title: Novel induction therapies for pleural mesothelioma.
abstract: Malignant mesothelioma is becoming increasingly common, and rates of diagnosis are expected to continue to increase in the coming years because of the extensive use of asbestos in industrialized countries and the long time interval between exposure and onset of disease. Although much research has been done on the optimal treatment for this disease, the overall prognosis remains grim. The main components of therapy are surgery, chemotherapy, and radiation therapy, but there is controversy in the literature about the optimal inclusion and sequencing of these treatments, as each has unique risk profiles. We have developed a new Surgery for Mesothelioma After Radiation Therapy protocol consisting of induction-accelerated hemithoracic radiation followed by extrapleural pneumonectomy. The rationale behind this protocol is to maximize both the tumoricidal and immunogenic potential of the radiotherapy while minimizing the radiation toxicity to the ipsilateral lung. Our initial trial demonstrated the feasibility of this approach and has shown encouraging results in patients with epithelial histology. In this article, we reviewed the current literature on induction chemotherapy for mesothelioma as well as described the Surgery for Mesothelioma After Radiation Therapy protocol and upcoming studies of novel induction therapies for mesothelioma.
authors.affiliation: Toronto Mesothelioma Research Program, Toronto General Hospital and Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.
authors.forename: Laura
authors.initials: L
authors.lastname: Donahoe
authors.affiliation: Toronto Mesothelioma Research Program, Toronto General Hospital and Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Cho
authors.affiliation: Toronto Mesothelioma Research Program, Toronto General Hospital and Princess Margaret Cancer Centre, University Health Network, Toronto, Canada. Electronic address: marc.deperrot@uhn.on.ca.
authors.forename: Marc
authors.initials: M
authors.lastname: de Perrot
mesh_terms: D017024:Chemotherapy, Adjuvant; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008654:Mesothelioma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D000086002:Mesothelioma, Malignant; D020360:Neoadjuvant Therapy / Q000009:adverse effects / Q000401:mortality; D010997:Pleural Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D011013:Pneumonectomy / Q000009:adverse effects / Q000401:mortality; D018714:Radiotherapy, Adjuvant; D016896:Treatment Outcome
keywords: extrapleural pneumonectomy; hemithoracic radiation; mesothelioma; neoadjuvant therapy; pleuropneumonectomy; surgery