Mesothelioma

Question 1

What are the known risk factors for meso?

Answer 1

• male preponderance
• most commonly from occupational exposure
• occupations: production of asbestos sheets,
  brake and clutch linings, construction/demolition work,
  dock and ship yard workers, electricians, plumbers and
  launderers
• brown and blue asbestos exposure
• rare cases associated with BAP1 gene breast ca

Question 2

T in TNM?

Answer 2

T1 Tumour limited to the ipsilateral pleura (any surface)
T2 Tumour involving ipsilateral pleural surfaces with at least:
►Involvement of diaphragmatic muscle
►Extension from visceral pleura into the underlying lung
T3 Describes locally advanced but potentially resectable tumour. Tumour involving all of the ipsilateral pleura with at least:
►Involvement of endothoracic fascia
►Extension into the mediastinal fat
►Solitary, completely resectable focus of tumour extending into the soft tissues of the chest wall
►Non-transmural involvement of the pericardium

T4 Describes locally advanced technically unresectable tumour. Tumour involving all of the ipsilateral pleura with at least:
►Diffuse extension or multifocal masses of tumour in the chest
wall, with or without associated rib destruction
►Direct transdiaphragmatic extension of tumour to peritoneum
►Direct extension of tumour to contralateral pleura
►Direct extension of tumour to mediastinal organs
►Direct extension of tumour into spine
►Tumour extending through to the internal surface of pericardium

Question 3

N in TNM?

Answer 3

N1 Metastases in ipsilateral bronchopulmonary, hilar or mediastinal (including internal mammary, peridiaphragmatic, pericardial fat pad or intercostal lymph nodes) LNs
N2 Metastases in the contralateral mediastinal, ipsilateral or contralateral supraclavicular LNs

Question 4

M in TNM?

Answer 4

M1 distant mets

Question 5

SUV threshold to define malignant v benign pleural disease?

Answer 5

SUV >2 sensitivity of 88%–100% and specificity of
88%–92%

Question 6

immunohistochemistry (IHC) test- what is helpful?

What subtype is it not as helpful in?

Answer 6

need two pos IHC and two neg adenoca IHC

p16 FISH deletion- very helpful and positive generally in MPM

GLUT-1 (good sens/spec)

other Positive IHC markers for MPM: calretinin, thrombomodulin, CK5/6, CAM5.2, EMA, vimentin, HBME-1, Wilms Tumour-1, p53
Negative IHC markers for MPM include Ber-Ep4, MOC-31,
CEA, Leu-1, CD15, TTF-1, B72.3

Diagnostic accuracy of IHC markers is reduced in sarcomatoid

Question 7

what is EMPHASIS?

Answer 7

trial done to look at chemo pemetrexed/cisplatin v control (cisplatin alone)
-3 month survival benefit
- time to progression was longer (5.7 v 3.9)
-response rate was 41% v 17%

Question 8

how does pemetrexed work?

Answer 8

inhibits thymidylate synthase, thereby preventing the formation
of precursor pyrimidine nucleotides

Question 9

what was MS01?

Answer 9

trial comparing:
1. active symptom Mx
2. active symptom Mx + MVP (mitomycin, cisplatin and
vinblastine)
3. active symptom Mx + vinorelbine

• no survival benefit
• no QOL differences

Question 10

What was MAPS?

Answer 10

trial with pem+cisplatin v bevacizumab

pem/cisplatin = longer survival 18months v 16