Malignant pleural mesothelioma (MPM) is a malignancy of pleural layers within the lung cavity and inner sides of the ribs.
Year of research has revealed asbestos exposure as the primary cause of the malignancy. The longer the asbestos exposure, more is the risk of a person developing mesothelioma. It can take a minimum of ten and a maximum of 50 years before the symptoms start to appear. Common malignant pleural mesothelioma symptoms include reduced stamina, dyspnoea, pain in the chest, blood in cough/ sputum, fatigue, pleural effusions, and fever.
With the advancement in the form of cancer, symptoms tend to become severe, including the deposition of the minerals on the pleural layers, worsening of pleural effusions, and scarring of the lungs also known as Asbestosis.
Malignant pleural mesothelioma Epidemiology
Malignant pleural mesothelioma is a type of global epidemic, with over 80% of the diagnosed cancer cases being mesothelioma cancers. Statistics say that around 2000 Americans gets diagnosed, however at a later stage, with MPM making it one of the most common forms of cancer.
According to a paper published in PubMed, Malignant pleural mesothelioma incidence varies with different geographies. The highest annual MPM incidence reported was around 30 cases per million a year in Australia and the UK.
In general, people working in mines and are heavily exposed to asbestos are at a higher risk of developing MPM. Around 2-18% of the miners and those working in asbestos manufacturing plants get diagnosed with MPM. Moreover, people who are heavily involved in using asbestos as one of the raw materials are not even spared. Shockingly, people who are living nearby these factories and are passively exposed to the element are put under the risk of contracting the disease.
According to statistics, around 10% of deaths reported due to AMPM in males whereas in females the per cent is slightly less around 8%.
The Malignant pleural mesothelioma diagnosis rate is poor owing to the late appearance of the symptoms. Consequently, MPM prognosis gets grim and makes it difficult in effectively treating cancer.
Diagnosis and treatment approaches
Diagnosing malignant pleural mesothelioma has multiple approaches involving imaging scans such as X-ray and CT scans. However, biopsy is the only way to verify the presence of tumour cells.
Malignant pleural mesothelioma treatment has limited survival success. The aim of the treatment is highly curative and has multimodal approaches to alleviate symptoms. The MPM treatment varies with the extent of metastasis of cancer.
A combination of pemetrexed and cisplatin is considered as the standard first-line treatment of malignant pleural mesothelioma. It is the most effective chemotherapy treatment. In a recent trial aimed at evaluating cisplatin and pemetrexed titled Mesothelioma Avastin Cisplatin Pemetrexed Study (MAPS) revealed the addition of bevacizumab significantly improved the survival rates of the MPM patients with minimal side effects.
Another malignant pleural mesothelioma therapy approach consists of combining chemotherapy with radiation therapy in patients who are still at an early stage of cancer. Patients who are at late-stage cancer for whom surgery is not an option due to metastasized tumour, chemotherapy combined with immunotherapy is a viable treatment approach.
So far, no therapy has been successful in providing complete relief to malignant pleural mesothelioma patients. In a phase III trial comparing pemetrexed to palliative care alone, demonstrated that pemetrexed improved progression-free survival (PFS) and time to progression without impact on OS. Other research strategies are currently being investigated, with promising results for immune checkpoint inhibitors or antimesothelin antibodies. However, their high cost could limit their use in developing countries once approved.
Companies like Verastem, Amphera, Bristol Myers Squibb, Targovax, and many others are manufacturing therapies to advance the Malignant pleural mesothelioma market. Emerging drug therapies such as immunotherapy, photodynamic therapy, virotherapy, gene therapy, cryotherapy and epigenetic therapy have the potential to advance the malignant pleural mesothelioma market.