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mesothelioma

mesothelioma

introduction

  • an uncommon cancer (3% of all cancers) which is almost exclusively related to exposure to asbestos with a synergistic effect of smoking
  • it has a latency period of 20-50 years following exposure to asbestos
  • Australia has one of the highest incidences of mesothelioma in the world, largely due to its extensive use and mining of asbestos.
  • currently ~500 Australians die each year with cases expected to peak this decade as cases hit 18,000 by 2020.
    • standardized incidence in Australia per 100,000 population: 2.3 new cases in 1982 rising to 5.4 in 2007 with peak expected within the next decade
  • mesothelioma may affect pleura (75%), peritoneum (20%), pericardium (5%) and rarely testicles.
  • currently no effective therapy as it is resistant to standard anticancer treatments
  • median survival ~10-12 months from diagnosis but this may be prolonged with newer therapies however, the major challenge for clinicians is the palliative management of dyspnoea, pain and cancer cachexia syndrome

surgical treatments

  • extended survival is more likely in those with complete resections, epithelial histology and no involvement of extrapleural lymph nodes
  • unfortunately, the majority of patients are not suited to this.

chemotherapy

  • median survival appeared to increase to 12 months from 9 months when the new antifolate agent, pemetrexed, was added to cisplatin Rx but did increase adverse effects such as neutropenia (28% vs 2.3%), vomiting (13% vs 3%), etc.1)
    • the adverse effects were reduced by use of vitamin B12 and folate supplements, while dexamethasone is given for 3 days at the start of Rx to reduce risk of skin rash
    • these agents are C/I in severe renal impairment
  • clinical trials are underway for a variety of targeted therapies:
    • epithelial growth factor receptor (EGFR) tyrosine kinase inhibitors such as erlotinib and gefitinib
    • vascular endothelial growth factor (VEGF)inhibitors
    • histone deactylase inhibitors
    • ribonuclease such as ranpirnase
    • proteasome inhibitors
    • thalidomide
    • anti-mesothelin monoclonal antibodies
    • etc.

palliative care

1)
Australian Prescriber volume 34 Number 5 October 2011
mesothelioma.txt · Last modified: 2012/04/23 08:06 by 127.0.0.1

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