Malignant pleural mesothelioma: current perspectives

Abstract

The objectives of this study are to review epidemiology, novel methods of detection, novel diagnostics, and novel therapeutic options of malignant pleural mesothelioma (MPM) in the literature that were published between 1977 and 2019. Malignant pleural mesothelioma, associated with prolonged respirable-asbestos-fiber exposure is a rare cancer with constantly increasing incidence and poor prognosis due to lacking the effective treatment options. The median survival ranges from 8 to 14 months. Sarcomatoid histological subtype has the worst prognosis. Video-assisted thoracoscopy plus mediastinoscopy is the current gold standard for staging malignant pleural mesothelioma and is superior to computerized tomography of the chest for assessing the tumor size and suspected nodal metastases. Several circulating biomarkers are detected in MPM patients, such as mesothelin, osteopontin, fibulin-3, high mobility group B1, vascular endothelial growth factor, reactive oxygen species, reactive nitrogen species, micro-ribonucleic acids, tumor deoxyribonucleic acid, etc.Surgery is controversial and restricted to patients with early stage disease and good functional status. There is still no curative treatment whereas chemotherapy is the only treatment modality that improve patients’ survival. Radiotherapy is beneficial as a palliative treatment and an adjuvant to chemotherapy and surgery in the context of trimodality treatment. In conclusion, there is potential for the development of biomarkers and radiological imaging in the years to come. Several novel therapeutic options are under studied and it is likely to involve highly personalized treatment. Its incidenceis expected to decrease in the next decade.