恶性胸膜间皮瘤诊治进展

Advances in diagnosis and management of malignant pleural mesothelioma

恶性胸膜间皮瘤是一种进展性胸部恶性肿瘤。病因可能与石棉、SV4 0病毒和遗传倾向有关。诊断方法包括X线摄片、病理学和分子生物学检测。大多数恶性胸膜间皮瘤患者不能进行手术或放射治疗 ,细胞毒药物化疗剂成为唯一可选择的方法 ,有效率 <2 0 %。近来一种多靶点抗叶酸剂 pemetrexed ,已进行了Ⅰ、Ⅱ、Ⅲ期临床试验并获得了可喜的结果。加用小剂量的叶酸和B12 补充治疗能减轻pemetrexced的毒副反应。pemetrexed/顺铂以被推荐为恶性胸膜间皮瘤的一线化疗方案。

Malignant mesothelioma is an aggressive malig na ncy that may be caused by environmental carcinogens(asbestos),viruses(SV40),and genetic predisposition.Diagnosis relies on radiographic studies as well as patho logy and mdecular bidogy tests.Most such patients are not suitable for surgical or radiotherapy treatment,and cytotoxic agents are the only options.Historically ,no single or combinations of agents consistently yielded response rates over 20 %.Recently,pemetrexed,a folate-based inhibitor of thymidylate synthase,has been evaluated in phase Ⅰ,ⅡandⅢ clinical trials with promising results.Moreover, low-dose folic acid and vitamin B 12 supplementation significantly reduced the toxicity observed with the use of pemetrexed.In light of these data,it is l ikely that pemetrexed/cisplatin will soon be recommended for malignant pleural m esothelioma as first-line standard chemotherapy.