Management of malignant pleural mesothelioma:

Abstract Background: Malignant pleural mesothelioma (MPM) is a rare disease with poor prognosis in spite of significant improvement in survival, due to new chemotherapy regimens. We describe here patients’ profiles and management in daily practice in France. Methods: Observational retrospective study. Data were collected from medical files. All patients with histologically proven MPM diagnosed from January 2005 to December 2008 were included in the participating sites. Results: Four hundred and six patients were included in 37 sites: mean age 68.9 ± 9.8 years, male predominance (sex ratio 3.27), latency of the disease 45.7 years, epithelioïd type 83 %. Diagnosis was made using thoracoscopy in 80.8 % of patients. Radical surgery was performed in 6.2 % of cases. Chemotherapy was administered to 74.6 % of patients. First line regimens consisted mainly of platinum + pemetrexed (91 %) or pemetrexed alone (7 %). Objective response rate was 17.2 % and another 41.6 % of patients experienced disease stabilization. Half of these patients underwent second line chemotherapy (platinium + pemetrexed 31.6 %, pemetrexed alone 24.6 %), resulting in a 6 % response rate. Third-line chemotherapy (56 patients) yielded disease control in 5.4 % of cases. Conclusions: The management of MPM in France is usually in accordance with guidelines. Response rates are somewhat lower than those described in clinical trials. Keywords: Malignant pleural mesothelioma, Treatment, Chemotherapy Background Malignant pleural mesothelioma (MPM) is a rare aggressive tumor. Since it is mainly associated with asbestos exposure, its incidence varies among countries and population subgroups, depending on the degree of exposure. The time between exposure and diagnosis of MPM often exceeds several decades. It has been shown recently that the risk continues to rise until 45 years following exposure [1]. The incidence of MPM is continuously increasing in some contries as Australia and United Kingdom [2–4] but remains very stable for over 5 years in U.S. and Japan. In France, the epidemiological pattern is different since asbestos use has been strictly controlled as early as 1978 and definitely forbidden in 1997. New cases are still diagnosed due to the long latency of the disease, but apparently, the incidence peak has been reached in 2000–2005 for men [5]. However, in the meantime, the incidence is still increasing in women, in whom professional exposure is often missing. The number of MPM-related deaths is approximately 1100/ year in men and 300/year in women in France [5] while the incidence ranges from less than 1/million for the general population to 50–100/million for at-risk subgroups [5]. A national network has been created in 1998 (PNSM: Programme National de Surveillance des Mésothéliomes) for epidemiological observation, clinical research and organization of healthcare supply [6]. Apart from the well-known occupational exposure, environmental exposure to asbestos or other carcinogenic compounds remains to be explained while they seem to