Interdisziplinäre Diagnostik und Therapie von malignen Mesotheliomen

Zusammenfassung

Das asbestbedingte maligne Mesotheliom (MM) gehört in Deutschland mit ca. 1000 Neuerkrankungen pro Jahr zu den häufigen berufsbedingten Krebserkrankungen. Die Diagnose eines MM ist, sofern die entsprechenden diagnostischen Kriterien erfüllt sind, sowohl aus histologischem als auch aus zytologischem Probenmaterial mit hoher Spezifität möglich. Allerdings werden viele MM zyto-/histologisch erst in fortgeschrittenen Stadien entdeckt. Klinisch/radiologische Aspekte ergänzen die Diagnostik und ermöglichen eine interdisziplinäre Beurteilung des Tumorstadiums und individuelle Entscheidungen über die bestmöglichen Therapieoptionen für jeden einzelnen Patienten. Diagnostisch hat die videoassistierte Thorakoskopie (VATS) den höchsten Stellenwert. Die Therapieplanung orientiert sich am vorliegenden MM-Subtyp, der Tumorausbreitung und Stadium sowie dem klinischen Zustand des Patienten. Die Prognose des MM ist im Allgemeinen sehr ungünstig. Dementsprechend zielt die Standardtherapie auf eine makroskopische radikale Tumorresektion im Sinne einer Zytoreduktion im Rahmen eines geeigneten multimodalen Therapiekonzepts (Chemotherapie, Strahlentherapie, Psychoonkologie). Ziel palliativer Maßnahmen sollte v.a. die Symptomkontrolle sein. Insgesamt ist die interdisziplinäre Diagnostik und Therapie des MM entscheidend für die bestmögliche Versorgung der MM-Kranken.

Abstract

The asbestos-related malignant mesothelioma (MM) is one of the common occupational cancers in Germany with approximately 1000 new cases per year. Provided that the appropriate diagnostic criteria are fulfilled, MM can be diagnosed with high specificity from both histological and cytological specimens. However, many MM are detected cyto-/histologically only at advanced stages. Clinical/radiological aspects complement each other and enable interdisciplinary assessment of tumor stage and individualized decisions on the best possible therapeutic options. Diagnostically, video-assisted thoracoscopy (VATS) has the highest priority. Therapy planning is based on the MM subtype, tumor spread and stage, and the patientʼs clinical condition. MM has generally a very unfavorable prognosis. Accordingly, the standard therapy aims at a macroscopic radical tumor resection in terms of cytoreduction within the framework of a suitable multimodal therapy concept (chemotherapy, radiotherapy, psychooncology). The aim of palliative measures should be primarily symptom control. Overall, interdisciplinary diagnosis and therapy of MM is crucial for the best possible care of MM patients.

Schlüsselwörter

malignes Mesotheliom - Zyto-/Histologie - interdisziplinäre Diagnostik und Therapie

Keywords

malignant mesothelioma - cyto-/histology - interdisciplinary diagnosis and therapy

• Literatur

• 1 McDonald J, McDonald A. The epidemiology of mesothelioma in historical context. Eur Respir J 1996; 9: 1932-1942
• 2 Aigner C, Brüning T, Eberhardt WEE. et al. Die aktuelle Therapie des asbestassoziierten malignen Pleuramesothelioms – Ein Experten-Konsensuspapier [The Current Therapy of Asbestos-Associated Malignant Pleural Mesothelioma – An Expert Consensus Paper]. Pneumologie 2021; 75: 776-794
• 3 Neumann V, Günther S, Müller K. et al. Malignant mesothelioma – German mesothelioma register 1997–1999. Int Arch Occup Environ Health 2001; 74: 383-395
• 4 Delgermaa V, Takahashi K, Park E. et al. Global mesothelioma deaths reported to the World Health Organization between 1994 and 2008. Bull World Health Organ 2011; 89: 716-724
• 5 Bianchi C, Giarelli L, Grandi G. et al. Latency periods in asbestos-related mesothelioma of the pleura. Eur J Cancer Prev 1997; 6: 162-166
• 6 Milano M, Zhang H. Malignant Pleural Mesothelioma A Population-Based Study of Survival. J Thorac Oncol 2010; 5: 1841-1848
• 7 Scherpereel A, Opitz I, Berghmans T. et al. ERS/ESTS/EACTS/ESTRO guidelines for the management of malignant pleural mesothelioma. Eur Respir J 2020; 55: 479-495
• 8 Scherpereel A, Astoul P, Baas P. et al. Guidelines of the European Respiratory Society and the European Society of Thoracic Surgeons for the management of malignant pleural mesothelioma. Euro Respir J 2010; 35: 479-495
• 9 Husain AN, Colby TV, Ordóñez NG. et al. Guidelines for Pathologic Diagnosis of Malignant Mesothelioma 2017 Update of the Consensus Statement From the International Mesothelioma Interest Group. Arch Pathol Lab Med 2018; 142: 89-108
• 10 Müller M. Hyaluronsäuremessung im Pleuraerguss – Diagnostischer Parameter maligner Mesotheliome. Dissertation. Universität Hamburg: Fachbereich Medizin; 2005
• 11 Galateau-Salle F, Churg A, Roggli V. et al. The 2015 World Health Organization Classification of Tumors of the Pleura: Advances since the 2004 Classification. J Thorac Oncol 2015; 11: 142-154
• 12 Colby TV. The Diagnosis of Desmoplastic Malignant Mesothelioma. Am J Clin Pathol 1998; 110: 135-136
• 13 Nicholson AG, Sauter JL, Nowak AK. et al. EURACAN/IASLC proposals for updating the histologic classification of pleural mesothelioma: towards a more multidisciplinary approach. J Thorac Oncol 2020; 15: 29-49
• 14 Travis W, Brambilla E, Nicholson A. et al. The 2015 World Health Organization Classification of Lung Tumors Impact of Genetic, Clinical and Radiologic Advances Since the 2004 Classification. J Thorac Oncol 2015; 10: 1243-1260
• 15 Welker L, Müller M, Holz O. et al. Cytological diagnosis of malignant mesothelioma – improvement by additional analysis of hyaluronic acid in pleural effusions. Virchows Arch 2007; 450: 455-461
• 16 Biancosino C, Linde LIS van der, Sauter G. et al. Cytological Diagnostic Procedures in Malignant Mesothelioma. Adv Exp Med Biol 2022; 1374: 41-49
• 17 WHO Reporting System for Lung Cytopathology, Ed. IAC-IARC Cytopathology. Reporting Systems. 1th Edition. Bd 1. Lyon: 2022
• 18 Hjerpe A, Ascoli V, Bedrossian C. et al. Guidelines for the Cytopathologic Diagnosis of Epithelioid and Mixed-Type Malignant Mesothelioma. Acta Cytologica 2015; 59: 2-16
• 19 Rusch VW. Diffuse Malignant Mesothelioma. et al. In: Shields TW, Locicero III J, Reed CE. General Thoracic Surgery. 7th ed. Lippincott Williams & Wilkins; 2009: 847-859
• 20 Shah R, Klotz LV, Glade J. Current Management and Future Perspective in Pleural Mesothelioma. Cancers (Basel) 2022; 14: 1044
• 21 Zhou N, Rice DC, Tsao AS. et al. Extrapleural Pneumonectomy Versus Pleurectomy/Decortication for Malignant Pleural Mesothelioma. Ann Thorac Surg 2022; 113: 200-208
• 22 Srour SA, Stoner JA. Pemetrexed in combination with cisplatin versus carboplatin as first-line therapy in patients with advanced-stage malignant pleural mesothelioma (MPM): A systematic review and meta-analysis. J Clin Oncol 2016; 34: 8554
• 23 Dudek AZ, Wang XF, Gu L. et al. Randomized phase 2 study of maintenance pemetrexed (Pem) versus observation (Obs) for patients (pts) with malignant pleural mesothelioma (MPM) without progression after first-line chemotherapy: Cancer and Leukemia Group B (CALGB) 30901 (Alliance). J Clin Oncol 2019; 37: 8157
• 24 Burgers JA, Gooijer C de, Cornelissen R. et al. Switch maintenance gemcitabine after first line chemotherapy in patients with malignant mesothelioma: a multicenter open label phase II trial (NVALT19). Poster presented at: European Society for Medical Oncology. Annual Meeting; 27 September–1 October 2019, Barcelona, Spain. Ann Oncol 2019; 30 (Suppl. 05) v851-v934
• 25 Zalcman G, Mazieres J, Margery J. et al. Bevacizumab for newly diagnosed pleural mesothelioma in the Mesothelioma Avastin Cisplatin Pemetrexed Study (MAPS): a randomised, controlled, open-label, phase 3 trial. Lancet 2016; 387: 1405-1414
• 26 Baas P, Scherpereel A, Nowak AK. First-line nivolumab plus ipilimumab in unresectable malignant pleural mesothelioma (CheckMate 743): a multicentre, randomised, open-label, phase 3 trial. The Lancet 2021; 397: P375-P386
• 27 Peters S, Scherpereel A, Cornelissen R. et al. LBA65 First-line nivolumab (NIVO) plus ipilimumab (IPI) vs chemotherapy (chemo) in patients (pts) with unresectable malignant pleural mesothelioma (MPM): 3-year update from CheckMate 743. Annals of Oncology 2021; 32 (Suppl. 05) S1341-S1342
• 28 Scherpereel A, Mazieres J, Greillier L. et al. Nivolumab or nivolumab plus ipilimumab in patients with relapsed malignant pleural mesothelioma (IFCT-1501 MAPS2): a multicentre, open-label, randomised, non-comparative, phase 2 trial. Lancet Oncol 2019; 20: 239-253
• 29 Popat S, Curioni-Fontecedro A, Dafni U. et al. A multicentre randomised phase III trial comparing pembrolizumab versus single-agent chemotherapy for advanced pre-treated malignant pleural mesothelioma: the European Thoracic Oncology Platform (ETOP 9–15) PROMISEmeso trial. Ann Oncol 2020; 31: 1734-1745
• 30 Bayman N, Appel W, Ashcroft L. et al. Prophylactic irradiation of tracts in patients with malignant pleural mesothelioma: an open-label, multicenter, phase III randomized trial. J Clin Oncol 2019; 37: 1200-1208