Onkológia 3/2018
Zriedkavý nádor hrudníka: malígny pleurálny mezotelióm
A rare thorax tumor – malignant pleural mesothelioma Malignant mesothelioma is a highly aggressive neoplasm of pleura with a very poor overall survival. The peak incidence was reached in year 2000, however today its decreasing tendency is attributed to cessation of asbestos exposure being a major risk factor of this disease. Latest research shows the incidence of MPM (Malignant Pleural Mesothelioma) is driven by the germline mutation of BAP1 gene (BRCA associated protein 1) as well as development of somatic mutations. Multimodal therapy is currently the most efficient treatment method of malignant mesothelioma, and as such it provides concurrent local and systemic control of the disease. The latest effective drug to be approved for the 1st line treatment was the intoduction of pemetrexed in combination with cisplatin. The results of the MAPS (Mesothelioma Avastin Cisplatin Pemetrexed )study have shown significant of OS (overall survival) improvement when bevacizumab was added to the combination of cisplatin with pemetrexed. Despite modest increase in OS, adding bevacizumab to this combination did not become a routine practice in most countries of the world, yet it is recommended as a treatment of choice by NCCN (National Comprehensive Cancer Network). Many clinical studies are currently under way for the treatment of MPM. Promising modalities include the modulation of check point inhibitor targets such as anti-CTLA4, anti-PD-1/anti-PD-L1, mesothelin as well as arginine deprivation therapy.
Keywords: malignant pleural mesothelioma, asbestos related diseases, pleural effusion, chemotherapy, immunotherapy
