Pleural mesothelioma

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Abstract
Diffuse pleural malignant mesothelioma (DMM) is an uncommon tumor in the general population, but its incidence can be very high in persons exposed to asbestos. There has been controversy about the role of the different fiber types and their responsibility for causing DMM, particularly with chrysotile. Distinguishing between DMM and peripheral adenocarcinoma with pleural involvement is a frequent diagnostic problem. Immunohistochemical markers (positive for vimentin and negative for carcinoembryonic antigen and Leu M1) and electronmicroscopy aid in the diagnosis. Therapeutic results remain poor, and cure of DMM is rare. Local treatments such as surgery or radiation therapy are technically difficult because of the extent of disease. DMM continues to be a chemoresistant tumor. Because DMM is rare, study of this tumor has been hampered by the limited number of available patients in any given institution. Therefore, animal models or representative human malignant mesothelioma cell lines are needed for a dual investigation: first of the basic biology of this disease and second for a preclinical evaluation of chemotherapeutic agents and recombinant anticancer cytokines alone or in combination. Ongoing trials confirm that DMM is resistant to standard forms of therapy, but mesothelial cells are susceptible to immune effector cells and cytokines in in vitro and in vivo models. Thus, recombinant interferon-alpha, -beta, and -gamma have been used for both local and systemic treatment, as has interleukin-2 with and without autologous lymphokine-activated killer cells. In addition, substantial experimental evidence suggests synergy between cytotoxic drugs and cytokines.

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