A group of medical researchers has just released an updated set of clinical practice guidelines for treating patients with malignant pleural mesothelioma, one of the rarest and most treatment-resistant forms of cancer.
The guidelines, released by the European Society for Medical Oncology and published in the newest issue of the Annals of Oncology, contain six sets of recommendations designed to support clinicians in the management of mesothelioma from diagnosis to treatment and follow-up.
Recommendation for Mesothelioma Diagnosis
The updated ESMO mesothelioma guidelines recommend that all patients undergo a thorough occupational history with emphasis on asbestos exposure and a CT scan of their chest. They also recommend that all patients with pleural thickening have a biopsy but do not recommend routine CT scanning as a screening tool for asbestos-exposed people.
While the researchers acknowledge the increased interest in trying to diagnose mesothelioma from pleural fluid, they still recommend that patients with suspected mesothelioma undergo a pleural biopsy to confirm the diagnosis as there are still no reliable biomarkers for mesothelioma. The larger the biopsy sample, the more definitive the diagnosis is likely to be when the recommended immunohistochemical testing is conducted.
Recommendations for Mesothelioma Treatment
The chemotherapy combination of pemetrexed (Alimta) and a platinum drug like cisplatin remains the standard of care for unresectable pleural mesothelioma. However, the authors recommend that patients in good condition be recommended to join a clinical trial on possible second-line mesothelioma treatments.
While radiotherapy has shown promise as a way to reduce mesothelioma pain and to help keep mesothelioma from recurring after surgery, the authors say there is no evidence supporting its use as a standard treatment for the disease. They say it is also unproven as a way to keep mesothelioma from growing along the tracks left after a pleural fluid drainage procedure.
Surgery is recommended as a way to remove tissue (including a lung, when necessary) affected by mesothelioma. It is also indicated for relieving pleural fluid buildup when tube drainage doesn’t work, to get a tissue sample for diagnosis, or to establish cancer stage.
The study recommendations were established after a review of the latest medical literature on mesothelioma.
Baas, P et al, “Malignant pleural mesothelioma: ESMO Clinical Practice Guidelines for diagnosis, treatment, and follow-up”, July 28, 2015, Annals of Oncology, Epub ahead of print