The following is a topical compilation of medical articles addressing various aspects of mesothelioma etiology, diagnosis and treatment. Check back often as this page is frequently updated with newly published articles.

• An electronic nose distinguishes exhaled breath of patients with Malignant Pleural Mesothelioma from controls
  
• Articles Comparing Pleurectomy/Decortication to Extra Pleural Pneumonectomy
• Articles Generally Addressing Surgical and Multi-Modal Treatment of Mesothelioma
• Articles Addressing Chemotherapy
• Articles Addressing Immunotherapy for Mesothelioma
• Articles Addressing Mesothelioma Diagnosis, Imaging and Response Markers
• Articles Addressing Developing or Novel Treatments for Mesothelioma
• Articles Addressing Mesothelioma Etiology and Case Studies

Articles Comparing Pleurectomy/Decortication to Extra Pleural Pneumonectomy

Speak Up: Reflections from a Nightmare Patient - Me! (Oncology Times, 6/25/2010)

Diagnosed in 2007 at the age of 48, Dr. Andrew Lawson is one of three doctors who trained at Guy’s Hospital in London, England diagnosed with mesothleioma. His travels from the diagnosis through his treatment choices are eye-opening. ” I have researched my illness. I see every paper published on Medline on mesothelioma. I have read all the abstracts from the international Mesothelioma Interest Group meetings, and I discussed my treatments with many colleagues from a variety of disciplines. I suppose I am the nightmare patient.” Click here

Surgical options in malignant pleural mesothelioma: extrapleural pneumonectomy or pleurectomy/decortication Semin Thorac Cardiovasc Surg. (2009) Overall survival reported in a recent multi-center analysis of these two operations supports the use of P/D for early stage MPM provided that a complete resection is feasible; otherwise EPP will confer a survival advantage. For stage II disease, however, EPP demonstrates a possible advantage. The focus in stage III disease should remain on the ability to achieve macroscopic complete resection, rather than N2 disease. Patients with stage IV cancers have better survival if the lung is left in place. Click here

Surgical techniques for multimodality treatment of malignant pleural mesothelioma: extrapleural pneumonectomy and pleurectomy/decortication Semin Thorac Cardiovasc Surg. (2009) Trimodality treatment of malignant pleural mesothelioma with cytoreductive surgery followed by radiation and chemotherapy has resulted in long-term survival for a select group of patients. Knowledge of the similarities and differences between the two operations that have evolved-extrapleural pneumonectomy and pleurectomy/decortication-is prerequisite to understanding the complex issues associated with patient selection, diagnosis, pathologic staging, preoperative assessment, perioperative management, and adjuvant treatment. Both operations are technically complex and should only be performed at experienced high-volume centers. Click here

Morbidity, mortality, mean survival, and the impact of histology on survival after pleurectomy in 64 patients with malignant pleural mesothelioma Int J Surg (08/08) Our results show that pleurectomy can be performed as a means of palliation for advanced-stage disease with a low mortality rate and may, in fact, improve survival in patients with epithelial subtype as compared with historical controls in the literature with no surgical intervention. Click here

Extrapleural pneumonectomy versus pleurectomy/decortication in the surgical management of malignant pleural mesothelioma: results in 663 patients European Journal of Cardio-Thoracic Surgery(03/08) Patients who underwent pleurectomy/decortication had a better survival than those who underwent extrapleural pneumonectomy; however, the reasons are multifactorial and subject to selection bias. At present, the choice of resection should be tailored to the extent of disease, patient comorbidities, and type of multimodality therapy planned.Click here or here

Malignant pleural mesothelioma: surgical management in 285 patients Annals of Thoracic Surgery (01/08) Extrapleural pneumonectomy can be performed with similar 30-day mortality as other procedures for malignant pleural mesothelioma with a median survival better than subtotal pleurectomy, exploration without resection, and biopsy alone. However, extrapleural pneumonectomy has significant morbidity and a 3-year survival of only 14%.Click here

Extrapleural Pneumonectomy Is the Preferred Surgical Management in the Multimodality Therapy of Pleural Mesothelioma: Con ArgumentThe Annals of Surgical Oncology (07/07) Click here

• No evidence the EPP is superior to lung-sparing P/D
• Both surgeries carry potentially serious risks
• Only experienced surgeons should attempt either surgery
• “The EPP should not become the (Sir Edmund Hillary) operation of Thoracic Surgery: being done simply because it is there and because it can be done

Ten traps for the unwary in surgical series: A case study in mesothelioma reportsThe Journal of Thoracic and Cardiovascular Surgery (06/07) We have to conclude that there is as yet no reliable evidence for the effectiveness of radical surgery or EPP for mesothelioma, and patients should be informed of that fact. Click here

Case-control Study Between Extra-pleural Pneumonectomy and Radical pleurectomy / decortication for Pathological N2 Malignant Pleural Mesothelioma European Journal of Cardio-Thoracic Surgery (05/07) Preservation of the lung during radical surgery for mesothelioma does not compromise survival even in an older group population. We therefore now have ceased to perform EPP and we make every effort to accurately stage patients with mediastinoscopy to identify them. Click here

Improved Survival with Interferon Alpha Maintenance Therapy Following Pleurectomy/Decortication and Radiation for Malignant Pleural Mesothelioma as presented by Dr. Robert Cameron at The Society of Thoracic Surgeon 42nd Annual Meeting (01/06) Complete pleurectomy/decortication and postoperative radiation therapy may provide similar survival to the more radical procedure of extrapleural pneumonectomy particularly in advanced stage disease. In addition, interferon alpha maintenance therapy may provide substantial improvement in survival over existing therapies. Click here

Improved survival with VATS pleurectomy-decortication in advanced malignant mesothelioma Eur J Surg Oncol.(2005) VATS pleurectomy-decortication is feasible in the majority of cases and independently improves survival for patients with advanced malignant mesothelioma. Click here

Pleurectomy/decortication plus chemotherapy: outcomes of 40 cases of malignant pleural mesothelioma ChirItal (2004) Low morbidity and mortality and good quality of life after treatment make pleurectomy/decortication with intracavitary and systemic chemotherapy not only a radical approach in early stages, but also a good palliative treatment in advanced malignant pleural mesothelioma, especially in patients who are unsuitable for extrapleural pneumonectomy.Click here

Articles Generally Addressing Surgical and Multi-Modal Treatment of Mesothelioma

Extrapleural pneumonectomy, photodynamic therapy and intensity modulated radiation therapy for the treatment of malignant pleural mesothelioma Cancer Biology and Therapy (09/10) Intensity modulated radiation therapy (IMRT) has recently been proposed with a multimodality approach for the treatment of mesothelioma, incorporating extrapleural pneumonectomy, intraoperative photodynamic therapy and postoperative hemithoracic IMRT. Multimodality therapy combining surgery with increased doses of radiation using IMRT, and newer treatment modalities such as PDT, appears safe. Future prospective analysis will be needed to demonstrate efficacy of this approach in the treatment of mesothelioma. Click here

How successful is lung-preserving radical surgery in the mesothelioma and radical surgery-trial environment? A case-controlled analysisTheEuropean Journal of Cardiovasc Surg (08/10) Study aims to determine whether there is a survival benefit from open-lung-preserving surgery (radical decortication) for mesothelioma, when compared with the non-radical approach. It concludes that radical open-lung-sparing surgery may confer a survival advantage to patients with mesothelioma, who are fit to undergo radical decortication followed by chemotherapy and radiotherapy. Click here

Two-stage operative cytoreduction and intraperitoneal chemotherapy for diffuse malignant peritoneal mesothelioma: Operative morbidity and mortality in phase I and II trialsEuropean Journal of Surgical Oncology(07/10) The standard of care for diffuse malignant peritoneal mesothelioma involves operative cytoreduction and intraperitoneal chemotherapy. Most centers favor very aggressive protocol. In our trials, we found that a two-stage cytoreduction with intraperitoneal chemotherapy offers median survival comparable to one-stage protocols, with relatively low morbidity, mortality, visceral resections and length of stay despite two operations. This series supports that our protocol is a feasible and safe approach. Click here Phase II trial of trimodality therapy for malignant pleural mesothelioma (EORTC 08031) TheEuropean Respiratory Journal (06/10) EORTC 08031 phase II trial investigated the feasibility of trimodality therapy consisting of induction chemotherapy followed by extrapleural pneumonectomy and postoperative radiotherapy in patients with cT3N1M0 or less malignant pleural mesothelioma. Although feasible, trimodality therapy in patients with mesothelioma was not completed within the strictly defined timelines of this protocol and adjustments are necessary. Click here

Surgery for malignant pleural mesothelioma Expert Review of Respiratory Medicine (06/10) The role of surgery for malignant pleural mesothelioma encompasses the need for rapid diagnosis, preoperative staging and surgical resection, and also the need for a greater biological understanding of this rare and aggressive malignancy. Pending the discovery of new drugs, the focus of clinical research over the next 5 years will emphasize refinements in patient selection, pathologic staging, molecular staging and other novel adjuvant therapies. Click here

Analysis of the effect of radiotherapy on malignant pleural mesothelioma when given on adjuvant or palliative basis Chinese Journal of Lung Cancer (01/10) This retrospective study was designed to evaluate the response and survival of malignant pleural mesothelioma to radiotherapy when delivered with surgery and chemotherapy and when delivered alone or with chemotherapy. Multimodality approach involving surgery, chemotherapy and radiotherapy have been evaluated and proved its superiority in improving survival, especially in stages II. Click here

Articles Addressing Chemotherapy

The investigation of effects of quercetin and its combination with Cisplatin on malignant mesothelioma cells in Vitro Journal of Biomedicine & Biotechnology (05/10) This study investigated the antiproliferative effect of Quercetin (QU) and its combination with Cisplatin (CIS) on mesothelioma. Our experiments showed that QU significantly reduced the proliferation of cell lines and altered the cell cycle distribution. Additionally, the combination of QU + CIS was found more effective when compared with individual treatment of agents. Click here

In vitro and in vivo therapeutic efficacy of the PPAR-gamma agonist troglitazone in combination with cisplatin against malignant pleural mesothelioma cell growth Cancer Science (05/10) This study examined the therapeutic efficacy of the PPAR-gamma agonist troglitazone (TGZ) in combination with cisplatin against a human mesothelioma cell line, both in vitro and orthotopically inoculated into severe combined immunodeficient (SCID) mice. Theresults suggest that TGZ in combination with cisplatin may become a novel therapy for mesothelioma. Click here

Articles Addressing Immunotherapy for Mesothelioma

Low-dose cyclophosphamide synergizes with dendritic cell-based immunotherapy in antitumor activity Journal of Biomedicine and Biotechnology (05/10) Mesothelioma tumor-bearing mice were treated with dendritic cell-based immunotherapy alone or in combination with low-dose of cyclophosphamide. The addition of cyclophosphamide improved immunotherapy leading to an increased median and overall survival. Future studies are needed to address the usefulness of this combination treatment for mesothelioma patients. Click here

Articles Addressing Mesothelioma Diagnosis, Imaging and Response Markers

Secretion of intelectin-1 from malignant pleural mesothelioma into pleural effusion British Journal of Cancer (08/10) It is hard to diagnose mesothelioma at the early stage because a sensitive and reliable diagnostic marker for mesothelioma has not been found in plasma or pleural effusion. Study found that pleural effusion of mesothelioma patients contained a higher concentration of intelectin-1 than that of lung cancer patients. These results suggest that detection of intelectin-1 may be useful for a differential diagnosis of epithelioid-type mesothelioma in immunohistochemistry and that a high concentration of intelectin-1 in pleural effusion can be used as a new marker for clinical diagnosis of mesothelioma. Click here

Soluble mesothelin-related Peptide and osteopontin as markers of response in malignant mesothelioma Journal of Clinical Oncology (06/10) In mesothelioma, radiologic assessment of disease status is difficult. Both soluble mesothelin-related peptide (SMRP) and osteopontin (OP) have utility in distinguishing mesothelioma from benign pleural disease. Study found that percentage changes in SMRP levels, but not changes in OP levels, are a potentially useful marker of disease course. These findings should be validated prospectively for a role as an objective adjunctive measure of disease course in both clinical trials and clinical practice. Click here

Imaging in pleural mesothelioma: A review of Imaging Research Presented at the 9th International Meeting of the International Mesothelioma Interest Group Lung Cancer (06/10) Imaging of mesothelioma poses many challenges for imaging specialists and clinicians due to the anatomic location and unique growth pattern of this tumor. The use of fluorodeoxyglucose positron emission tomography (FDG-PET) at the point of diagnosis, in prognostication, and in the assessment of response to chemotherapy showed a high sensitivity and specificity for differentiation of benign from malignant pleural disease when combined with CT scans. Click here

Integrated positron emission tomography-computed tomography does not accurately stage intrathoracic disease of patients undergoing trimodality therapy for malignant pleural mesothelioma The Thoracic and Cardiovascular Surgeon (06/10) The results of trimodality therapy for mesothelioma are related to staging by various imaging tests, all of which have limitations. Study found that PET-CT does not accurately identify advanced tumor stage (T4) or mediastinal nodal disease (N2). Click here

Development of an enzyme-linked immunosorbent assay for the detection of human calretinin in plasma and serum of mesothelioma patients BMC Cancer (05/10) Study developed an enzyme-linked immunosorbent assay (ELISA) for human calretinin in blood and to assess its usefulness as a potential minimally invasive diagnostic marker for mesothelioma. Study found novel assay is highly sensitive and applicable to human serum and plasma. Calretinin appears to be a promising marker for the blood-based detection of mesothelioma and might complement other markers.Click here

9p21 deletion in the diagnosis of malignant mesothelioma, using fluorescence in situ hybridization analysisPathology International (05/10) 9p21 homozygous deletion correlated well with p16 protein expression in the tumor cells. Study suggests that 9p21 homozygous deletion assessed by FISH on paraffin-embedded tissue may be very useful for differentiating mesothelioma from reactive mesothelial proliferation. Click here

Articles Addressing Developing or Novel Treatments for Mesothelioma

Valproate-doxorubicin: promising therapy for progressing mesothelioma. A phase II study TheEuropean Respiratory Journal (06/10) In vitro data suggested that valproic acid (VA), a histone deacetylase inhibitor (HDACi), had pro-apoptotic effect and synergized with doxorubicin (D) to induce apoptosis in mesothelioma cells. Study aims to determine response rate of combined VA and D in patients with unresectable mesothelioma failing after platinum-based CT.Click here

Articles Addressing Mesothelioma Etiology and Case Studies

Asbestos is Still With Us: Repeat Call for a Universal Ban New Solutions: a journal of environmental and occupational health policy (2010) All forms of asbestos are proven human carcinogens and there is no safe threshold of exposure. Asbestos is now banned in 52 countries and safer products have replaced many materials that once were made with asbestos. Nonetheless, a large number of countries still use, import, and export asbestos and asbestos-containing products. Countries of the world must once again join in the international endeavor to ban all forms of asbestos.Click here

Malignant Mesothelioma Among Employees of a Connecticut Factory that Manufactured Friction Materials Using Chrysotile The Annals of Occupational Hygiene (06/10) There is ongoing argument about the potency of chrysotile asbestos to cause malignant mesothelioma. Study discusses the Raybestos Manhattan friction products plant in Connecticut, a plant that essentially used only chrysotile asbestos in relation to the most recent epidemiological information for chrysotile. Calculation suggests that mesothelioma rates at this plant were similar to those observed among Quebec miners and the South Carolina textile plant. We urge everyone concerned with the risk assessment of chrysotile asbestos to make use of all available data.Click here

Porcelain Factory Worker With Asbestos-related Mesothelioma Journal of the Formosan Medical Association(05/10) Asbestos is a significant source of hazardous exposure in old buildings, and this case serves as a reminder of the importance of asbestos-related exposure history, which facilitated the correct diagnosis of pulmonary malignant mesothelioma. Asbestos-containing materials that are now banned or regulated are still present in older buildings and remain an exposure hazard; they continue to be a serious health concern in many countries.Click here