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13.1 months to recurrence, and median survival of 15 months [Baldini EH et al. J Thorac Cardiovasc Surg. 2015], with local relapse in the homolateral hemithorax still representing the most typical pattern of relapse. When patients are treated with EPP, it offers complete resection of all gross tumors and allows for the delivery of high-dose adjuvant hemithoracic RT, but it is linked with greater morbidity and mortality than lesser operations. Also, rapid progression of disease and limited life expectancy often occurs. The use of P/D is diffusively increasing, which often leads to equal or better outcomes than EPP [Hiddinga BI, van Meerbeeck JP. J Thorac Oncol. 2013]. P/D, as it is a less complete resection than EPP and has a higher risk for locoregional recurrence, poses a difficult problem for delivering RT, noted Prof Ricardi. According to Prof Ricardi, pleural intensity-modulated RT, whether alone or after P/D, is feasible and safe, with delivered RT doses of 47 to 55 Gy and rates of grade 3 or higher toxicity of 20% to 30%. Adjuvant irradiation after P/D is not recommended outside clinical trials, which are ongoing. Overall, MPM still has a dismal prognosis and it is unclear if any local treatment changes long-term survival. No local treatment has been found effective. OLD DRUGS AND NEW APPROACHES TO MESOTHELIOMA Mesothelioma was previously considered a rare tumor, is asbestos related, is a public health issue in the developing world, has many diagnostic pitfalls, and has no validated curative treatment, said Paul Baas, MD, PhD, The Netherlands Cancer Institute, Amsterdam, The Netherlands. He explained the problems of mesothelioma studies, including that they take 2 to 8 years, which is too long; the population is heterogeneous in terms of previous treatments, stage and pathology, and measurable disease; the study setup is incomplete and lacks data on the impact of poststudy chemotherapy; and the number of translational studies is limited with no tumor assessments before or after treatment. First-line treatment is chemotherapy, which provides symptom relief and increases OS. The standard is combining cisplatin and anti-folate, and it results in 80% of tumors recurring within 2 years and a median OS of 12 to 13 months, according to a 2003 study. So far, novel and targeted agents have had no or very limited success. Amatuximab [Hassan R et  al. Clin Cancer Res. 2014], thalidomide [Buikhuisen WA et  al. Lancet Oncol. 2013], and vorinostat [Krug LM et  al. Lancet Oncol. 2015] have failed or had minimal improvements. The PI3K-mTOR pathway is of interest to target in MPM. One recent study showed that 40% of cases express programmed death ligand [Mansfield AS et  al. J Thorac Oncol. 2014], so immunotherapy is also of interest. Another approach is to test many drugs, including old ones, using a drug library to identify the best approach. The library includes histone deacetylase inhibitors, proteasome inhibitors, anthracyclines, and antineoplastic antibiotics. Peer-Reviewed Highlights From the European Society for Medical Oncology 2015 European Lung Cancer Conference 27

Table of Contents for the Digital Edition of MD Conference Express - ELCC 2015

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MD Conference Express - ELCC 2015

MD Conference Express - ELCC 2015 - (Page Cover1)
MD Conference Express - ELCC 2015 - (Page Cover2)
MD Conference Express - ELCC 2015 - (Page i)
MD Conference Express - ELCC 2015 - (Page ii)
MD Conference Express - ELCC 2015 - Contents (Page 1)
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