Alternative Options in the Management of Malignant Pleural Mesothelioma

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.