TY - JOUR
T1 - Guidelines of the European Respiratory Society, the European Society of Thoracic Surgeons, the European Association for Cardio-Thoracic Surgery and the European Society for Radiotherapy and Oncology for management of Malignant Pleural Mesothelioma
AU - Faivre-Finn, Corinne
AU - et al.,
PY - 2019/9/1
Y1 - 2019/9/1
N2 - The 2017 ERS/ESTS/EACTS/ESTRO Taskforce brought together experts to update previous 2009 ERS/ESTS guidelines on management of malignant pleural mesothelioma (MPM), a rare cancer with global poor outcome, after a systematic review of the 2009-2018 literature. The evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluation approach. The evidence syntheses were discussed and recommendations formulated by this multidisciplinary group of experts. Diagnosis: Pleural biopsies remain the gold standard for confirming the diagnosis, usually obtained by thoracoscopy but occasionally via images-guided percutaneous needle biopsy in cases of pleural symphysis or poor performance status. Pathology: standard staining procedures are insufficient in about 10% of cases justifying using specific markers, including BAP-1 and CDKN2A (p16) for the separation of atypical mesothelial proliferation from MPM. Staging: in the absence of a uniform, robust and validated staging system, we advice to use the most recent 2016 8th TNM classification, with an algorithm for pre-therapeutic assessment. Monitoring: Patient’s performance status, histological subtype and tumor volume are the main prognostic factors of clinical importance in MPM management in routine. Other potential parameters should be recorded at baseline and reported in clinical trials. Treatment: Chemotherapy has limited efficacy in MPM patients with only selected candidates for radical surgery. New promising targeted therapies, immunotherapies and strategies have been reviewed. Because of limited data on the best combination treatment, we still emphasize that patients who are considered candidates for a multimodal approach, including radical surgery, should be treated as part of a clinical trials in MPM dedicated centres.
AB - The 2017 ERS/ESTS/EACTS/ESTRO Taskforce brought together experts to update previous 2009 ERS/ESTS guidelines on management of malignant pleural mesothelioma (MPM), a rare cancer with global poor outcome, after a systematic review of the 2009-2018 literature. The evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluation approach. The evidence syntheses were discussed and recommendations formulated by this multidisciplinary group of experts. Diagnosis: Pleural biopsies remain the gold standard for confirming the diagnosis, usually obtained by thoracoscopy but occasionally via images-guided percutaneous needle biopsy in cases of pleural symphysis or poor performance status. Pathology: standard staining procedures are insufficient in about 10% of cases justifying using specific markers, including BAP-1 and CDKN2A (p16) for the separation of atypical mesothelial proliferation from MPM. Staging: in the absence of a uniform, robust and validated staging system, we advice to use the most recent 2016 8th TNM classification, with an algorithm for pre-therapeutic assessment. Monitoring: Patient’s performance status, histological subtype and tumor volume are the main prognostic factors of clinical importance in MPM management in routine. Other potential parameters should be recorded at baseline and reported in clinical trials. Treatment: Chemotherapy has limited efficacy in MPM patients with only selected candidates for radical surgery. New promising targeted therapies, immunotherapies and strategies have been reviewed. Because of limited data on the best combination treatment, we still emphasize that patients who are considered candidates for a multimodal approach, including radical surgery, should be treated as part of a clinical trials in MPM dedicated centres.
KW - pleura
KW - cancer
KW - mesothelioma
KW - guidelines
KW - asbestos
KW - treatment
M3 - Article
SN - 0903-1936
JO - The European respiratory journal
JF - The European respiratory journal
ER -