Questions About Cancer? 1-800-4-CANCER

Malignant Mesothelioma Treatment (PDQ®)

Health Professional Version
Last Modified: 08/15/2014

Changes to This Summary (08/15/2014)

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

General Information About Malignant Mesothelioma Treatment

Added level of evidence 3iiiA.

Added Prognostic Scoring Systems as a new subsection.

Added text to state that multimodality therapy incorporating radical surgery with or without chemotherapy, administered with or without radiation, may be considered for patients with limited disease and has been associated with a relatively long survival in observational series (cited Flores et al. as reference 6 and level of evidence 3iiiA). Also added level of evidence 3iiiD to list of factors associated with improved long-term survival.

Cellular Classification of Malignant Mesothelioma

Revised text to state that histologically, these tumors are composed of spindle cells or epithelial elements or both; also added that desmoplastic mesothelioma, consisting of bland tumor cells between dense bands of stroma, is a subtype of sarcomatoid mesothelioma. Added that the epithelioid form is occasionally confused with lung adenocarcinoma or metastatic carcinomas; epithelioid tumors account for approximately 60% of mesothelioma diagnoses (cited Travis et al. as reference 1).

Revised text to state that examination of the gross tumor at surgery and use of special stains or electron microscopy can often help to determine diagnosis; pancytokeratin stains are positive in nearly all mesotheliomas. Also added that particularly useful immunohistochemical stains for the differential diagnosis of epithelioid mesothelioma include cytokeratin 5 and 6, calretinin, WT-1 and D2-40. Added that calretinin and D2-40 positivity in combination with pancytokeratin positivity is most useful to distinguish sarcomatoid mesothelioma from sarcoma and other histologies (cited Travis et al. as reference 1). Also revised text to state that histologic appearance seems to be of prognostic value, and most clinical studies show that patients with epithelial mesotheliomas have a better prognosis than those with sarcomatoid or biphasic mesotheliomas.

Stage Information for Malignant Mesothelioma

Revised text to state that the American Joint Committee on Cancer (AJCC) and International Union Against Cancer (UICC) have designated staging by TNM classification to define malignant mesothelioma.

Revised text of subheading to state AJCC and UICC TNM Staging for Diffuse Malignant Pleural Mesothelioma.

Treatment Option Overview

Added text to state that trimodality therapy refers to a combination of chemotherapy, definitive surgery, and radiation therapy. Also added that because of the rarity of mesothelioma and the complexities of patient selection, surgical technique, and optimal sequencing of therapy, delivery of such therapy in centers with medical personnel who have established experience and expertise in the management of mesothelioma has shown better results.

Revised text to state that several single-arm, phase II studies have demonstrated prolonged survival times for selected patients who received adjuvant radiation after definitive surgery (cited Rusch et al. as reference 4 and Batirel et al. as reference 5). Also revised text to state that other single-arm, phase II studies investigated neoadjuvant chemotherapy followed by definitive surgery followed by adjuvant radiation (cited Krug et al. as reference 8, Flores et al. as reference 9, and Weder et al. as reference 10). These studies also have shown prolonged survival compared with historical controls; however, this advantage has yet to be confirmed in a randomized study.

Advanced Malignant Mesothelioma (Stages II, III, and IV)

Revised text of standard treatment options to state that for patients with pain related to their cancer, palliative radiation therapy is a consideration. Also added text to state that first-line combination chemotherapy with cisplatin and pemetrexed showed improved survival compared with single-agent cisplatin.

This summary is written and maintained by the PDQ Adult Treatment Editorial Board, which is editorially independent of NCI. The summary reflects an independent review of the literature and does not represent a policy statement of NCI or NIH. More information about summary policies and the role of the PDQ Editorial Boards in maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ NCI's Comprehensive Cancer Database pages.