Quoted from http://highwire.stanford.edu/cgi/medline/pmid;22406029

Rare thoracic cancers, including peritoneum mesothelioma. S Siesling, JM Zwan, I Izarzugaza, R Foschi, U Ricardi, H Groen, A Tavilla, E Ardanaz, and on behalf of the RARECARE working group Eur J Cancer, March 9, 2012; .   Department of Registry and Research, Comprehensive Cancer Centre The Netherlands, P.O. Box 330, 9700 AH Groningen, The Netherlands; Twente University, Health Technology and Services Research, P.O. Box 217, 7500 AE Enschede, The Netherlands.
Rare thoracic cancers include those of the trachea, thymus and mesothelioma (including peritoneum mesothelioma). The aim of this study was to describe the incidence, prevalence and survival of rare thoracic tumours using a large database, which includes cancer patients diagnosed from 1978 to 2002, registered in 89 population-based cancer registries (CRs) and followed-up to 31st December 2003. Over 17,688 cases of rare thoracic cancers were selected based on the list of the RACECARE project. Mesothelioma was the most common tumour (19 per million per year) followed by epithelial tumours of the trachea and thymus (1.3 and 1.7, respectively). The age standardised incidence rates of epithelial tumours of the trachea was double in Eastern and Southern Europe versus the other European regions: 2 per million per year. Epithelial tumours of the thymus had the lowest incidence in Northern and Eastern Europe and UK and Ireland(1) and somewhat higher incidence in Central and Southern Europe.(2) Highest incidence in mesothelioma was seen in UK and Ireland(23) and lowest in Eastern Europe.(4) Patients with tumours of the thymus had the best prognosis (1-year survival 85%, 66% at 5years). Five year survival was lowest for the mesothelioma 5% compared to 14% of patients with tumours of the trachea. Mesothelioma was the most prevalent rare cancer (12,000 cases), followed by thymus (7000) and trachea (1400). Cancer Registry (CR) data play an important role in revealing the burden of rare thoracic cancers and monitoring the effect of regulations on asbestos use and smoking related policies.

Quoted from http://highwire.stanford.edu/cgi/medline/pmid;22409465

Systemic treatment of malignant pleural mesothelioma. F Grosso and GV Scagliotti Future Oncol, March 1, 2012; 8(3): 293-305. Division of Medical Oncology, SS. Antonio e Biagio General Hospital, Alessandria, Italy.
Malignant pleural mesothelioma is a rare malignancy with a dismal prognosis. The clinical management of most of the patients with this disease is quite challenging, and, overall, the therapeutic strategy has not yet benefited from the recent advances in molecular biology. Randomized evidence supports the use of cisplatin in combination with pemetrexed or raltitrexed as first-line treatments. In elderly patients with comorbidities cisplatin may be replaced by carboplatin because of a lesser burden of toxicities. The role of second-line chemotherapy is unproven, although pemetrexed can be regarded as the standard option in pemetrexed-naive patients and therapeutic rechallenge with pemetrexed may be considered in selected patients with prolonged disease control after first-line therapy. Targeted therapies failed to demonstrate any substantial activity; however, immunotherapies may complement other treatment strategies. In summary, there is an unmet clinical need and innovative approaches to select new potentially active drugs are highly warranted.

Quoted from http://www.news-medical.net/news/20120316/Patients-with-early-stage-MPM-may-be-eligible-for-aggressive-multi-modality-therapy.aspx

Patients with early stage MPM may be eligible for aggressive multi-modality therapy

Published on March 16, 2012 at 12:59 AM

MPM caused by exposure to asbestos; latest in IASLC’s Journal of Thoracic Oncology

 

Patients with early stage malignant pleural mesothelioma (MPM), a cancer that develops in the lining of the lungs, may be eligible for aggressive multi-modality therapy involving surgery, radiotherapy and chemotherapy. There are two main approaches, and controversy has existed about which approach is superior. One is called extrapleural pnemonectomy (EPP), a very extensive surgery where surgeons remove the entire diseased lung, lung lining (pleura), part of the membrane covering the heart (pericardium) and part of the diaphragm. Another approach involves a less extensive surgery called pleurectomy/decortication (P/D), where surgeons remove part of the lining around the lungs, potentially part, but not all of the lung, and potentially part of the diaphragm and/or membrane around the heart. Research presented in the April 2012 issue of the International Association for the Study of Lung Cancer‘s (IASLC) Journal of Thoracic Oncology concludes that the P/D method had better results for patients in a recent analysis.

According to the study, “EPP resulted in higher mortality and morbidity than P/D, and P/D resulted in significantly better survival in our experience as in others.” The authors, “propose that P/D becomes the standard surgical procedure offered as part of multi-modality therapy in malignant pleural mesothelioma.”

Until recently, EPP was the considered the standard of treatment. But this latest study along with other recent research seems to point to P/D becoming the new standard of treatment. Dr. Michael Weyant, thoracic surgeon and assistant professor at the University of Colorado, wrote an editorial in the April JTO about this topic. He concludes that, “the results of the current study by Lang-Lazdunksi et al provide additional data that should lead us to consider P/D in all trials of treatment for MPM. It is too early based on this data to completely abandon EPP altogether as there may be patient subsets where the potential reward outweighs the risks of the procedure.”

Quoted from http://highwire.stanford.edu/cgi/medline/pmid;22324095

Asbestosis in Louisiana: a descriptive review and demographic analysis of hospitalizations for abestosis, 1999-2009. C Davis, J Vijaykumar, M Lackovic, and JH Diaz J La State Med Soc, November 1, 2011; 163(6): 336-41. Louisiana Department of Health and Hospitals, Office of Public Health, Section of Environmental Epidemiology and Toxicology, USA.
Asbestosis is a debilitating, chronic, lung disease with no known treatment and most commonly occurs among workers in certain occupational settings. As a condition highly associated with occupational exposure, its incidence has been affected by changes in industry standards. In particular, the bans on both production and new uses of asbestos fibers put in place during the past 20 to 30 years have significantly reduced occupational exposures. Despite these restrictions, asbestos can still be found in many products. Louisiana has more facilities that produce, process, or use asbestos than any other state in the US. Health outcomes associated with asbestos exposure include asbestosis, mesothelioma, and lung cancer. To evaluate the impact of asbestos exposure on Louisiana residents, Louisiana Hospital Inpatient Discharge Data (LAHIDD) from 1999-2009 was analyzed. Results indicate that asbestosis hospitalizations have remained steady over the 11-year period with approximately 295 cases per year. White males have the highest rates, and cases are clustered geographically. Overall, Louisiana’s rate is significantly greater than the US rate (p < 0.0001).

Quoted from http://highwire.stanford.edu/cgi/medline/pmid;22345416

Malignant pleural mesothelioma. SE Chen and MB Pace Am. J. Health Syst. Pharm., March 1, 2012; 69(5): 377-85.
Purpose The etiology, diagnosis, staging, and management of malignant pleural mesothelioma (MPM) are reviewed, with an emphasis on clinical trials of newer approaches to first-line, second-line, and adjuvant chemotherapy. Summary In the past decade, more effective chemotherapy regimens have been developed for patients with MPM, a rapidly progressing disease linked to a history of asbestos exposure in about 70% of cases. Patients with MPM often require multimodal treatment with surgery, radiotherapy, and adjuvant or neoadjuvant (presurgical) chemotherapy. The current standard of first-line chemotherapy for MPM is cisplatin or carboplatin in combination with pemetrexed, an antifolate compound that has been shown to increase the cytotoxic effects of platinum-based drugs. In Phase II and III clinical trials, combination therapy with pemetrexed and either cisplatin or carboplatin yielded some of the highest rates of tumor response (21-41%) and overall survival (about 12-14 months) reported to date. Dual-agent neoadjuvant chemotherapy (cisplatin plus gemcitabine or pemetrexed) followed by radical surgery with or without radiotherapy has been reported to yield median survival of up to 23-29 months in small clinical trials, but larger randomized controlled studies are needed to better define the role of neoadjuvant therapy in MPM management. Other chemotherapeutic agents that have been used against MPM, with variable results, include gemcitabine, vinorelbine, taxanes, anthracyclines, and molecular-targeted agents. Conclusion Treatment approaches for MPM include surgery, radiation, and systemic chemotherapy. MPM carries a poor prognosis, but recent studies of pemetrexed and platinum analogue combination therapies have demonstrated improved response rates over other treatments.

Quoted from http://ehp03.niehs.nih.gov/article/fetchArticle.action?articleURI=info:doi/10.1289/ehp.00108s4665

Health Effects of Asbestos and Nonasbestos Fibers

Omowunmi Y.O. Osinubi, Michael Gochfeld, Howard M. Kipen

UMDNJ-Robert Wood Johnson Medical School, Piscataway, New Jersey, USA

Abstract

Exposures to asbestos and synthetic fibers remain areas of great concern in the field of occupational lung disease. Despite extensive study, the health effects associated with fibers remains an area of substantial controversy. In particular, effects of fibers at relatively low doses, particularly for mesothelioma, remain a matter of evolving opinion, especially when integrated with the divergence of opinion on relative pathogenicity of different fiber types. Mechanistic studies continue to provide a window into pathogenesis and some hope for understanding dose-response relationships at the lower levels seen in contemporary Western workplaces and the general environment. Changes in clinical assessment based on use of new chest imaging techniques beyond the traditional plain film are also an area of evolution and begin to challenge B-reading as the definitive tool for noninvasive assessment of disease. Public health concerns have to a great extent been transported to the developing world where there is a strong trend toward increased use of asbestos, although it has been virtually eliminated from commerce in most developed countries. For nonasbestos fibers, the major unsettled issues are their relative potencies as carcinogens for the human lung and mesothelium and the need to sort out the relation between physical and chemical properties of these fibers and their pathogenicity. The recent discovery of “flock worker’s lung” due to synthetic fibers once again alerts us to emerging diseases associated with new technologies.

[Article continues at original source]

Quoted from http://www.ncbi.nlm.nih.gov/pubmed/19357540

J Thorac Oncol. 2009 May;4(5):620-8.

Screening for malignant pleural mesothelioma and lung cancer in individuals with a history of asbestos exposure.

Roberts HC, Patsios DA, Paul NS, DePerrot M, Teel W, Bayanati H, Shepherd F, Johnston MR.

Source

Department of Medical Imaging, University Health Network, ON, Canada. heidi.roberts@uhn.on.ca

Abstract

PURPOSE:

We established a screening program for prior asbestos workers using low-dose computed tomography (LDCT).

METHODS:

Between March 2005 and October 2007 we performed LDCT (50-60 mA, 120 kV, 1.25 mm) in 516 asbestos-exposed individuals. Parenchymal nodules were followed according to lung cancer screening recommendations, morphology and location of pleural plaques was noted in detail.

RESULTS:

We included 507 men and 9 women (median 60.0 years), 395 (76.6%) were smokers. Annual repeat has been performed in 356 participants. We found plaques in 357 subjects (69.2%), commonly calcified (79.6%), flat (86.6%), and symmetric (86.8%), and mostly involving the costal (96.4%) and diaphragmatic (81.8%) pleura. Uncommon plaques were lobulated (13.2%), right-dominant asymmetric (4.5%), or with effusions (0.1%).We found pulmonary nodules in 371 subjects (71.9%), 91 (17.6%) had at least one nodule > or =5 mm; 10 growing nodules were found on annual repeat LDCT. In 41 individuals, plaques were regarded as atypical; three had new pleural/peritoneal abnormalities on annual repeat LDCT. An interim limited computed tomography of the observed abnormality prompted 10 diagnostic biopsies, resulting in a diagnosis of six lung cancers, two pleural mesothelioma and two peritoneal mesothelioma; overall rate of screen-detected malignancies is 2.1%. There were four interval cancers, diagnosed after baseline (n = 1) or after the annual repeat (n = 3): two pleural and one peritoneal mesothelioma, and one mixed squamous/small cell carcinoma.

CONCLUSION:

Screening prior asbestos workers detects advanced malignant pleural mesothelioma and early as well as late stage lung cancer. We expect to learn more about the appearance of “early mesothelioma” with continued screening.

Quoted from http://www.lung.org/lung-disease/mesothelioma/symptoms-diagnosis.html

Mesothelioma: Symptoms, Diagnosis and Treatment

 

What are the Symptoms of Mesothelioma? 

Symptoms can vary depending on which organ is involved but can include:

 

• Shortness of breath
• Persistent cough
• Pain under the rib cage
• Weight loss
• Abdominal pain and swelling
• Fever
• Anemia
• Problems with blood clotting

 

How is Mesothelioma Diagnosed?

 

• Complete physical exam, including lung function tests, lung X-ray, blood tests
• CT (CAT) scan or MRI, which give detailed pictures of tissues and organs inside the body
• Biopsy—surgery to remove a tissue sample that is studied by a specialist (pathologist)

 

How is Mesothelioma Treated?

Like most cancers, treatment can vary depending on what stage the cancer is in (how far it has progressed) and where it is located, as well as the patient’s overall health and age. Treatment can include:

 

• Surgery to remove tumors
• Radiation
• Chemotherapy
• A combination of the above
• Removal of fluid build-up from the chest or abdomen (to relieve pain and other symptoms)

 

[Article continues at original source]

Quoted from http://www.chestnet.org/accp/article/chest-physician/update-mesothelioma

Update on Mesothelioma

CHEST Physician Article | 02.16.12

Malignant pleural mesothelioma (MPM) is an orphan disease that has been challenging researchers and clinicians since it was first recognized as a distinct disease entity in the 1960s. There are approximately 3,500 new cases of mesothelioma diagnosed yearly in the United States. Pleural mesothelioma accounts for approximately 80% of cases, peritoneal mesothelioma accounts for 10% to 15% of cases, and there are rare reports of cases originating in the pericardium, testes, and tunica vaginalis.

Asbestos exposure has been directly linked to the development of malignant mesothelioma. The male to female incidence of mesothelioma is reported as 4:1, due largely to workplace exposure to asbestos. Secondhand exposure, due to fibers brought home on clothing and non-workplace exposure during home remodeling/ repair, often leads to a diagnosis at a younger age rather than the average age of diagnosis, which is reported as 70 years…. The latency period from exposure, primarily to asbestos, to the development of disease has been reported to be between 20 and 60 years.

[Article continues at original source]

Quoted from http://www.ajhp.org/content/69/5/377.abstract?maxtoshow=&HITS=10&hits=6&RESULTFORMAT=&andorexacttitle=or&andorexacttitleabs=and&fulltext=asbestos&andorexactfulltext=and&searchid=1&usestrictdates=yes&resourcetype=HWCIT&ct

Malignant pleural mesothelioma

Abstract

Purpose The etiology, diagnosis, staging, and management of malignant pleural mesothelioma (MPM) are reviewed, with an emphasis on clinical trials of newer approaches to first-line, second-line, and adjuvant chemotherapy.

Summary In the past decade, more effective chemotherapy regimens have been developed for patients with MPM, a rapidly progressing disease linked to a history of asbestos exposure in about 70% of cases. Patients with MPM often require multimodal treatment with surgery, radiotherapy, and adjuvant or neoadjuvant (presurgical) chemotherapy. The current standard of first-line chemotherapy for MPM is cisplatin or carboplatin in combination with pemetrexed, an antifolate compound that has been shown to increase the cytotoxic effects of platinum-based drugs. In Phase II and III clinical trials, combination therapy with pemetrexed and either cisplatin or carboplatin yielded some of the highest rates of tumor response (21–41%) and overall survival (about 12–14 months) reported to date. Dual-agent neoadjuvant chemotherapy (cisplatin plus gemcitabine or pemetrexed) followed by radical surgery with or without radiotherapy has been reported to yield median survival of up to 23–29 months in small clinical trials, but larger randomized controlled studies are needed to better define the role of neoadjuvant therapy in MPM management. Other chemotherapeutic agents that have been used against MPM, with variable results, include gemcitabine, vinorelbine, taxanes, anthracyclines, and molecular-targeted agents.

Conclusion Treatment approaches for MPM include surgery, radiation, and systemic chemotherapy. MPM carries a poor prognosis, but recent studies of pemetrexed and platinum analogue combination therapies have demonstrated improved response rates over other treatments.

• Copyright © 2012 by the American Society of Health-System Pharmacists, Inc. All rights reserved.