Treatment of pleural mesothelioma

Published July 8, 2016 · Updated October 25, 2016

The prognosis of pleural mesothelioma unfavorable, the median survival of patients (symptomatic treatment) is 7 months. Surgical treatment in the amount of pleurectomy or plevropnevmonektomii is rare, with localized forms, only in 7-10% of patients. After plevropnevmonektomy operative mortality reaches 14-15%, significantly higher than the (minimum) plevrektomy mortality. Indicators of life expectancy do not differ after these operations: the median survival corresponds to 9-21 months.; 2-year survival rate is 11-45% (Giaccone G., 2002; Rahman M. et al, 2003.). Improving long-term results of surgical treatment (primarily plevropnevmonektomy) associated with adjuvant chemotherapy.

Experience surgery, the combined treatment (surgery + chemotherapy + radiotherapy) has allowed to develop the following recommendations for pleural mesothelioma: Performing extrapleural pneumonectomy (plevropnevmonektomii), carrying through 4-6 weeks to 6 cycles of chemotherapy with the appointment of platinum drugs, followed by radiation therapy to the area of remote lung and mediastinum. Direct mortality in different comparison groups accounted for 5-22%, median – 21 months, 2-5-year survival – 45 and 22%, respectively. Factors most favorable prognosis are the type of epithelial tumors, as well as the absence of metastases. Radiotherapy (ODS 50 Gy.) Reduces the pain, but does not increase the duration of life (the dose increasing, as well as combination of chemotherapy and radiotherapy does not improve survival).

The effectiveness of modern of chemotherapy for pleural mesothelioma rarely exceeds 20%. Marked tumor regression and objective improvement in the application of cisplatin, tsikloplatama, mitomycin, raltitreksida (tomudeksa), etoposide, carboplatin, ifosfamide, vinorelbine, gemcitabine (Gemzar), pemetrexed (Alimta).

Combination chemotherapy is carried out under the schemes: doxorubicin + cyclophosphamide, doxorubicin, ifosfamide, doxorubicin and cisplatin + – mitomycin C, Campto + cisplatin and mitomycin C, gemcitabine + cisplatin (carboplatin) gemcitabine + Alimta, Alimta and cisplatin (carboplatin). Last 3 schemes are considered standard treatment for pleural mesothelioma.

In the presence of pleural effusion may intrapleural administration of cytotoxic drugs or of biotherapy products to stop or slow down the accumulation of fluid. For this purpose, cisplatin, bleomycin, and – interferon and interleukin-2. Possibilities of photodynamic therapy investigated.

In addition, in clinical trials targeted therapies: Avastin, Iressa, Gleevec, thalidomide, and others, which may increase the survival rate.. Among the targeted agents should pay attention to inhibitors of vascular endothelial growth factor. It is noted that for pleural mesothelioma high level expression of vascular endothelial growth factor correlates with increased capillary density and low survival. In this regard, with mesothelioma semaksanib study, bevacizumab (Avastin) and thalidomide.