eMedicine Specialties > Oncology > Carcinomas of the Lung and Other Intrathoracic Carcinomas

Mesothelioma: Treatment & Medication

Author: Winston W Tan, MD, Assistant Professor of Medicine, Mayo Medical School; Consulting Staff, Mayo Group Practices
Contributor Information and Disclosures

Updated: Mar 4, 2009

Treatment

Medical Care

Treatment options for the management of malignant mesothelioma include surgery, chemotherapy,13,14 radiation, and multimodality treatment. Surgery in patients with disease confined to the pleural space is reasonable.

  • Chemotherapy
    • Currently, cisplatin as a single drug has been used as the standard drug for phase III clinical trials. None of the standard treatment options has improved survival. (See related CME at Advances in the Systemic Therapy of Malignant Pleural Mesothelioma and Chemotherapy Does Not Improve Survival in Patients With Mesothelioma.) The most active agents are anthracycline, platinum, and alkylating agents; each produces a response rate of 10-20%.
    • Vogelzang et al presented the results of a phase III study of pemetrexed in combination with cisplatin versus cisplatin alone. Pemetrexed (500 mg/m2/d) and cisplatin (75 mg/m2/d) or cisplatin (75 mg/m2/d) was given on day 1. Both arms were given every 21 days. The median survival time in the cisplatin/pemetrexed arm was 12.1 months versus 9.3 months for cisplatin alone. The response rate was 41.3% for the cisplatin/pemetrexed arm and 16.7% for the cisplatin arm. Folic acid and vitamin B-12 were given routinely to prevent the adverse effects of pemetrexed. This trial established the regimen as the standard choice for this disease.15 See related CME at Management of Metastatic Non-Small Cell Lung Cancer (Slides With Transcript).
    • Santoro et al reported the results of an expanded access program that the activity of pemetrexed/cisplatin and pemetrexed/carboplatin in chemonaive patients had similar time to progressive disease and 1-year survival rates. The pemetrexed/cisplatin group demonstrated a response rate of 26.3% compared with 21.7% for the pemetrexed/carboplatin group, similar 1-year survival rates (63.1% vs 64%) and median time to progressive disease (7 vs 6.9 months).16
    • The combination of pemetrexed plus gemcitabine as first-line chemotherapy for patients with peritoneal mesothelioma is active and can be an option for patients who cannot take cisplatin. A phase II study of gemcitabine 1000 mg/m2  on day 1 and day 8 and pemetrexed 500 mg/m2 day 8 every 21 days for 6 cycles or until progression showed a response rate of 15% (95% CI, 3.2-37.9%) with 3 patients with partial response. Disease control rate was 50%. The most common nonhematologic toxicities include fatigue (20%), constipation (10%), vomiting (10%), and dehydration 10%. Hematologic toxicities include neutropenia (60%) and febrile neutropenia (10%).17
    • Single-agent pemetrexed showed a response rate of 10.5%, median time to progressive disease was 6 months, and median survival was 14 months in chemo-naive patients. Of the pretreated patients, the response rate was 12.1% and median time to progressive disease was 4.9 months.18
    • A 1999 phase II study by Byrne et al using cisplatin (100 mg/m2) on day 1 and gemcitabine (1000 mg/m2) administered intravenously on days 1, 8, and 15 of a 28-day cycle for 6 cycles showed response rates of 47.6% (complete and partial response), 42.8% (stable disease), and 9.5% (progressive disease). The median response duration was 25 weeks, progression-free survival was 25 weeks, and the overall survival was 41 weeks. Toxicity was mainly gastroenterologic and hematologic in nature.19
    • Several other combinations have been found to be active, including cisplatin/doxorubicin (Adriamycin)/mitomycin C, bleomycin/intrapleural hyaluronidase, cisplatin/doxorubicin (Adriamycin), carboplatin/gemcitabine, and cisplatin/vinblastine/mitomycin C.20 The cisplatin/gemcitabine combination has yielded the best results.
    • Ranpirnase (Onconase) is a novel cytotoxic ribonuclease. It is a nonmyelosuppressive agent with minimal apparent toxicity to vital organs. It binds to the cell surface and penetrates the cell's interior through the energy-dependent endocytotic process. In the cytosol, it degrades tRNA, and this damage constitutes a signal for apoptosis and contributes to inhibition of cell growth and proliferation.21
      • The dose-limiting toxicity was renal manifested by proteinuria, azotemia, peripheral edema, flushing, myalgia, dizziness, and decreased appetite.
      • In a Phase II study by Miluski et al, 105 patients with 0-2 performance status were treated with ranpirnase. Median survival time was 6 months for the intent to treat and 8.3 months for the treatment target group. Among the 81 patients assessable for tumor response, 4 had partial response, 2 had minor regressions, and 35 experienced stabilization of previously progressive disease.22
    • With the isolation of mesothelial cell lines, several chemotherapeutic agents are being tested  to assess their efficacy. One explanation for the poor response to chemotherapy is the low apoptotic rate, as evidenced by low BCL2 and BAX expression.23 These data suggest that apoptosis is not a key phenomenon in mesothelioma development and histologic differentiation.
    • Numerous trials of chemotherapeutic agents have been performed; however, until recently, the studies were small, the staging systems used were different, and the measurements of disease were inaccurate.
  • Radiation
    • Results with radiation therapy are also disappointing.24
    • Radiation has no effect on survival, but it has caused significant palliation in 50% of patients treated for chest pain and chest wall metastasis.
  • Trimodality therapy
    • This involves a combination of all 3 standard strategies (ie, surgery, chemotherapy, radiation).
    • One trimodality approach involved extrapleural pneumonectomy followed by combination chemotherapy and radiotherapy. Overall survival rates were 45% at 2 years and 22% at 5 years.
    • Lymph node involvement was a significant negative prognostic factor. The epithelial type had a better survival rate compared with the sarcomatous or mixed type (65% vs 20% at 2 y and 27% vs 0% at 5 y).
    • Survival based on the Brigham staging system was 22 months for stage I, 17 months for stage II, and 11 months for stage III.
    • Overall median survival was 17 months, yielding a 2-year survival rate of 36% and a 5-year survival rate of 14%. Epithelial cell type survival was better, with a 2-year survival rate of 68% and 5-year survival rate of 46%.
    • Different chemotherapeutic regimens found to be useful in the trimodality treatment include cyclophosphamide/doxorubicin (Adriamycin)/cisplatin, carboplatin/paclitaxel, and cisplatin/methotrexate/vinblastine. External beam radiotherapy is delivered in a standard fractionation over 5.5-6 weeks.

Surgical Care

Surgical resection has been relied upon because radiation and chemotherapy have been ineffective primary treatments.25 The 2 surgical procedures used are pleurectomy with decortication and extrapleural pneumonectomy.

  • Pleurectomy with decortication is a more limited procedure and requires less cardiorespiratory reserve. It involves dissection of the parietal pleura, incision of the parietal pleura, and decortication of the visceral pleura followed by reconstruction. It has a morbidity rate of 25% and a mortality rate of 2%.26 It is a difficult procedure because the tumor encases the whole pleura; the local recurrence rate is high.
  • Extrapleural pneumonectomy is a more extensive procedure and has a higher mortality rate. Recently, the mortality rate has been lowered to 3.8%. It involves dissection of the parietal pleura; division of the pulmonary vessels; and en bloc resection of the lung, pleura, pericardium, and diaphragm followed by reconstruction. It provides the best local control because it removes the entire pleural sac along with the lung parenchyma.
  • With surgery alone, the recurrence rate is very high and most patients die after a few months. At least half the patients who have local control with surgery have distant metastasis upon autopsy.
  • In patients with epithelioid type, if fit to tolerate a thoracotomy, the best option is still a thoracotomy and macroscopic clearance of the tumor as part of multimodality therapy.

Consultations

  • If an infection is suggested initially, consultation with a pulmonary specialist is essential if the infection does not resolve within 2 weeks with adequate antibiotic treatment.
  • Chest radiographs are mandatory for follow-up if the infection has resolved. If the patient has diffuse calcification of the pleura and a history of weight loss with chronic cough, a full evaluation by a pulmonary specialist and oncologist is necessary.
  • A referral for thoracoscopy is warranted if the diagnosis is considered and the initial workup is not diagnostic.
  • Occupational history is important, and family members with exposure to asbestos should also be evaluated.

Diet

  • Patients are usually cachetic after surgery, chemotherapy, and radiation. Good supportive care and a regular nutritional status assessment are warranted. Patients should be referred to a nutritionist.

Activity

  • Beginning physical activity as soon as possible is important to prevent postoperative complications.
  • Pulmonary physiotherapy is very helpful because of the extensive lung resection in such patients.

Medication

Treatment options for the management of malignant mesothelioma include surgery, chemotherapy, radiation, and multimodality treatment. Currently, no therapy is considered standard. The standard methods of surgery, radiation, or chemotherapy alone have not improved survival (see Treatment).

Pemetrexed disodium was recently approved by the US Food and Drug Administration to treat patients with malignant pleural mesothelioma in unresectable disease and those who are not candidates for curative surgery. Several trials from a combination drug to therapy with pemetrexed have been performed. Hughes et al showed a 32% response rate using pemetrexed 500 mg/m2 and carboplatin (AUC-5) on an every 21-day schedule.27 An interesting combination of drugs, including raltitrexed and oxaliplatin, has shown a response rate of 20% in previously treated patients.

Antineoplastic Agent, Miscellaneous

These agents interfere with cell reproduction. Some agents are cell-cycle specific, while others (eg, alkylating agents, anthracyclines, cisplatin) are not phase-specific. Cellular apoptosis (ie, programmed cell death) is also a potential mechanism of many antineoplastic agents.


Gemcitabine (Gemzar)

Cytidine analog, after intracellular metabolism to active nucleotide, inhibits ribonucleotide reductase and competes with deoxycytidine triphosphate for incorporation into DNA. Cell-cycle specific for S phase.

Adult

1000 mg/m2 IV once weekly for up to 7 wk or until toxic effects not tolerated; follow with 1 wk rest with subsequent cycles of once weekly infusion for 3 consecutive wk out of every 4 wk

Pediatric

Not established

Pregnancy

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

May cause myelosuppression (particularly thrombocytopenia); toxicities include flulike syndrome, LFT abnormality, maculopapular rash, pruritus, nausea, vomiting, dyspnea, hematuria, proteinuria, and hemolytic uremic syndrome; clearance reduced in women and elderly individuals


Pemetrexed disodium (Alimta)

Disrupts folate-dependent metabolic processes essential for cell replication. Specifically inhibits thymidylate synthase (TS), dihydrofolate reductase (DHFR), and glycinamide ribonucleotide formyltransferase (GARFT), which are folate-dependent enzymes involved in de novo biosynthesis of thymidine and purine nucleotides. Indicated in combination with cisplatin to treat patients with malignant pleural mesothelioma in unresectable disease and those who are not candidates for curative surgery.
See related CME at FDA Approvals: Reyataz and Alimta.

Adult

500 mg/m2 IV infused over 10 min on day 1 of 21-d cycle; administer cisplatin 75 mg/m2 IV infused over 2 h beginning 30 min after pemetrexed disodium infusion completed

Pediatric

Not established

Coadministration with drugs that compete for renal tubular excretion (eg, probenecid) may decrease clearance; do not administer NSAIDs in cases of mild to moderate renal impairment (ie, CrCl, 45-79 mL/min), NSAIDs with short elimination half-life should not be administered for 2 d before administration and 2 d after; avoid NSAIDs with longer half-life 5 d before administration and 2 d after

Pregnancy

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Eliminated unchanged, primarily by renal excretion; insufficient data available with CrCl <45 mL/min; suppresses bone marrow function, dose-limiting toxicity is myelosuppression; common adverse effects include hematologic effects, fever, infection, stomatitis, pharyngitis, rash, and desquamation; pretreatment required with folate and vitamin B-12 supplementation (decreases hematologic and GI toxicity) and corticosteroids (decreases rash incidence); aggressive hydration required before and/or after cisplatin administration


Cisplatin (Platinol)

Platinum-based alkylating agent. Inhibits DNA synthesis and, thus, cell proliferation by causing DNA crosslinks and denaturation of double helix. Indicated in combination with cisplatin to treat patients with malignant pleural mesothelioma in unresectable disease and those who are not candidates for curative surgery.

Adult

75 mg/m2 IV infused over 2 h beginning 30 min after pemetrexed disodium infusion completed

Pediatric

Not established

Increases toxicity of bleomycin and ethacrynic acid

Documented hypersensitivity; preexisting renal insufficiency; myelosuppression; hearing impairment

Pregnancy

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Administer adequate hydration before and 24 h after cisplatin dosing to reduce risk of nephrotoxicity; myelosuppression, ototoxicity, nausea, and vomiting may occur


Ranpirnase (Onconase)

Designated orphan drug to treat malignant mesothelioma. Shown in vitro and in vivo to target tumor cells while sparing normal cells. Internalized by endocytosis and released into cancerous cell cytosol, where selective rRNA degradation occurs. Results in protein synthesis inhibition, cell cycle proliferation cessation, and apoptosis induction. Administered in conjunction with doxorubicin.

Adult

480 mcg/m2 IV qwk initially; infuse over 30 min; modify dose based on tolerability

Pediatric

Not established

Documented hypersensitivity; severe renal impairment; severe congestive heart failure

Pregnancy

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Nephrotoxicity is predominant adverse effect at doses higher than recommended; caution with mild or moderate renal impairment, liver disease (may decrease clearance), hypoalbuminemia, asthma, mild heart failure, hypertension, or other cardiovascular disease or conditions that peripheral edema would exacerbate; hydration recommended before infusion

More on Mesothelioma

Overview: Mesothelioma
Differential Diagnoses & Workup: Mesothelioma
Treatment & Medication: Mesothelioma
Follow-up: Mesothelioma
References
[ CLOSE WINDOW ]

References

  1. Hodgson JT, Darnton A. The quantitative risks of mesothelioma and lung cancer in relation to asbestos exposure. Ann Occup Hyg. Dec 2000;44(8):565-601. [Medline].

  2. Ascoli V, Scalzo CC, Facciolo F, et al. Malignant mesothelioma in Rome, Italy 1980-1995. A retrospective study of 79 patients. Tumori. Nov-Dec 1996;82(6):526-32. [Medline].

  3. Manfredi JJ, Dong J, Liu WJ, et al. Evidence against a role for SV40 in human mesothelioma. Cancer Res. Apr 1 2005;65(7):2602-9. [Medline].

  4. Murthy SS, Testa JR. Asbestos, chromosomal deletions, and tumor suppressor gene alterations in human malignant mesothelioma. J Cell Physiol. Aug 1999;180(2):150-7. [Medline].

  5. Renshaw AA, Dean BR, Antman KH, et al. The role of cytologic evaluation of pleural fluid in the diagnosis of malignant mesothelioma. Chest. Jan 1997;111(1):106-9. [Medline].

  6. Betta PG, Andrion A, Donna A, et al. Malignant mesothelioma of the pleura. The reproducibility of the immunohistological diagnosis. Pathol Res Pract. 1997;193(11-12):759-65. [Medline].

  7. Orengo AM, Spoletini L, Procopio A, et al. Establishment of four new mesothelioma cell lines: characterization by ultrastructural and immunophenotypic analysis. Eur Respir J. Mar 1999;13(3):527-34. [Medline].

  8. Wang ZJ, Reddy GP, Gotway MB, et al. Malignant pleural mesothelioma: evaluation with CT, MR imaging, and PET. Radiographics. Jan-Feb 2004;24(1):105-19. [Medline].

  9. Benard F, Sterman D, Smith RJ, et al. Prognostic value of FDG PET imaging in malignant pleural mesothelioma. J Nucl Med. Aug 1999;40(8):1241-5. [Medline].

  10. Sugarbaker DJ, Garcia JP, Richards WG, et al. Extrapleural pneumonectomy in the multimodality therapy of malignant pleural mesothelioma. Results in 120 consecutive patients. Ann Surg. Sep 1996;224(3):288-94; discussion 294-6. [Medline].

  11. Curran D, Sahmoud T, Therasse P, van Meerbeeck J, Postmus PE, Giaccone G. Prognostic factors in patients with pleural mesothelioma: the European Organization for Research and Treatment of Cancer experience. J Clin Oncol. Jan 1998;16(1):145-52. [Medline].

  12. Herndon JE, Green MR, Chahinian AP, et al. Factors predictive of survival among 337 patients with mesothelioma treated between 1984 and 1994 by the Cancer and Leukemia Group B. Chest. Mar 1998;113(3):723-31. [Medline].

  13. Ryan CW, Herndon J, Vogelzang NJ. A review of chemotherapy trials for malignant mesothelioma. Chest. Jan 1998;113(1 Suppl):66S-73S. [Medline].

  14. Taub RN, Antman KH. Chemotherapy for malignant mesothelioma. Semin Thorac Cardiovasc Surg. Oct 1997;9(4):361-6. [Medline].

  15. Vogelzang NJ, Rusthoven JJ, Symanowski J, et al. Phase III study of pemetrexed in combination with cisplatin versus cisplatin alone in patients with malignant pleural mesothelioma. J Clin Oncol. Jul 15 2003;21(14):2636-44. [Medline].

  16. Santoro A, O'Brien ME, Stahel RA, et al. Pemetrexed plus cisplatin or pemetrexed plus carboplatin for chemonaïve patients with malignant pleural mesothelioma: results of the International Expanded Access Program. J Thorac Oncol. Jul 2008;3(7):756-63. [Medline].

  17. Simon GR, Verschraegen CF, Janne PA, et al. Pemetrexed plus gemcitabine as first-line chemotherapy for patients with peritoneal mesothelioma: final report of a phase II trial. J Clin Oncol. Jul 20 2008;26(21):3567-72. [Medline].

  18. Taylor P, Castagneto B, Dark G, et al. Single-agent pemetrexed for chemonaïve and pretreated patients with malignant pleural mesothelioma: results of an International Expanded Access Program. J Thorac Oncol. Jul 2008;3(7):764-71. [Medline].

  19. Byrne MJ, Davidson JA, Musk AW, et al. Cisplatin and gemcitabine treatment for malignant mesothelioma: a phase II study. J Clin Oncol. Jan 1999;17(1):25-30. [Medline].

  20. Favaretto AG, Aversa SM, Paccagnella A, et al. Gemcitabine combined with carboplatin in patients with malignant pleural mesothelioma: a multicentric phase II study. Cancer. Jun 1 2003;97(11):2791-7. [Medline].

  21. Pavlakis N, Vogelzang NJ. Ranpirnase--an antitumour ribonuclease: its potential role in malignant mesothelioma. Expert Opin Biol Ther. Apr 2006;6(4):391-9. [Medline].

  22. Mikulski SM, Costanzi JJ, Vogelzang NJ, McCachren S, Taub RN, Chun H. Phase II trial of a single weekly intravenous dose of ranpirnase in patients with unresectable malignant mesothelioma. J Clin Oncol. Jan 1 2002;20(1):274-81. [Medline].

  23. Betta PG, Bottero G, Pavesi M. Apoptosis and Related Proteins BCL-2and BAX in Malignant Mesothelioma of the Pleura. Presented at: American Society of Clinical Oncology 35th Annual Meeting. Vol 18. Atlanta, Ga: 1999.

  24. Rice DC, Stevens CW, Correa AM, Vaporciyan AA, Tsao A, Forster KM, et al. Outcomes after extrapleural pneumonectomy and intensity-modulated radiation therapy for malignant pleural mesothelioma. Ann Thorac Surg. Nov 2007;84(5):1685-92; discussion 1692-3. [Medline].

  25. Nakas A, Trousse DS, Martin-Ucar AE, Waller DA. Open lung-sparing surgery for malignant pleural mesothelioma: the benefits of a radical approach within multimodality therapy. Eur J Cardiothorac Surg. Oct 2008;34(4):886-91. [Medline].

  26. Neragi-Miandoab S, Richards WG, Sugarbaker DJ. Morbidity, mortality, mean survival, and the impact of histology on survival after pleurectomy in 64 patients with malignant pleural mesothelioma. Int J Surg. Aug 2008;6(4):293-7. [Medline].

  27. Hughes A, Calvert P, Azzabi A, et al. Phase I clinical and pharmacokinetic study of pemetrexed and carboplatin in patients with malignant pleural mesothelioma. J Clin Oncol. Aug 15 2002;20(16):3533-44. [Medline].

  28. Huncharek M, Kelsey K, Mark EJ, et al. Treatment and survival in diffuse malignant pleural mesothelioma; a study of 83 cases from the Massachusetts General Hospital. Anticancer Res. May-Jun 1996;16(3A):1265-8. [Medline].

  29. Sterman DH, Kaiser LR, Albelda SM. Gene therapy for malignant pleural mesothelioma. Hematol Oncol Clin North Am. Jun 1998;12(3):553-68. [Medline].

  30. Baas P, Murrer L, Zoetmulder FA, et al. Photodynamic therapy as adjuvant therapy in surgically treated pleural malignancies. Br J Cancer. 1997;76(6):819-26. [Medline].

  31. Abdel Rahman AR, Gaafar RM, Baki HA, et al. Prevalence and pattern of lymph node metastasis in malignant pleural mesothelioma. Ann Thorac Surg. Aug 2008;86(2):391-5. [Medline].

  32. Bofeftta P and Trichopoulos D. Cancer of the Lung, larynx, and Pleura. In: Adami, Hunter and Trichopoulos. Textbook of Cancer Epidemiology. 2nd ed. 2008:243-280. Chapter 12.

  33. Boffetta P, Stayner LT. Pleural and peritoneal neoplasm. In: Schottenfeld D, Fraumeni J, eds. Cancer epidemiology and prevention. 3rd ed. 2008:34.

  34. Boutin C, Schlesser M, Frenay C, Astoul P. Malignant pleural mesothelioma. Eur Respir J. Oct 1998;12(4):972-81. [Medline].

  35. Boutin C, Schlesser M, Frenay C, et al. [Malignant mesothelioma. Diagnosis and treatment]. Rev Prat. Jun 15 1997;47(12):1333-9. [Medline].

  36. Chahinian AP, Pajak TF, Holland JF, et al. Diffuse malignant mesothelioma. Prospective evaluation of 69 patients. Ann Intern Med. Jun 1982;96(6 Pt 1):746-55. [Medline].

  37. Davidson JA, Musk AW, Wood BR, et al. Intralesional cytokine therapy in cancer: a pilot study of GM-CSF infusion in mesothelioma. J Immunother. Sep 1998;21(5):389-98. [Medline].

  38. de Graaf-Strukowska L, van der Zee J, van Putten W, Senan S. Factors influencing the outcome of radiotherapy in malignant mesothelioma of the pleura--a single-institution experience with 189 patients. Int J Radiat Oncol Biol Phys. Feb 1 1999;43(3):511-6. [Medline].

  39. Friedlander PL, Delaune CL, Abadie JM, et al. Efficacy of CD40 ligand gene therapy in malignant mesothelioma. Am J Respir Cell Mol Biol. Sep 2003;29(3 Pt 1):321-30. [Medline].

  40. Gadgeel SM, Pass HP. Malignant Mesothelioma. Community Oncology. 2006;3:215-224.

  41. Govindan R, Kratzke RA, Herndon JE, et al. Gefitinib in patients with malignant mesothelioma: a phase II study by the Cancer and Leukemia Group B. Clin Cancer Res. Mar 15 2005;11(6):2300-4. [Medline].

  42. Kaiser LR. New therapies in the treatment of malignant pleural mesothelioma. Semin Thorac Cardiovasc Surg. Oct 1997;9(4):383-90. [Medline].

  43. Kasseyet S, Astoul P, Boutin C. Results of a phase II trial of combined chemotherapy for patients with diffuse malignant mesothelioma of the pleura. Cancer. Apr 15 1999;85(8):1740-9. [Medline].

  44. Mutti L, Broaddus VC. Malignant mesothelioma as both a challenge and an opportunity. Oncogene. Dec 9 2004;23(57):9155-61. [Medline].

  45. O'Reilly EM, Ilson DH, Saltz LB, Heelan R, Martin L, Kelsen DP. A phase II trial of interferon alpha-2a and carboplatin in patients with advanced malignant mesothelioma. Cancer Invest. 1999;17(3):195-200. [Medline].

  46. Pinto M, Melotti B, Piana E, et al. Phase II Study of Mitoxantrone, Methotrexate, and Mitomycin (MMM Regimen) in Malignant Mesothelioma of the Pleura. Presented at: American Society of Clinical Oncology 35th Annual Meeting. Vol 18. Atlanta, Ga: Abst 2113; 1999.

  47. Politi E, Kandaraki C, Apostolopoulou C, et al. Immunocytochemical panel for distinguishing between carcinoma and reactive mesothelial cells in body cavity fluids. Diagn Cytopathol. Mar 2005;32(3):151-5. [Medline].

  48. Roggli VL, Oury TD, Moffatt EJ, et al. Malignant mesothelioma in women. Anat Pathol. 1997;2:147-63. [Medline].

  49. Ruffie P, Lehmann M, Galateau-Salle F, et al. [Standards, Options, and Recommendations for the management of patients with malignant mesothelioma of the pleura. Federation Nationale des Centres de Lutte Contre le Cancer]. Bull Cancer. Jun 1998;85(6):545-61. [Medline].

  50. Sterman DH, Kaiser LR, Albelda SM. Advances in the treatment of malignant pleural mesothelioma. Chest. Aug 1999;116(2):504-20. [Medline].

  51. Surveillance, Epidemiology, and End Results (SEER) Program. SEER Cancer Statistics Review 1973-1990. Publication 93-2798. National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics. Available at www.seer.cancer.gov.

  52. Tan WW. Malignant mesothelioma. Hosp Med. 1998;54-6.

  53. Yang H, Testa JR, Carbone M. Mesothelioma Epidemiology, Carcinogenesis, and Pathogenesis. Curr Treat Options Oncol. Aug 15 2008;[Medline].

  54. Yates DH, Corrin B, Stidolph PN, et al. Malignant mesothelioma in south east England: clinicopathological experience of 272 cases. Thorax. Jun 1997;52(6):507-12. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

malignant mesothelioma, lung cancer, lung tumor, pulmonary cancer, pulmonary tumor, pulmonary malignancy, asbestos-related cancer, cancer of the pleura, asbestos exposure, plural cancer, mesothelioma malignancy, pleural malignant mesothelioma, sarcomatous mesothelioma, epithelial mesothelioma, mixed mesothelioma, pleural mesothelioma

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Winston W Tan, MD, Assistant Professor of Medicine, Mayo Medical School; Consulting Staff, Mayo Group Practices
Winston W Tan, MD is a member of the following medical societies: American College of Physicians, American Society of Clinical Oncology, American Society of Hematology, Philippine Medical Association, and Texas Medical Association
Disclosure: Roche Grant/research funds Other; Sanofi Aventis Grant/research funds Other; Genentech Grant/research funds Other; Bristol Myers Squibb Grant/research funds Other

Medical Editor

Michael Perry, MD, MS, MACP, Nellie B Smith Chair of Oncology Emeritus, Professor, Department of Internal Medicine, Division of Hematology and Oncology, University of Missouri /Ellis Fischel Cancer Center
Michael Perry, MD, MS, MACP is a member of the following medical societies: Alpha Omega Alpha, American Association for Cancer Research, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society of Clinical Oncology, American Society of Hematology, International Association for the Study of Lung Cancer, and Missouri State Medical Association
Disclosure: Bionumerik Consulting fee Consulting; Proactya Consulting fee Consulting; GSK Consulting fee Consulting; NovoNordisk Consulting fee Consulting; Amgen Honoraria Speaking and teaching; GSK Consulting fee Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Benjamin Movsas, MD, Vice-Chairman, Department of Radiation Oncology, Fox Chase Cancer Center
Benjamin Movsas, MD is a member of the following medical societies: American College of Radiology, American Radium Society, and American Society for Therapeutic Radiology and Oncology
Disclosure: Nothing to disclose.

CME Editor

Rajalaxmi McKenna, MD, FACP, Consulting Staff, Department of Medicine, Southwest Medical Consultants, SC, Good Samaritan Hospital, Advocate Health Systems
Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis
Disclosure: Nothing to disclose.

Chief Editor

Jules E Harris, MD, Clinical Professor of Medicine, Division of Hematology/Medical Oncology, Department of Internal Medicine, University of Arizona College of Medicine at Tucson; Consulting Staff, Arizona Cancer Center
Jules E Harris, MD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Association of Immunologists, American Society of Hematology, and Central Society for Clinical Research
Disclosure: GlobeImmune Salary Consulting; Amplimed Consulting fee Consulting

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.