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Prise en charge diagnostique et thérapeutique du mésothéliome pleural malin en 2008

Diagnostic and therapeutic strategy for malignant pleural mesothelioma in 2008. An update

  • Synthese / Review Article
  • Published:
Oncologie

Abstract

Malignant pleural mesothelioma (MPM) is a rare tumour, secondary to professional asbestosis exposure. MPM incidence is rising since the late sixties and this increase will continue till 2020–2030, with curently 800 to 1000 new cases in France. Molecular carcinogenesis of MPM is still poorly understood but gene alterations of NF2, c-met, WT1 RASSF1, and p16, have been described. These genes are involved in cell invasion and motility, cell division and apoptosis control. The histological diagnosis remains critical since the morphology of this neoplasm is extremely variable, but immunohistochemical analyses have been precisely described by the French Mesopath Group. The clinical diagnosis relies on thoracos-copy and large pleural biopsy. The therapeutic strategy always includes the irradiation of drainage channels or pleural punctures with 3 × 7 Grays within the four weeks following these procedures. Rarely, in carefully selected patients, extensive extra-pleural pneumonectomy can be performed. The recommended first-line chemotherapy is based on a doublet of pemetrexed and cisplatin that has demonstrated in a phase III setting, an overall increase in survival and improvement of quality of life when compared to a cisplatin-based monotherapy. Antiangiogenic agents such as bevacizumab could be of interest but they have to be tested in randomized phase III trials.

Résumé

Le mésothéliome pleural malin (MPM) reste une tumeur rare de l’adulte, consécutive à l’exposition professionnnelle aux fibres d’amiante. Son incidence ne cesse de croître depuis 40 ans et cette augmentation devrait se poursuivre jusqu’en 2020–2030, avec actuellement 800 à 1000 cas/an en France. La carcinogenèse moléculaire encore imparfaitement comprise fait intervenir des altérations des gènes NF2, c-met, WT1, RASSF1 et p16, impliqués dans l’invasion et la motilité cellulaire, le contrôle de la division cellulaire et l’apoptose. Le diagnostic histologique est difficile du fait de la grande variabilité morphologique des MPM et repose sur une analyse immunohistochimique codifiée par le groupe Mésopath. La prise en charge diagnostique repose sur la thoracoscopie avec de larges et profondes biopsies. La prise en charge thérapeutique repose toujours sur l’irradiation précoce des trajets de ponction et biopsies, rarement chez des patients très sélectionnés, sur la pleuropneumonectomie extrapleurale. La chimiothérapie repose sur des doublets d’antifolate (pemetrexed) et sel de platine, les seuls évalués en phase III, ayant démontré un allongement de la survie et une amélioration de la qualité de vie. L’apport d’agents antiangiogéniques, comme le bévacizumab, pourrait s’avérer intéressant mais reste à évaluer en phase III.

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Authors and Affiliations

  1. Service de pneumologie, université Basse-Normandie, CHU de Caen, 1, avenue Côte-de-Nacre, F-14033, Caen cedex 05, France

    G. Zalcman, E. Porret, J. Madelaine & E. Bergot

  2. Pôle coeur-poumons-vaisseaux, université Basse-Normandie, CHU de Caen, 1, avenue Côte-de-Nacre, F-14033, Caen cedex 05, France

    G. Zalcman, E. Porret, J. Madelaine & E. Bergot

  3. Équipe régionale Inserm 3 « Cancer & Populations », université Basse-Normandie, CHU de Caen, 1, avenue Côte-de-Nacre, F-14033, Caen cedex 05, France

    G. Zalcman, J. Madelaine & E. Bergot

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  2. E. Porret
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  3. J. Madelaine
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Correspondence to G. Zalcman.

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Zalcman, G., Porret, E., Madelaine, J. et al. Prise en charge diagnostique et thérapeutique du mésothéliome pleural malin en 2008. Oncologie 10, 545–550 (2008). https://doi.org/10.1007/s10269-008-0941-0

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  • DOI: https://doi.org/10.1007/s10269-008-0941-0

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