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
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