Malignant Pleural Mesothelioma: an Update on Investigation, Diagnosis and Treatment

Overview

Journal Eur Respir Rev

Specialty Pulmonary Medicine

Date 2016 Dec 2

PMID 27903668

Citations 136

Authors

Anna C Bibby

Selina Tsim

Nikolaos Kanellakis

Hannah Ball

Denis C Talbot

Kevin G Blyth

Nick A Maskell

Ioannis Psallidas

Affiliations

Soon will be listed here.

Abstract

Malignant pleural mesothelioma is an aggressive malignancy of the pleural surface, predominantly caused by prior asbestos exposure. There is a global epidemic of malignant pleural mesothelioma underway, and incidence rates are predicted to peak in the next few years.This article summarises the epidemiology and pathogenesis of malignant pleural mesothelioma, before describing some key factors in the patient experience and outlining common symptoms. Diagnostic approaches are reviewed, including imaging techniques and the role of various biomarkers. Treatment options are summarised, including the importance of palliative care and methods of controlling pleural effusions. The evidence for chemotherapy, radiotherapy and surgery is reviewed, both in the palliative setting and in the context of trimodality treatment. An algorithm for managing malignant pleural effusion in malignant pleural mesothelioma patients is presented. Finally new treatment developments and novel therapeutic approaches are summarised.

Citing Articles

Telomeres and telomerase in mesothelioma: Pathophysiology, biomarkers and emerging therapeutic strategies (Review).

Andreikos D, Spandidos D, Georgakopoulou V Int J Oncol. 2025; 66(3).

PMID: 39981889 PMC: 11844339. DOI: 10.3892/ijo.2025.5729.

Myeloid Cell Mobilization and Recruitment by Human Mesothelioma in NSG-SGM3 Mice.

Shindyapin V, Gubernatorova E, Gorshkova E, Chicherina N, Sysonov F, Yakovleva A Cells. 2025; 13(24.

PMID: 39768223 PMC: 11675005. DOI: 10.3390/cells13242135.

The presence of pleural effusion is an independent prognostic factor in patients with malignant pleural mesothelioma.

Wang H, Yang R, Liu D, Li W Sci Rep. 2025; 15(1):392.

PMID: 39748018 PMC: 11696534. DOI: 10.1038/s41598-024-84108-6.

The role of healthcare professionals' communication in trial participation decisions: a qualitative investigation of recruitment consultations and patient interviews across three RCTs.

Farrar N, Elliott D, Jepson M, Young B, Donovan J, Conefrey C Trials. 2024; 25(1):829.

PMID: 39695876 PMC: 11653767. DOI: 10.1186/s13063-024-08656-y.

Establishment and bioinformatics analysis of a four-miRNA prognostic signature for pleural mesothelioma.

Yang X, Lin Y, Dong B, Li B, Liu R, Wang X J Cancer. 2024; 15(20):6505-6520.

PMID: 39668817 PMC: 11632982. DOI: 10.7150/jca.101914.

References

Socinski M, Schell M, Peterman A, Bakri K, Yates S, Gitten R . Phase III trial comparing a defined duration of therapy versus continuous therapy followed by second-line therapy in advanced-stage IIIB/IV non-small-cell lung cancer. J Clin Oncol. 2002; 20(5):1335-43. DOI: 10.1200/JCO.2002.20.5.1335. View

Muers M, Stephens R, Fisher P, Darlison L, Higgs C, Lowry E . Active symptom control with or without chemotherapy in the treatment of patients with malignant pleural mesothelioma (MS01): a multicentre randomised trial. Lancet. 2008; 371(9625):1685-94. PMC: 2431123. DOI: 10.1016/S0140-6736(08)60727-8. View

Hughes N, Arber A . The lived experience of patients with pleural mesothelioma. Int J Palliat Nurs. 2008; 14(2):66-71. DOI: 10.12968/ijpn.2008.14.2.28597. View

Santoro A, OBrien M, Stahel R, Nackaerts K, Baas P, Karthaus M . Pemetrexed plus cisplatin or pemetrexed plus carboplatin for chemonaïve patients with malignant pleural mesothelioma: results of the International Expanded Access Program. J Thorac Oncol. 2008; 3(7):756-63. DOI: 10.1097/JTO.0b013e31817c73d6. View

Garland L, Rankin C, Gandara D, Rivkin S, Scott K, Nagle R . Phase II study of erlotinib in patients with malignant pleural mesothelioma: a Southwest Oncology Group Study. J Clin Oncol. 2007; 25(17):2406-13. DOI: 10.1200/JCO.2006.09.7634. View

Howel D, Arblaster L, Swinburne L, Schweiger M, Renvoize E, Hatton P . Routes of asbestos exposure and the development of mesothelioma in an English region. Occup Environ Med. 1997; 54(6):403-9. PMC: 1128800. DOI: 10.1136/oem.54.6.403. View

ORourke N, Garcia J, Paul J, Lawless C, McMenemin R, Hill J . A randomised controlled trial of intervention site radiotherapy in malignant pleural mesothelioma. Radiother Oncol. 2007; 84(1):18-22. DOI: 10.1016/j.radonc.2007.05.022. View

Richards W, Zellos L, Bueno R, Jaklitsch M, Janne P, Chirieac L . Phase I to II study of pleurectomy/decortication and intraoperative intracavitary hyperthermic cisplatin lavage for mesothelioma. J Clin Oncol. 2006; 24(10):1561-7. DOI: 10.1200/JCO.2005.04.6813. View

Carbone M, Pass H, Rizzo P, Marinetti M, Di Muzio M, Mew D . Simian virus 40-like DNA sequences in human pleural mesothelioma. Oncogene. 1994; 9(6):1781-90. View

10.

Scherpereel A, Astoul P, Baas P, Berghmans T, Clayson H, De Vuyst P . Guidelines of the European Respiratory Society and the European Society of Thoracic Surgeons for the management of malignant pleural mesothelioma. Eur Respir J. 2009; 35(3):479-95. DOI: 10.1183/09031936.00063109. View

11.

Rusch V, Rosenzweig K, Venkatraman E, Leon L, Raben A, Harrison L . A phase II trial of surgical resection and adjuvant high-dose hemithoracic radiation for malignant pleural mesothelioma. J Thorac Cardiovasc Surg. 2001; 122(4):788-95. DOI: 10.1067/mtc.2001.116560. View

12.

Pass H, Levin S, Harbut M, Melamed J, Chiriboga L, Donington J . Fibulin-3 as a blood and effusion biomarker for pleural mesothelioma. N Engl J Med. 2012; 367(15):1417-27. PMC: 3761217. DOI: 10.1056/NEJMoa1115050. View

13.

Flores R, Pass H, Seshan V, Dycoco J, Zakowski M, Carbone M . Extrapleural pneumonectomy versus pleurectomy/decortication in the surgical management of malignant pleural mesothelioma: results in 663 patients. J Thorac Cardiovasc Surg. 2008; 135(3):620-6, 626.e1-3. DOI: 10.1016/j.jtcvs.2007.10.054. View

14.

Davies H, Mishra E, Kahan B, Wrightson J, Stanton A, Guhan A . Effect of an indwelling pleural catheter vs chest tube and talc pleurodesis for relieving dyspnea in patients with malignant pleural effusion: the TIME2 randomized controlled trial. JAMA. 2012; 307(22):2383-9. DOI: 10.1001/jama.2012.5535. View

15.

Zalcman G, Mazieres J, Margery J, Greillier L, Audigier-Valette C, Moro-Sibilot D . Bevacizumab for newly diagnosed pleural mesothelioma in the Mesothelioma Avastin Cisplatin Pemetrexed Study (MAPS): a randomised, controlled, open-label, phase 3 trial. Lancet. 2016; 387(10026):1405-1414. DOI: 10.1016/S0140-6736(15)01238-6. View

16.

Stahel R, Riesterer O, Xyrafas A, Opitz I, Beyeler M, Ochsenbein A . Neoadjuvant chemotherapy and extrapleural pneumonectomy of malignant pleural mesothelioma with or without hemithoracic radiotherapy (SAKK 17/04): a randomised, international, multicentre phase 2 trial. Lancet Oncol. 2015; 16(16):1651-8. DOI: 10.1016/S1470-2045(15)00208-9. View

17.

Flores R, Akhurst T, Gonen M, Larson S, Rusch V . Positron emission tomography defines metastatic disease but not locoregional disease in patients with malignant pleural mesothelioma. J Thorac Cardiovasc Surg. 2003; 126(1):11-6. DOI: 10.1016/s0022-5223(03)00207-1. View

18.

Clayson H, Seymour J, Noble B . Mesothelioma from the patient's perspective. Hematol Oncol Clin North Am. 2005; 19(6):1175-90, viii. DOI: 10.1016/j.hoc.2005.09.003. View

19.

Lopez-Rios F, Illei P, Rusch V, Ladanyi M . Evidence against a role for SV40 infection in human mesotheliomas and high risk of false-positive PCR results owing to presence of SV40 sequences in common laboratory plasmids. Lancet. 2004; 364(9440):1157-66. DOI: 10.1016/S0140-6736(04)17102-X. View

20.

Gunatilake S, Brims F, Fogg C, Lawrie I, Maskell N, Forbes K . A multicentre non-blinded randomised controlled trial to assess the impact of regular early specialist symptom control treatment on quality of life in malignant mesothelioma (RESPECT-MESO): study protocol for a randomised controlled trial. Trials. 2014; 15:367. PMC: 4180732. DOI: 10.1186/1745-6215-15-367. View