The incidence of malignant mesothelioma, a neoplastic process affecting the pleura, and to a lesser extent the peritoneum, is increasing. Mesothelioma is almost always caused by inhalation of asbestos fibers years before the development of the malignancy. Since asbestos exposure generally occurs on the job site, obtaining a thorough occupational history is critical. The elapsed time between first exposure to asbestos and the development of an asbestos-induced disease is called latency. The minimum latency for mesothelioma is 10 years; however, a latency of 30 to 40 years is more usual (Finnish Institute. Scan J Work Environ Health 1997; 23:311). Latency and longevity are key factors in the mesothelioma epidemic of 2000.

Current surgical management of malignant pleural mesothelioma

Malignant pleural mesothelioma is a rare and very aggressive malignancy with an increasing incidence. Single-modality therapy has failed to improve median survival. Current surgical therapies include palliative and cytoreductive procedures. The rarity of the disease, the lack of randomized surgical studies, and the lack of a universally accepted and validated staging system make it difficult to reach consensus and establish stage-specific protocols. However, with strict criteria, subsets of patients can be identified who can benefit from aggressive cytoreductive surgical approaches, such as extrapleural pneumonectomy, and adjuvant chemoradiation protocols. Our experience with this type of protocol in carefully selected patients has resulted in increased median survival. The lack of cure in any of the published protocols demonstrates the need for new therapies and approaches for this disease.

Patients with a cancer of the lining of the lung, known as malignant pleural mesothelioma (MPM), lived longer than previously reported(1), when treated with Eli Lilly and Company's Alimta(®) (pemetrexed) in combination with cisplatin, according to updated data presented at the 11th annual Conference on Lung Cancer (WCLC).

Mature data presented at WCLC represent an update from trial results from the largest randomized, Phase III mesothelioma trial ever reported involving 448 patients published in the Journal of Clinical Oncology (JCO) in July 2003(2). This data showed median survival of patients treated with Alimta plus cisplatin was almost thirteen (12.8) months after diagnosis and 42 percent (3.8 months) longer than patients who received cisplatin alone (p = 0.003).