Onkológia 4/2019
Diagnosis and treatment of malignant mesothelioma
Malignant mesothelioma is a rare and agressive malignancy, with extensive diffuse spread on serosal membrane. It is usually diagnosed at advanced stages. It is most commonly encountered in the pleura (80%), less in the peritoneum, and extremely rare in the pericardium and the tunica vaginalis testis. It has been linked mainly to asbestos exposure. The epiteloid subtype has the best prognosis. The mainstay of therapy of early-stage malignant mesothelioma is surgical resection, but there is a limitation by the extensive surface and the intricate location of serous membrane. Surgical procedures are arduous and they should be carried out only in specialised centres. The best results of treatment of early-stage pleural malignant mesothelioma is achieved by multimodality therapy, which consists of neoadjuvant (or adjuvant) chemotherapy, surgery and postoperative radiotherapy. Immunotherapy is studied in this setting. Advanced stages of pleural malignant mesothelioma are treated with chemotherapy pemetrexed plus cisplatin and in most countries triplet cisplatin/pemetrexed/bevacizumab is recommended. This triplet showed better results in randomised trial MAPS (Mesothelioma Avastin Cisplatin Pemetrexed). Other targeted drugs and immunotherapy are studied in clinical trials. Salvage therapy with pembrolizumab, nivolumab +/- ipililimumab are accepted in some countries. The standard treatment of peritoneal mesothelioma is cytoreductive surgery and perioperative heated intraperitoneal chemotherapy (HIPEC). Unresectable disease is treated with chemotherapy, with similar agents as in pleural malignant mesothelioma. The mainstay of therapy of malignant mesothelioma of the pericardium and the tunica vaginalis testis is a surgical resection, possibly radiotherapy is added.
Keywords: malignant mesothelioma, multimodality treatment, chemotherapy, targeted therapy, immunotherapy
