Malignant Pleural Mesothelioma: an Update for Pulmonologists

Purpose of ReviewMalignant pleural mesothelioma (MPM) is an incurable disease, and its global incidence is predicted to rise. The epidemiology is changing especially in developed countries where the increases in incidence centers around the older age group. Pulmonologists are the frontline specialists faced with the challenges of diagnosing MPM and management of the associated respiratory issues, especially malignant pleural effusions. Although much of recent literature surrounds treatment of MPM, this review highlights latest developments in aspects of MPM care relevant to pulmonologists' practice.Recent FindingsAdvances in imaging have allowed more MPM cases to be diagnosed with percutaneous-guided biopsy without resorting to thoracoscopy. Cytological examination, coupled with molecular testing (e.g., BAP-1 loss and fluorescent in situ hybridization for CDKN2A gene loss), now allows many cases of MPM to be diagnosed by pleural fluid cytology. Many biomarkers have been proposed for mesothelioma; however, work is needed to first validate initial studies and then tease-out the interactions between known prognostic indicators and any proposed biomarker. A series of multicenter randomized trials have established the role of indwelling pleural catheter (IPC) as the choice of management for malignant pleural effusions. Combining IPC with talc pleurodesis is a new approach. Prognostic factors, including a new algorithm, are reviewed to assist pulmonologists.SummaryMany guidelines have been published by various agencies, again with different recommendations (especially regarding therapies). Pulmonologists must therefore stay abreast of the literature in order to provide the best care for patients.