Advances in treatment of mesothelioma

ABSTRACT

Introduction: Malignant pleural mesothelioma (MPM) is an uncommon, aggressive cancer, derived from pleural mesothelial cells, that has a close relationship to asbestos exposure. To date, MPM prognosis is poor and very few treatment options are available for both localized and advanced MPM. Areas covered: The standard of care is still chemotherapy with platinum derivates and antifolate agents. In the last few years, several new agents have been studied on the basis of mesothelioma carcinogenesis and invasiveness mechanisms; however, the recent results are poor and few drugs have been tested in phase III trials because of toxicity or because they did not improve patient outcomes. The aim of this review is to focus on the current available treatment for MPM through the analysis of the results comes from the phase III trials and to discuss the future perspectives in the pathogenesis, diagnosis and treatment. Expert Opinion: Many compounds are currently under investigation in different subsets of patients. Interesting data have come from preliminary studies on immunotherapy, but randomized studies are needed to confirm the preliminary positive results of this new strategy. A better comprehension of MPM pathogenesis should be obtained to improve and develop new diagnostic tools and target therapies.

KEYWORDS:

• Malignant pleural mesothelioma
• chemotherapy
• immunotherapy
• clinical trials

Article highlights

• Malignant pleural mesothelioma (MPM) is an uncommon, aggressive cancer, derived from pleural mesothelial cells, that has a close relationship to asbestos exposure with increasing incidence;

• Roles of surgery and radiotherapy are still debated because of the absence of adequate clinical trials that can evaluate the real potential benefit of these strategies in limited disease patients, even in multimodal approaches.

• New agents have been studied on the basis of mesothelioma carcinogenesis and invasiveness mechanisms; results are poor and few drugs have been tested in phase III trials;

• Standard of care is still chemotherapy with platinum derivate and antifolate agents

• MAPS trial in front line setting showed improvement in overall survival (OS) in cisplatinum and pemetrexed combined with bevacizumab compared to cisplatin and pemetrexed;

• The role of maintenance therapy is not defined, pemetrexed, NGR-hTNF and other new compounds are under investigation;

• In patients with prolonged PFS with platinum and pemetrexed, retreatment with pemetrexed can be considerated at progression;

• Immunotherapy shows promising results in treatment of MPM;

• Better comprehension of MPM pathogenesis is necessary to improve and develop new target therapies and diagnostic tools.This box summarizes key points contained in the article.

Declaration of interests

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.