously assumed. In general, there are still a great number of unanswered questions and unknown factors regarding the ideal treatment approach for MPM. Hopefully, more research into multimodality therapy will provide insight into which combination of treatment modalities is most effective.

Cancer-directed surgery in malignant pleural mesothelioma: extrapleural pneumonectomy and pleurectomy/decortication

Journal of Cancer Metastasis and Treatment ◽

10.20517/2394-4722.2021.159 ◽

2021 ◽

Author(s):

Brian Housman ◽

Andrea S. Wolf

Keyword(s):

Asbestos Exposure ◽

Morbidity Rate ◽

High Morbidity ◽

Pleural Mesothelioma ◽

Solid Malignancy ◽

Future Treatment ◽

High Morbidity Rate ◽

Therapeutic Alternatives

Malignant pleural mesothelioma (MPM) is a primary solid malignancy related to inhalational asbestos exposure. Despite advances in therapy, MPM remains challenging to treat with a post-treatment survival of only 15% at 5-year. In recent years, extra-pleural pneumonectomy has decreased in popularity due to a high morbidity rate and mortality compared to pleurectomy/decortication and other therapeutic alternatives. In this review, we will discuss both procedures, outcomes, ongoing studies, and the roles of surgery in the future treatment of this disease.

Malignant Pleural Mesothelioma

Journal of Clinical Oncology ◽

10.1200/jco.2008.19.8523 ◽

2009 ◽

Vol 27 (12) ◽

pp. 2081-2090 ◽

Cited By ~ 204

Author(s):

Anne S. Tsao ◽

Ignacio Wistuba ◽

Jack A. Roth ◽

Hedy Lee Kindler

Keyword(s):

Median Overall Survival ◽

Intensity Modulated Radiotherapy ◽

The United States ◽

Pleural Mesothelioma ◽

Controversial Issues ◽

Significant Progress ◽

The Impact

Malignant pleural mesothelioma (MPM) is a deadly disease that occurs in 2,000 to 3,000 people each year in the United States. Although MPM is an extremely difficult disease to treat, with the median overall survival ranging between 9 and 17 months regardless of stage, there has been significant progress over the last few years that has reshaped the clinical landscape. This article will provide a comprehensive discussion of the latest developments in the treatment of MPM. We will provide an update of the major clinical trials that impact mesothelioma treatment in the resectable and unresectable settings, discuss the impact of novel therapeutics, and provide perspective on where the clinical research in mesothelioma is moving. In addition, there are controversial issues, such as the role of extrapleural pneumonectomy, adjuvant radiotherapy, and use of intensity-modulated radiotherapy versus hemithoracic therapy that will also be addressed in this manuscript.

Progress in the Understanding of the Immune Microenvironment and Immunotherapy in Malignant Pleural Mesothelioma

Current Drug Targets ◽

10.2174/1389450121666200719011234 ◽

2020 ◽

Vol 21 (15) ◽

pp. 1606-1612 ◽

Cited By ~ 1

Author(s):

Lei Cheng ◽

Na Li ◽

Xiao-ling Xu ◽

Wei-Min Mao

Keyword(s):

Tumor Microenvironment ◽

Asbestos Exposure ◽

Pleural Mesothelioma ◽

Immune Microenvironment ◽

Tumor Immune Microenvironment ◽

Mechanism Of Carcinogenesis ◽

Cycle Regulation ◽

The Relationship

Malignant pleural mesothelioma (MPM) is a remarkably aggressive thoracic malignancy with a limited survival of only 5-12 months. However, MPM still remains unresponsive to conventional standards of treatment, including pleurectomy and decortication, extrapleural pneumonectomy for resectable disease with or without chemotherapy, and/or radiation therapy. The mechanism of carcinogenesis has not been fully elucidated, although approximately 80% of cases can still be linked to asbestos exposure. The tumor immune microenvironment (TME) has been proven to play an important role in MPM pathogenesis and treatment outcomes. Several molecular pathways have been implicated in the MPM tumor microenvironment, such as angiogenesis, apoptosis, cell cycle regulation, and stromal processes. Immunotherapy has already shown promising results in other thoracic solid tumors, such as non-small-cell lung cancer (NSCLC). However, immunotherapy has shown less convincing results in MPM than in melanoma and NSCLC. A multicenter, randomized trial (DETERMINE) proved that immune checkpoint inhibition using tremelimumab, an anti-cytotoxic T lymphocyteassociated protein 4 (CTLA-4) antibody, failed to improve median overall survival. Therefore, it is important to explore the relationship between the characteristics of the tumor microenvironment and immunotherapy. Here, we review the heterogeneity of the TME and the progress in the understanding of the immune microenvironment and immunotherapy in MPM to explore the mechanisms of resistance to immunotherapy.