Malignant mesothelioma—the UK experience
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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