Elsevier

Lung Cancer

Volume 45, Supplement, August 2004, Pages S133-S135
Lung Cancer

Malignant mesothelioma—the UK experience

https://doi.org/10.1016/j.lungcan.2004.04.024Get rights and content

Abstract

In Britain it is estimated that the annual number of mesothelioma deaths will rise from approximately 1500 in the year 2000 to a peak of approximately 3000 in 2020. A database on the natural history of mesothelioma has provided a baseline for a new trial at The Royal Marsden looking at early versus delayed chemotherapy in mesothelioma as a new approach to treatment. In the UK chemotherapy is usually in the form of MVP (mitomycin, vinblastine and cisplatin) or vinorelbine, and data have been collected from trials covering both regimens. There is now a national working group for mesothelioma (BMIG) and a proposal for a national trial is being taken forward, comparing chemotherapy with MVP or single agent vinorelbine in addition to active symptom control (ASC) with ASC alone. Novel agents are also being investigated and SRL172 has shown some benefits in combination with chemotherapy in the treatment of malignant mesothelioma.

Introduction

Malignant mesothelioma is almost invariably fatal, and the incidence of the disease is rising rapidly. In Britain, the age-standardised death rate per 100,000 men rose from 0.33 in 1970–74 to 1.20 in 1990–94, and it is estimated that the annual number of mesothelioma deaths will rise from approximately 1500 in the year 2000 to a peak of approximately 3000 in 2020 [1]. The highest incidence is seen in men born in 1945–50, reflecting the extent of use of asbestos in the 1960s and 1970s at the beginning of their working lives. Like other groups in the UK, we note that predictors for poor outcome include male sex, poor performance status (PS), sarcomatous pathology, low haemoglobin and high white cell count [2].

We in the UK have experience and data in three areas which will be covered in detail below. We have a database now on the natural history of mesothelioma, we have a large experience of the benefits of chemotherapy in this area and we have used novel agents with and without chemotherapy and have mature data.

Section snippets

The natural history of mesothelioma

We have looked at our database prospectively collected in which patients were labelled as ‘asymptomatic’ to study the natural history of mesothelioma in this group. These patients were put on a “watch and wait” policy and offered chemotherapy only when symptoms developed or mild stable symptoms worsened. Thirty-three patients with a median age of 62 years (29 male) were identified between 1994 and 2000. Of this group, 24 patients were randomised in a trial comparing best supportive care alone (n

Chemotherapy treatment

We first reported our chemotherapy experience in 1998 [3] on 39 patients treated with six cycles of MVP (mitomycin: 8 mg/m2, day 1, cycles 1, 2, 4 and 6; vinblastine: 6 mg/m2, day 1; and cisplatin: 50 mg/m2, day 1, repeated every 21 days). Sixty-two percent of patients had an overall improvement in their symptoms, palliation being particularly good for pain (79%) and cough (67%). Symptom palliation was achieved within two chemotherapy cycles. Palliation was achieved in all of the 20% of patients

SRL172

SRL172 is a suspension of heat-killed M. vaccae, a fast growing avirulent mycobacterium, which may have non-specific immunomodulating properties, e.g. it may promote Th1 and down-regulate Th2 cytokine production [5]. The proposed rationale behind the combination was that the chemotherapy, although slightly immunosuppressive, could cause the in vivo release and subsequent presentation of tumour antigens and trigger a tumour-specific response by the immune system when boosted by an

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