Malignant Pleural Mesothelioma Treatment Options

Malignant Pleural Mesothelioma Rolf Stahel, MD University Hospital Zurich, Switzerland Ermatingen April 6.2011

[object Object],Pleural plaques Asbestosis Pleural mesothelioma

Epidemiology and tumorigenesis ,[object Object],[object Object],[object Object],[object Object]

Mesothelioma in Europe ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Latency period in pleural mesothelioma after asbestos-exposure ,[object Object],Marinaccio, EJC 2007

Asbestos in the developing world

Multistep carcinogenesis in pleural mesothelioma Mutsaers, 2004 ,[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],Alterations of NF2 and ink4a/ARF are important for MPM development

Alterations of NF2 in mesothelioma ,[object Object],[object Object],[object Object]

Soluble mesothelin-related peptide ,[object Object],[object Object],[object Object],Robinson, Lancet 2003 Cristaudo, Clin Cancer Res 2007

Soluble mesothelin-related peptide: Controls vs asbestos-exposed Stage Pass, ATS 2008 Disease monitoring, questionable value in earlydiagnosis No significant differences according to histology or stage Schneider, JTO 2008

Systemic therapy ,[object Object],[object Object],[object Object],[object Object],[object Object]

MVP in Mesothelioma Provides Symptom Relief ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Middleton, Ann Oncol 1998; Andreopoulou, Ann Oncol 2004

Pemetrexed + Cisplatin vs Cisplatin: Tumor Response Rates and Survival Vogelzang , JCO 2003

Pemetrexed and carboplatin in MPM ,[object Object],[object Object],[object Object],[object Object],Manegold, JTO 2008 Reported responses: 28.3% for pem/cis and 21.7% for pem/carbo Time to progressive disease :

Active symptom control with or without chemotherapy Muers, Lancent Oncol 2008

Second line chemotherapy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Second line chemotherapy ,[object Object],[object Object],[object Object],[object Object],[object Object]

Important questions on current treatment modalities ,[object Object],[object Object],[object Object],[object Object],[object Object],Bevacizumab Placebo VEGF above median

Important questions on current treatment modalities ,[object Object],[object Object],[object Object],[object Object],[object Object]

Important questions on current treatment modalities ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Important questions on current treatment modalities ,[object Object],[object Object],[object Object],[object Object]

Tymidylate synthase and ERCC1 in mesothelioma treated with pem/cis ,[object Object],[object Object],[object Object],Righi, JCO 2010 TS (median H-score) ERCC1 (3 rd tertile gene expression)

Surgery and multimodaltiy therapy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Case report ,[object Object],[object Object]

Case report ,[object Object],[object Object],[object Object]

Multimodality therapy including extrapleural pneumonectomy (EPP) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Neoadjuvant chemotherapy, EPP and radiotherapy in MPM Number of patients Survival (months) Author Stage Chemoth. EPP Radioth. ITT EPP Weder, JCO 2004 T1-3, N0-2 19 16 (84%) 13 (68%) 23 n/a Weder, AO 2007 T1-3, N0-2 61 45 (74%) 36 (59%) 19.8 23 Rea, LC 2007 T1-3, N0-2 21 17 (81%) 15 (71%) 25.5 27.5 Batirel, JTO 2008 T1-3, N0-2 20 16 (80%) 12 (60%) 17 19.6 Krug, JCO 2009 T1-3, N0-2 77 57 (74%) 44 (57%) 16.8 21.9 Van Schil, ERJ 2010 T1-3, N0-1 59 42 (73%) 38 (64%) 18.4 n/a 257 193 (75%) 158 (61%)

Important questions on current treatment modalities ,[object Object],[object Object],March 2011: - 122 pts entered - 39 pts randomized

Adjuvant radiotherapy ,[object Object],[object Object],[object Object],[object Object]

Case report January 07 March 07 ,[object Object]

Case report ,[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Malignant Pleural Mesothelioma

Malignant Pleural Mesothelioma Treatment Options

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