Alternative Options in the Management of Malignant Pleural Mesothelioma

S. Neragi-Miandoab, Christine Gosen
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Abstract

Malignant pleural mesothelioma is a solid, locally aggressive tumor that has been linked to asbestos exposure. Without treatment MPM is associated with a poor median survival, ranging from 4 to 12 months. Extrapleural pneumonectomy offers better local control compared to pleurectomy/decortication. Chemotherapy combined with IL-2 and radiation provides some palliation. However, unsatisfactory results of these approaches have led clinicians to pursue novel therapeutic options. Local photodynamic therapy (PDT) has been studied with pleurectomy or extrapleural pneumonectomy. Intrapleural IFN-α radiosensitization and targeted immunotherapies may downstage tumors preoperatively. Gene therapies can sensitize tumor cells to antiviral drugs and may be used as a neoadjuvant therapy or to destroy residual tumor after resection. Inhibition of angiogenic growth factors or their receptors can slow tumor growth. Intracavitary hyperthermic chemotherapy, photodynamic therapy, vaccination, immunotherapy, and gene therapy are relatively new options with potential to be integrated into multimodality approach.
恶性胸膜间皮瘤的治疗选择
恶性胸膜间皮瘤是一种固体的局部侵袭性肿瘤,与接触石棉有关。如果不进行治疗,MPM的中位生存期较差,为4 - 12个月。与胸膜切除术/去皮术相比,胸膜外全肺切除术提供了更好的局部控制。化疗联合白介素-2和放疗提供了一些缓解。然而,这些方法的令人不满意的结果导致临床医生追求新的治疗选择。局部光动力治疗(PDT)与胸膜切除术或胸膜外全肺切除术的研究。术前胸膜IFN-α放射增敏和靶向免疫治疗可降低肿瘤的分期。基因治疗可使肿瘤细胞对抗病毒药物敏感,可作为一种新辅助治疗或在切除后摧毁残余肿瘤。抑制血管生成生长因子或其受体可减缓肿瘤生长。腔内热化疗、光动力治疗、疫苗接种、免疫治疗和基因治疗是相对较新的选择,有可能整合到多模态方法中。
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