Malignant pleural mesothelioma: 2013 state of the art

Malignant pleural mesothelioma (MPM) is a bad-prognosis cancer raising difficult issues according to diagnosis. Reliable histological diagnosis indeed requires large-sized pathological samples obtained by thoracoscopy, and need diagnosis certification by the MESOPATH national expert pathological committee. MPM epidemiology shows a rising incidence among females, whereas an incidence plateau has been reached for males in France. The incidence peak is still predicted for 2030 decade in UK, Australia and North America, because of the asbestosis massive use in their industry until the end of 1980 decade. Pleural carcinogenesis is better understood with the recent discovery of BAP1 susceptibility gene although no oncogenic driver has been ever uncovered for targeted therapies, although several more or less targeted biological therapies are currently tested in early phase or more advanced-phase trials. Surgery is more and more questioned, since radical surgery is currently abandoned, whereas debulking or cyto-reduction surgery has been proposed within a multimodality approach also including adjuvant chemotherapy and radiotherapy but still need prospective trials. Pemetrexed and cisplatin-based chemotherapy remains the reference treatment, which has proved in mesothelioma some efficacy on overall survival in randomized trials, with a 13-15 months median-overall survival. Final results of the large phase 3 clinical trial " MAPS" sponsored by French collaborative Intergroup (IFCT) evaluating the effect of bevacizumab addition to pemetrexed-cisplatin doublet will be released in early 2015, since 445 patients have been included by November 2013. triangle