see also:

• lung cancer
• neoplasia / cancer / tumours
• asbestos.com - a US-based resource for patients with mesothelioma

• 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

• 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.

• 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.

• pleurodesis
• partial pleurectomy
• pleural drainage catheter systems
• radiation therapy may help pain
• pain, analgesia and analgesics such as opiates and opioids
• corticosteroids may be useful for Rx of anorexia and cachexia
• Mx of depression