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.

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