MD Conference Express - ELCC 2015 - (Page 27)
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
Contents
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)
MD Conference Express - ELCC 2015 - Contents (Page 2)
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