Current Issues in Malignant Pleural Mesothelioma Evaluation and Management
Current Issues in Malignant Pleural Mesothelioma Evaluation and Management
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DOI：
10.1634/theoncologist.2014-0122
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发表时间：
2014-09-01
期刊：
影响因子：
5.8
通讯作者：
Stevenson, James P.
中科院分区：
文献类型：
--
作者：
Ai, Jing;Stevenson, James P.
恶性胸膜间皮瘤(MPM)是一种罕见的疾病，最常与职业性石棉接触有关，并且在全球范围内发病率稳步上升。患者通常年龄较大，临床分期较晚，并有其他内科合并症，这使得管理非常具有挑战性。尽管付出了巨大的努力，MPM的预后仍然很差，特别是在最初的治疗后进展更是如此。MPM的宏观完全切除可以通过胸膜外肺切除术(EPP)或扩大(即根治性)肺切除术(e-P/D)来实现，如果结合多模式手术，可以延长患者的生存时间。考虑到外科手术切除MPM的发病率，优化识别合适的患者是至关重要的。不幸的是，由于晚期、年龄和/或内科合并症，大多数患者不适合EPP或e-P/D。培美曲塞和铂联合化疗已经成为不能切除的疾病患者治疗的基石，因为联合化疗与改善接受治疗的患者的存活率和生活质量有关。然而，MPM最终会对初始治疗产生抵抗力，而且进一步治疗的益处还没有在随机临床试验中得到证实。翻译研究为MPM的肿瘤发生、生物标记物和免疫反应提供了令人兴奋的见解，导致了目前处于临床试验中的多种新型治疗剂的开发。这些进展预示着MPM治疗的新纪元，并表明这种疾病将不会在抗癌战争中掉队。
Malignant pleural mesothelioma (MPM) is an uncommon disease most often associated with occupational asbestos exposure and is steadily increasing in worldwide incidence. Patients typically present at an older age, with advanced clinical stage and other medical comorbidities, making management quite challenging. Despite great efforts, the prognosis of MPM remains poor, especially at progression after initial treatment. Macroscopic complete resection of MPM can be achieved through extrapleural pneumonectomy (EPP) or extended (ie, radical) pleurectomy (e-P/D) in selected patients and can result in prolonged survival when incorporated into a multimodality approach. Given the morbidity associated with surgical resection of MPM, optimizing identification of appropriate patients is essential. Unfortunately, most patients are not candidates for EPP or e-P/D due to advanced stage, age, and/or medical comorbidity. Pemetrexed and platinum combination chemotherapy has become the cornerstone of therapy for patients with unresectable disease because the combination is associated with improved survival and quality of life in treated patients. However, MPM eventually becomes resistant to initial therapy, and benefit to further lines of therapy has not been substantiated in randomized clinical trials. Translational research has provided exciting insights into tumorigenesis, biomarkers, and immune response in MPM, leading to the development of multiple novel therapeutic agents that are currently in clinical trials. These advances hold the promise of a new era in the treatment of MPM and suggest that this disease will not be left behind in the war on cancer.