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Unformatted text preview: SPECIAL FEATURE Asbestos and Malignant Mesothelioma Current therapies for malignant pleural mesothelioma Takashi Nakano Received: 30 July 2007 / Accepted: 26 September 2007 / Published online: 28 February 2008 Ó The Japanese Society for Hygiene 2008 Abstract Mesothelioma is a highly lethal tumor derived from mesothelial cells, and its global incidence is increasing because of widespread exposure of numerous individuals to asbestos in the last 50 years. Mesothelioma is largely untreatable with any of the therapeutic modali- ties. Recently, a novel multitargeted antifolate pemetrexed has shown promising activity against malignant pleural mesothelioma, producing response rates of up to 40% when used in combination with cisplatin. In a large phase III study, use of a combination of pemetrexed and cisplatin was associated with significantly improved survival time and with greater antitumor activity compared with cisplatin alone. This combination also gave a significant response rate of approximately 50% in patients with epithelioid malignant pleural mesothelioma. These clinical benefits of pemetrexed–cisplatin doublet have changed the perception of mesothelioma chemotherapy. Other combinations, including gemcitabine in combination with cisplatin, have also shown encouraging response rates. Prognosis depends on gender, clinical stage of the tumor, histological subtype, platelet count, leukocyte counts, and performance status. Radiotherapy can palliate mesothelioma patients with chest pain, and has been indicated to be of benefit for the pre- vention of malignant seeding along the tract of a chest tube or needle biopsy. Trimodality treatment using extrapleural pneumonectomy, radiation and chemotherapy has shown promising therapeutic value. The development of chemo- therapeutic regimens and the favorable outcomes of trimodality have led to new combined modality trials. In Japan, multicenter national trials against mesothelioma will begin in the near future. Keywords Asbestos Á Extrapleural pneumonectomy Á Mesothelioma Á Pemetrexed Introduction Malignant mesothelioma used to be a relatively uncommon disease, but its incidence has been rising in recent times and is predicted to peak around the year 2030 in Japan. There are currently 1,000 new mesothelioma cases per year. In June 2005, several inhabitants suffered from mesothelioma in Amagasaki, Hyogo, and their environ- mental exposure to asbestos resulted in medico-legal problems related to mesothelioma and social compensation for asbestos-related diseases in Japan. Since then, over- whelming media interest in the mesothelioma tragedy caused by asbestos has produced a high level of awareness of the risks of asbestos and mesothelioma....
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