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Pleural Therapies Can Help Pleural Mesothelioma Patients

Published: June 28, 2024

Malignant mesothelioma is a cancer of the mesothelium, which is the lining of certain areas of the body including the lungs (called the pleura). It is mainly caused by asbestos, and usually occurs 30 to 50 years after initial asbestos exposure. Mesothelioma has a poor outlook, with most patients living only 18 months after diagnosis. Mesothelioma is known as a rare cancer, but cases continue to pop up and the cancer is growing in populations. In 2020, there were around 30,000 cases reported worldwide. The yearly rate is supposed to grow to 53,000 by 2040. Rising cases are attributed to growing asbestos use and asbestos being used in banned areas.

The pleural space is a thin gap between two pleural mesothelial layers filled with fluid. The layers line the chest wall and the lungs. They help in the normal functioning of the lungs by helping them expand and contract smoothly during breathing. The area can have pleural build up called pleural effusion or tumor growth directly on the membrane called pleural mesothelioma. Pleural mesothelioma causes symptoms like shortness of breath, chest pain, and pleural effusion. Due to symptoms of mesothelioma not being specific to the disease, it is hard to diagnose pleural mesothelioma early. There is also a large delay between asbestos exposure and symptom onset. There are different techniques to diagnose mesothelioma. These can include CT scans, PET-CT scans, and thorascopy. Staging is a crucial part of treatment. Stage I, also known as pleura only, shows pleural issues without invasion. Accurate staging is important because it could identify who benefits from specific treatments, like intrapleural therapies.

Intrapleural therapies involve injecting anticancer drugs into the pleural space. This practice is best done on people when people are in early stages of the disease when the cancer is only on the pleural surfaces. This practice increases drug amounts in the area, helping to reduce side effects. Trials of intrapleural immunotherapies in the 1990s showed good responses, but the rise of systemic chemotherapy led to less of a focus on this method. Trying to expand intrapleural trials faces different hardships like the pleural space being hard to access. There are methods like pleural catheters and talc pleurodesis which are used for pleural effusion, but they must be fine-tuned for intrapleural therapy. It is crucial to select suitable patients through thorough radiological checks and to educate patients and caregivers.

New technologies are also emerging. There is a chance that they can boost effectiveness of intrapleural treatment. Injectable hydrogels and nanotechnology devices could improve drug delivery and distribution for example. Innovations like this promise better outcomes for pleural mesothelioma patients.

Kevin G. Blyth et al., “Leveraging the pleural space for anticancer therapies in pleural mesothelioma” The Lancet Respiratory Medicine” (May 10, 2024). [Link]
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