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Carbone M, Kanodia S, Chao A, Miller A, Wali A, Weissman D, Adjei A, Baumann F, Boffetta P, Buck B, de Perrot M, Dogan AU, Gavett S, Gualtieri A, Hassan R, Hesdorffer M, Hirsch FR, Larson D, Mao W, Masten S, Pass HI, Peto J, Pira E, Steele I, Tsao A, Woodard GA, Yang H, Malik S. Consensus Report of the 2015 Weinman International Conference on Mesothelioma. J Thorac Oncol 2017; 11:1246-1262. [PMID: 27453164 PMCID: PMC5551435 DOI: 10.1016/j.jtho.2016.04.028] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 03/31/2016] [Accepted: 04/26/2016] [Indexed: 01/31/2023]
Abstract
On November 9 and 10, 2015, the International Conference on Mesothelioma in Populations Exposed to Naturally Occurring Asbestiform Fibers was held at the University of Hawaii Cancer Center in Honolulu, Hawaii. The meeting was cosponsored by the International Association for the Study of Lung Cancer, and the agenda was designed with significant input from staff at the U.S. National Cancer Institute and National Institute of Environmental Health Sciences. A multidisciplinary group of participants presented updates reflecting a range of disciplinary perspectives, including mineralogy, geology, epidemiology, toxicology, biochemistry, molecular biology, genetics, public health, and clinical oncology. The group identified knowledge gaps that are barriers to preventing and treating malignant mesothelioma (MM) and the required next steps to address barriers. This manuscript reports the group’s efforts and focus on strategies to limit risk to the population and reduce the incidence of MM. Four main topics were explored: genetic risk, environmental exposure, biomarkers, and clinical interventions. Genetics plays a critical role in MM when the disease occurs in carriers of germline BRCA1 associated protein 1 mutations. Moreover, it appears likely that, in addition to BRCA1 associated protein 1, other yet unknown genetic variants may also influence the individual risk for development of MM, especially after exposure to asbestos and related mineral fibers. MM is an almost entirely preventable malignancy as it is most often caused by exposure to commercial asbestos or mineral fibers with asbestos-like health effects, such as erionite. In the past in North America and in Europe, the most prominent source of exposure was related to occupation. Present regulations have reduced occupational exposure in these countries; however, some people continue to be exposed to previously installed asbestos in older construction and other settings. Moreover, an increasing number of people are being exposed in rural areas that contain noncommercial asbestos, erionite, and other mineral fibers in soil or rock (termed naturally occurring asbestos [NOA]) and are being developed. Public health authorities, scientists, residents, and other affected groups must work together in the areas where exposure to asbestos, including NOA, has been documented in the environment to mitigate or reduce this exposure. Although a blood biomarker validated to be effective for use in screening and identifying MM at an early stage in asbestos/ NOA-exposed populations is not currently available, novel biomarkers presented at the meeting, such as high mobility group box 1 and fibulin-3, are promising. There was general agreement that current treatment for MM, which is based on surgery and standard chemotherapy, has a modest effect on the overall survival (OS), which remains dismal. Additionally, although much needed novel therapeutic approaches for MM are being developed and explored in clinical trials, there is a critical need to invest in prevention research, in which there is a great opportunity to reduce the incidence and mortality from MM.
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Affiliation(s)
- Michele Carbone
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, Hawaii.
| | - Shreya Kanodia
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, Hawaii; Samuel Oschin Comprehensive Cancer Institute and Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Ann Chao
- Center for Global Health, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Aubrey Miller
- National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - Anil Wali
- Center to Reduce Cancer Health Disparities, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - David Weissman
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
| | | | | | - Paolo Boffetta
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Brenda Buck
- Department of Geoscience, University of Nevada Las Vegas, Las Vegas, Nevada
| | - Marc de Perrot
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - A Umran Dogan
- Chemical and Biochemical Engineering Department and Center for Global and Regional Environmental Research, University of Iowa, Iowa City, Iowa
| | - Steve Gavett
- Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina
| | | | - Raffit Hassan
- Thoracic Oncology Branch, Center for Cancer Research, National Institutes of Health, Bethesda, Maryland
| | - Mary Hesdorffer
- Mesothelioma Applied Research Foundation, Alexandria, Virginia
| | - Fred R Hirsch
- University of Colorado Cancer Center, Denver, Colorado
| | - David Larson
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, Hawaii
| | - Weimin Mao
- Cancer Research Institute, Zhejiang Cancer Hospital and Key Laboratory of Diagnosis and Treatment Technology on Thoracic Oncology of Zhejiang, Hangzhou, People's Republic of China
| | - Scott Masten
- National Toxicology Program, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - Harvey I Pass
- Cardiothoracic Surgery, New York University Langone Medical Center, New York, New York
| | - Julian Peto
- Cancer Research UK, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Enrico Pira
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Ian Steele
- Notre Dame Integrated Imaging Facility, Notre Dame University, Notre Dame, Indiana
| | - Anne Tsao
- Department of Thoracic and Head and Neck Medical Oncology, Division of Cancer Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Gavitt Alida Woodard
- Thoracic Surgery, University of California at San Francisco, San Francisco, California
| | - Haining Yang
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, Hawaii
| | - Shakun Malik
- Cancer Therapy Evaluation Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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Bibby AC, Tsim S, Kanellakis N, Ball H, Talbot DC, Blyth KG, Maskell NA, Psallidas I. Malignant pleural mesothelioma: an update on investigation, diagnosis and treatment. Eur Respir Rev 2017; 25:472-486. [PMID: 27903668 PMCID: PMC9487555 DOI: 10.1183/16000617.0063-2016] [Citation(s) in RCA: 181] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 10/12/2016] [Indexed: 02/06/2023] Open
Abstract
Malignant pleural mesothelioma is an aggressive malignancy of the pleural surface, predominantly caused by prior asbestos exposure. There is a global epidemic of malignant pleural mesothelioma underway, and incidence rates are predicted to peak in the next few years. This article summarises the epidemiology and pathogenesis of malignant pleural mesothelioma, before describing some key factors in the patient experience and outlining common symptoms. Diagnostic approaches are reviewed, including imaging techniques and the role of various biomarkers. Treatment options are summarised, including the importance of palliative care and methods of controlling pleural effusions. The evidence for chemotherapy, radiotherapy and surgery is reviewed, both in the palliative setting and in the context of trimodality treatment. An algorithm for managing malignant pleural effusion in malignant pleural mesothelioma patients is presented. Finally new treatment developments and novel therapeutic approaches are summarised. This article on mesothelioma describes pathogenesis, symptoms, diagnostic approaches and treatment optionshttp://ow.ly/cjkb305aQGz
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Affiliation(s)
- Anna C Bibby
- Academic Respiratory Unit, University of Bristol, Bristol ,UK .,North Bristol NHS Trust, Bristol, UK
| | - Selina Tsim
- Queen Elizabeth University Hospital, Glasgow, UK.,Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Nikolaos Kanellakis
- Respiratory Trials Unit, University of Oxford, Churchill Hospital, Oxford, UK.,Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, UK
| | - Hannah Ball
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, UK.,Dept of Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Denis C Talbot
- Dept of Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Kevin G Blyth
- Queen Elizabeth University Hospital, Glasgow, UK.,Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Nick A Maskell
- Academic Respiratory Unit, University of Bristol, Bristol ,UK.,North Bristol NHS Trust, Bristol, UK
| | - Ioannis Psallidas
- Respiratory Trials Unit, University of Oxford, Churchill Hospital, Oxford, UK.,Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, UK
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Halezeroğlu S, Migliore M. Management of recurrence after initial surgery for malignant pleural mesothelioma: a mini-review. Future Oncol 2016; 11:23-7. [PMID: 26638919 DOI: 10.2217/fon.15.312] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Recurrence after surgery in the multimodality therapy for malignant pleural mesothelioma is a common problem. As the majority of patients experience not only local but also distant metastases, a systemic treatment strategy in addition to local control measures remains necessary. Nevertheless, none of the chemotherapy regimens have achieved clinical success. Local management modalities such as stereotaxic treatments, cryoablation and redo surgery on the other hand have promising results, but provide palliative outcomes.
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Affiliation(s)
- Semih Halezeroğlu
- Thoracic Surgery Department, Faculty of Medicine, Acıbadem University, Acıbadem Maslak Hospital, Buyukdere Cad, 34457 Istanbul, Turkey
| | - Marcello Migliore
- Academic Thoracic Surgery, Department of Surgery & Medical Specialties, University of Catania, 95124 Catania, Italy
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Cook AM, Khong A, Nowak AK, Lake RA. Novel insights into the pathophysiology and treatment of malignant pleural mesothelioma. Lung Cancer Manag 2015. [DOI: 10.2217/lmt.15.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Malignant pleural mesothelioma is an aggressive, treatment-resistant tumor, which continues to increase in frequency throughout the world because the causative agent, asbestos, has high economic importance, particularly in developing countries. Patients typically present with breathlessness and chest pain with pleural effusions. Median survival is around 12 months from diagnosis. Palliative chemotherapy is beneficial for mesothelioma patients with high performance status. The role of aggressive surgery remains controversial. This review will outline some of the recent advances in the development of novel therapies for malignant pleural mesothelioma, with a focus on immunological approaches.
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Affiliation(s)
- Alistair M Cook
- National Centre for Asbestos Related Diseases & School of Medicine & Pharmacology, University of Western Australia, Crawley WA, Australia
| | - Andrea Khong
- National Centre for Asbestos Related Diseases & School of Medicine & Pharmacology, University of Western Australia, Crawley WA, Australia
| | - Anna K Nowak
- National Centre for Asbestos Related Diseases & School of Medicine & Pharmacology, University of Western Australia, Crawley WA, Australia
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Perth, Western Australia
| | - Richard A Lake
- National Centre for Asbestos Related Diseases & School of Medicine & Pharmacology, University of Western Australia, Crawley WA, Australia
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