Update on biology and management of mesothelioma

Abstract

Malignant pleural mesothelioma is an aggressive, incurable cancer that is usually caused by asbestos exposure several decades before symptoms arise. Despite widespread prohibition of asbestos production and supply, its incidence continues to increase. It is heterogeneous in its presentation and behaviour, and diagnosis can be notoriously difficult. Identification of actionable gene mutations has proven challenging and current treatment options are largely ineffective, with a median survival of 10-12 months.However, the past few years have witnessed major advances in our understanding of the biology and pathogenesis of mesothelioma. This has also revealed the limitations of existing diagnostic algorithms and identified new treatment targets.Recent clinical trials have re-examined the role of surgery, provided new options for the management of associated pleural effusions and heralded the addition of targeted therapies. The increasing complexity of mesothelioma management, along with a desperate need for further research, means that a multidisciplinary team framework is essential for the delivery of contemporary mesothelioma care.This review provides a synthesised overview of the current state of knowledge and an update on the latest research in the field.

FIGURE 1

Computed tomography scan image of the chest, with right-sided irregular and nodular pleural thickening in a case of malignant pleural mesothelioma.

FIGURE 2

Axial magnetic resonance imaging (MRI) thorax images (T1 with contrast) demonstrate a) left-sided irregular pleural thickening and b) left-sided enhancing posterior chest wall invasion in a patient with malignant pleural mesothelioma; c) coronal MRI thorax image of the same patient, demonstrating the left-sided enhancing pleural thickening and chest wall invasion.