Mésothéliomes pleuraux malins

Malignant mesothelioma is a rare and aggressive tumor issued from the mesothelial surface, essentially of the pleural space. A previous (mainly occupational) exposure to asbestos is the main risk factor of mesothelioma. Clinical signs are most of time late and unspecific. Chest CT-scan, a key procedure, usually shows (unilateral) pleurisy associated with pleural thickening. Other procedures such as PET-scan associated with CT-scan, chest resonance magnetic imaging and blood or pleural fluid biomarkers, including soluble mesothelin are not recommended for the diagnosis of malignant mesothelioma in routine. Therefore the diagnosis of mesothelioma is based on histology with compulsory immunohistochemistry study on pleural biopsies best obtained by thoracoscopy. The treatment relies mostly on first-line chemotherapy by cisplatin-pemetrexed with very few options in case of progression. Pleurectomy/decortication becomes currently preferred compared to extrapleural pneumonectomy (almost stopped) but any surgery with curative intent in mesothelioma is not recommended yet outside a clinical trial, as well as adjuvant chest radiotherapy. Prophylactic irradiation of chest scars and drains, validated in France, is however highly discussed by international experts. However, many clinical trials presently assess the value of targeted therapies and anti-tumor immunotherapy, as well as intraoperative pleural treatments in mesothelioma, bringing new hopes in the management of this cancer. Thus, following the recent and positive results of the French trial MAPS, a new standard of first-line chemotherapy including bevacizumab may soon emerge for patients with unresectable mesothelioma or even for all patients. The optimisation of management and the speeding of research studies will be also enhanced by the establishment of the French national network of expert clinical centres for mesothelioma (MESOCLIN), associated with French pathology expert network (MESOPATH) and the INVS in the new national project MESOBANK dedicated to all patients and actors of this disease.