Published: March 13, 2010
New NCCN Guidelines for Malignant Pleural Mesothelioma Presented at Annual Conference
HOLLYWOOD, Fla. - (BUSINESS WIRE) - A new addition to the NCCN
Clinical Practice Guidelines in Oncology (NCCN Guidelines ),
the NCCN Guidelines for Malignant Pleural Mesothelioma (MPM), was
presented at the NCCN 15th Annual Conference. Lee M. Krug, MD
of Memorial
Sloan-Kettering Cancer Center and a member of the NCCN Guidelines
Panel discussed recommended treatment options for patients with MPM as
well as first-line therapy regimens.
Mesothelioma is a rare form of cancer in which malignant cells are found
in the mesothelium, a protective sac that covers most of the body's
internal organs. Pleural mesothelioma refers to the thoracic-based form
of the disease, the most common type of mesothelioma.
Although asbestos exposure is a major risk factor for mesothelioma, it
can remain latent for more than 20 years and may require a
predisposition to the disease. In addition, it can also occur in
individuals that previously experienced radiation exposure (e.g.
treatment for Hodgkin's lymphoma).
Dr. Krug noted that, "Diagnosing mesothelioma is often difficult,
because the symptoms are similar to those of a number of other
conditions. In addition, a physician's initial evaluation of a patient
may reveal pleural effusion, but it can often be missed on pleural fluid
cytology."
Common symptoms of mesothelioma are shortness or breath or chest pain
among others including tumor fevers, sweats, weight loss, and pneumonia.
A surgical biopsy is often required to effectively diagnose a patient
with mesothelioma according to Dr. Krug. PET scans can aid in staging as
well, detecting unexpected metastases in 10 percent of cases.
Prognostic factors include gender, lymph node status, and histology, but
Dr. Krug also pointed to other potential markers that may be indicative
of the disease.
"Serum markers may also have prognostic significance as studies show
that patients with mesothelioma have higher levels of Soluble
Mesothelin-Relation Protein (SMRP) and Osteopontin," said Dr. Krug.
Like any cancer, treatment for mesothelioma depends on many factors
including the stage of the cancer, where the cancer is, and how far the
cancer has spread. Dr. Krug described treatments such as surgery,
chemotherapy, and radiation that may benefit patients as described in
the NCCN
Guidelines for MPM.
Surgical procedures for MPM can range from a pleurectomy/decortication
for those patients with early stage disease to more aggressive
procedures, such as extrapleural pneumonectomy. Extrapleural
pneumonectomy includes the removal of pleura, the lung, diaphragm, and
pericardium, but can result in major complications and should only be
performed by experienced surgeons.
"The role of aggressive surgery remains controversial," said Dr. Krug.
"As outlined in the Principles for Surgical Resection for Malignant
Pleural Mesothelioma in the NCCN Guidelines, physicians need to be
highly selective when choosing potential candidates for this procedure."
Surgery alone can be inadequate due to residual disease and a high rate
of relapse, so the NCCN Guidelines recommend a combined modality therapy
approach for select patients noted Dr. Krug.
The NCCN Guidelines consist of a section detailing the Principles of
Radiation Therapy for MPM that stress the need for a multimodality
approach including evaluation of the patient by radiation oncologists,
surgeons, medical oncologists, diagnostic imaging specialists, and
pulmonologists.
"Radiation is recommended as an adjuvant therapy to improve local
control after surgery, and it is also an effective palliative treatment
for relief of chest pain that is often associated with mesothelioma,"
said Dr. Krug.
Dr. Krug explained that MPM was historically felt to be chemoresistant,
but that recent studies have shown that certain regimens can benefit
patients and also can be added for systemic therapy either before or
after surgery.
"The NCCN Guidelines recommends pemetrexed (Alimta, Lilly
USA, LLC) with cisplatin (Platinol, Bristol-Myers Squibb) or
carboplatin (Paraplatin, Bristol-Myers Squibb) as the
optimal first-line combination chemotherapy regimen for patients, though
others can be considered based on comorbid conditions," said Dr. Krug.
"On the other hand, there are extremely limited data on the benefit of
second line therapy. A few specific regimens are listed as second line
options in the NCCN Guidelines."
The NCCN Guidelines are developed and updated through an evidence-based
process with explicit review of the scientific evidence integrated with
expert judgment by multidisciplinary panels of physicians from NCCN
Member Institutions. The most recent version of this and all the
NCCN Guidelines are available free of charge at NCCN.org.
About the National Comprehensive Cancer Network
The National Comprehensive Cancer Network (NCCN), a not-for-profit
alliance of 21 of the world's leading cancer centers, is dedicated to
improving the quality and effectiveness of care provided to patients
with cancer. Through the leadership and expertise of clinical
professionals at NCCN Member Institutions, NCCN develops resources that
present valuable information to the numerous stakeholders in the health
care delivery system. As the arbiter of high-quality cancer care, NCCN
promotes the importance of continuous quality improvement and recognizes
the significance of creating clinical practice guidelines appropriate
for use by patients, clinicians, and other health care decision-makers.
The primary goal of all NCCN initiatives is to improve the quality,
effectiveness, and efficiency of oncology practice so patients can live
better lives.
The NCCN Member Institutions are: City of Hope Comprehensive Cancer
Center, Los Angeles, CA; Dana-Farber/Brigham and Women's Cancer Center |
Massachusetts General Hospital Cancer Center, Boston, MA; Duke
Comprehensive Cancer Center, Durham, NC; Fox Chase Cancer Center,
Philadelphia, PA; Huntsman Cancer Institute at the University of Utah,
Salt Lake City, UT; Fred Hutchinson Cancer Research Center/Seattle
Cancer Care Alliance, Seattle, WA; The Sidney Kimmel Comprehensive
Cancer Center at Johns Hopkins, Baltimore, MD; Robert H. Lurie
Comprehensive Cancer Center of Northwestern University, Chicago, IL;
Memorial Sloan-Kettering Cancer Center, New York, NY; H. Lee Moffitt
Cancer Center & Research Institute, Tampa, FL; The Ohio State University
Comprehensive Cancer Center - James Cancer Hospital and Solove Research
Institute, Columbus, OH; Roswell Park Cancer Institute, Buffalo, NY;
Siteman Cancer Center at Barnes-Jewish Hospital and Washington
University School of Medicine, St. Louis, MO; St. Jude Children's
Research Hospital/University of Tennessee Cancer Institute, Memphis, TN;
Stanford Comprehensive Cancer Center, Stanford, CA; University of
Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL; UCSF
Helen Diller Family Comprehensive Cancer Center, San Francisco, CA;
University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; UNMC
Eppley Cancer Center at The Nebraska Medical Center, Omaha, NE; The
University of Texas M. D. Anderson Cancer Center, Houston, TX; and
Vanderbilt-Ingram Cancer Center, Nashville, TN.
For more information, visit NCCN.org.
NCCN
Megan Martin, 610-550-1621
martin@nccn.org
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