The American Society of Clinical Oncology (ASCO) has recently published a clinical practice guideline for the treatment of malignant pleural mesothelioma. The purpose of the guideline is, “to provide evidence-based recommendations to practicing physicians and others on the management of malignant pleural mesothelioma.” The guidelines are the work of mesothelioma expert physicians, patient advocates, a patient representative, and ASCO staff, who reviewed over 200 relevant studies to identify and recommend a guide line based on scientific evidence, for the diagnosis, and treatment of people with malignant pleural mesothelioma.
What is ASCO? The American Society of Clinical Oncology was founded in 1964, in Chicago by seven physicians. The early 1960’s was the beginning of the use of chemotherapy, these seven doctors found information and education lacking. Today, ASCO has over 40,000 members who are dedicated to the treatment of patients with cancer.
The clinical guidelines answer a lot of questions about malignant pleural mesothelioma. It is known that malignant mesothelioma is a rare disease, accounting for less than 1% of all cancers in the United States. Treatment for malignant pleural mesothelioma has shown some limited progress with certain histological subtypes, surgery, chemotherapy, and radiation. Having a limited number of patients, and some patients opting for palliative care, it has been difficult for scientists to conduct randomized trials with sufficient numbers of patients.
The guidelines are offering the best recommendations from the literature and expert review of the treatment for malignant pleural mesothelioma. The five clinical questions that are addressed are:
1. What is the optimal approach to obtain a diagnosis of mesothelioma?
2. What initial assessment is recommended before initiating any therapy for mesothelioma?
3. What is the appropriate first and second line systemic treatment of patients with mesothelioma?
4. What is the appropriate role of surgical cytoreduction in the management of mesothelioma?
5. When should radiation be recommended for mesothelioma?
In addition to their findings on these questions there is more in- depth evidence on the timing of chemotherapy, radiation, and surgery. The guidelines also address chemotherapy. The only approved regime is from 2004 and consists of platinum and pemetrexed with folic acid and vitamin B12 supplementation. This is the treatment that is offered to most patients with malignant pleural mesothelioma. The point is made that, although platinum and pemetrexed are still the only approved drugs for the treatment of malignant pleural mesothelioma, progress has been made in understanding the biology behind mesothelioma. Different therapies may be available in the context of a clinical trial.
Centers of Excellence across the country are where experts can be found to treat mesothelioma and are and where clinical trials are conducted. The guidelines mention once again show the importance of consulting a center where a multidisciplinary team led by an expert in malignant pleural mesothelioma can evaluate the patient. During this process, the team takes many factors into consideration including functional status, stage of disease, and other chronic health conditions. After evaluation, and in conjunction with the patient’s wishes, specialty mesothelioma centers offer the best evidenced-based treatment options currently available.
The guidelines also note the importance of realizing that there is limited access to health care and some patients are at risk for receiving sub-optimal care often due to socio-economic issues.
Through cooperation, continued collaboration among the experts and the mesothelioma community, these guidelines can help to improve the care of mesothelioma patients as progress is made to a cure for all.
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