For patients with the drug so far as little as a controllable current malignant pleural mesothelioma, there is now a treatment option. Studies have shown that the antifolate pemetrexed in combination with cisplatin can prolong the survival of these patients.

Pemetrexed (Alimta ®) was approved in September for the indication for pleural mesothelioma and second-line chemotherapy in advanced cancer. It is the first drug that has an approval in Europe for the treatment of patients with malignant pleural mesothelioma.

In a large Phase III trial survived the patients who received pemetrexed and cisplatin had an average of twelve months. Untreated patients with malignant pleural mesothelioma usually die within months after diagnosis. Just over half the patients treated with pemetrexed and cisplatin was, after a year still alive. Of the patients in the control group who received only cisplatin, at that time lived only 38 percent.

“In combination with cisplatin, pemetrexed has become the standard for the treatment of patients with malignant pleural mesothelioma”, said Professor Christian Manegold of Heidelberg University oncologist at the European Congress in Vienna. could the first time, patients with a disease, its abundance in the western world because of its association with a 20 to 40 years back lying to asbestos grow strongly for several years, will be offered chemotherapy.

Manegold highlighted the good tolerability of pemetrexed treatment. The substance, which is administered once every three weeks along with vitamin B12 and folic acid come, the ideal of a quality of life only slightly debilitating chemotherapy very near, Manegold at the event supported by the company Lilly

Asbestos, also known as asbestos is a group of fibrous metamorphic minerals. They are composed of double chain silicates.

Asbestos minerals have long, strong fibers that can be separated and are flexible enough to be intertwined and also resist high temperatures.

Because of these special characteristics, asbestos has been used for a wide variety of manufactured products, mainly in construction materials (tiles for roofing, tiles, paper products and asbestos cement products), friction products (automobile clutch, brake, transmission components), heat-resistant textile materials, containers, packaging and coatings, protective equipment, paints, vermiculite or talc …. is also present in some foods.

It has been determined by international medical bodies that asbestos-related products / asbestos cause cancer with high mortality and therefore, for decades, has prohibited its use in all developed countries, although it is still used in some countries developing.

The main carcinogenic asbestos

Asbestos effects on health have been known for a long time, because in the first century, Pliny the Elder, in Rome, described the disease in the lungs of slaves who wove asbestos clothing.

The ancient alchemists believed that the extraordinary asbestos fibers were made by “the hair of mythical and salamanders toxic fire resistant” and named it “salamander’s wool. The deadly substance that poisoned the salamander segregated fruit trees and the waters of rivers and wells. It is said that 2000 men and 4000 horses of Alexander the Great died in India after drinking poisoned by a stream salamander.

Charlemagne had a tablecloth asbestos fibers, with which acts of fire impressed with their guests and diners, who cleaned and bleached by simply inserting it into the fire.

During the second half of the thirteenth century explorer Marco Polo visited China asbestos mines in describing the process of ore extraction and finally discarding the myths and eliminating the old “theory of the salamander.

It was in 1906 in London (England) when he described the first known case of “pulmonary fibrosis Asbestos” a worker of 33 years, the area of carding in a textile factory.

Since 1935, the first known scientific work related asbestos exposure and lung cancer in 1947 and describes the mesothelioma of pleura and peritoneum, and is now known that asbestos is the best known of industrial chemicals linked to cancer lung.

Today it is absolutely certain of two types of cancer caused by asbestos exposure: asbestosis, lung cancer and mesothelioma. Not recognized a minimal amount of the agent below which an exposure is safe. Lung cancer in workers exposed becomes up to 7 times more frequent than in the general population.

Chemotherapy of malignant pleural mesothelioma unresectable was approved in Europe in 2004. This combination of cisplatin to a new multi-target antifolate, pemetrexed (Alimta), improves length and quality of survival. In monotherapy, Alimta is indicated as second line treatment of lung cancer in non-small cell.
Malignant pleural mesothelioma (MPM), said Dr. P. Ruffié (IGR, Villejuif), has long been a kind of orphan disease without treatment. It is mainly caused by exposure to asbestos while also discussing the role of genetic predisposition, ionizing radiation, some viruses. Its incidence increased by 25% every three years because of its development time (latency from thirty to forty years), the worst is yet to come: a peak of incidence is planned for 2020.

Late diagnosis.

Occupational diseases related to asbestos are underreported (25%) as the industries concerned, they could be underway to relocate in the world. The diagnosis is delayed (98% of cases) at a time when surgery and radiotherapy are not possible, the prognosis is poor, little changed by different chemo-and radiotherapy isolated tried so far. The median survival of epithelioid MPM (68% of MPM) is ten to seventeen months in the absence of any treatment, which means that half the patients died within this period, the sarcomatous MPM is resistant to treatment ( survival of four to seven months). However, the prognosis depends on the patient profile: respiratory pain, anemia, leukocytosis and increased platelet elements are pejorative. Treatment received a European marketing authorization in September 2004: pemetrexed (Alimta) in combination with cisplatin is indicated for patients with unresectable MPM not received previous chemotherapy. Its objective is to enable the patient to survive as long as possible under the best conditions. Alimta is an analogue of folic acid, which inhibits three multi-target folate-dependent enzymes essential for cell replication. Cisplatin is an anticancer reference in the treatment of thoracic tumors, the combination works synergistically to block the replication of DNA tumor. One study (N. Vogelzang et al., “Journal of Clinical Oncology, 2003) compared the efficacy of combined than cisplatin alone. The results show a clear superiority of the association: response of 41% of patients (17% cons), median survival twelve months (nine months): half of patients gained three months of extra life “which may seem very little but at this late stage, it is a good result “said Dr Ruffié; half of patients still alive one year after diagnosis with a significant improvement in lung function and symptoms (pain, shortness of breath).

Lung cancer non small cell.

Alimta is indicated as monotherapy in second-line treatment of lung cancer in non-small cell (NSCLC: 80% of lung cancers) with locally advanced or metastatic. In this context, a study (N. Hanna et al., “JCO, 2004) compared Alimta to docetaxel monotherapy. Three out of four patients were at an advanced stage (IV or metastatic), all had relapsed after chemotherapy. The aim was not cure patients, said Dr. T. Knight (IGR Villejuif), but a survival benefit in the best conditions, whereas previously only the palliative care were considered. The median overall survival was “compares favorably” to that of docetaxel (8.3 and 7.9 months); again, the results may seem small, but there are only ten years, we did not second-line treatment , patients are already dead.
The toxicity profile of Alimta is more favorable than leukopenia (5.3% against 40.2%) inparticular less febrile neutropenia, fewer hospitalizations for side effects, use of growth factors very expensive, less alopecia. Vomiting, fatigue, nausea are comparable. Supplementation with folic acid and vitamin B12 required Alimta (500 mg/m2 body surface area) is administered by venous infusion (peripheral vein) of ten minutes on the first day of each cycle of 21 days. Supplementation with folic acid (from 0.350 to 1 mg daily) and oral vitamin B12 (1 000 mcg every nine weeks) by intramuscular route is necessary. With dexamethasone 4 mg morning and evening is administered orally, the day before and day after infusion. Vitamin supplementation is usually very appreciated by the patient since a cancer patient on two would (also) use of alternative medicine. It is essential to reduce the toxicity, the patient can receive up to six cycles, which improves efficiency.

Each progress as infimme be it in research is a step forward. We must learn from the cancer plan: we are the European country which treats the most cancers, and whoever has the most deaths from cancer. The cause of this: the lack of early detection due to lack of prevention. Today medicine has TDM equipment (scanner) very powerful so that it could reverse the trend by discovering native tumors before they grow and metastasize. For this, it would take at least that people know they have been exposed to asbestos, a scanner and go consult a pulmonologist.

What are the causes?

The pleura and the pleura is a double, smooth and slippery membrane around the lungs is: one membrane (pleural) holds the lungs and other membrane holds the chest wall.
Inhalation (inhalation or inspiration) sets the chest (or chest) out. Thanks pleural as an interface serving, put the lungs. The pleura may be an outbreak of cancer. Pleurakanker is 50 to 70% of the cases due to exposure to asbestos, mostly in the context of a professional (insulation, textiles, construction, filters). Pleurakanker is not caused by smoking.

Natural perilously

Asbestos is a natural product, a silicate of iron, magnesium and calcium (ie a mineral) that is flexible fibers that can not rot and fire resistant. Canada is the world’s leading producer of asbestos. Zgn. “amphibole” asbestos fibers are commonly used for heat and sound insulation and the ‘chrysotile’ asbestos fibers are used to make cement. Inhalation (or inhalation) of amphibole fibers may cause pleurakanker. The countries that produce chrysotile asbestos fibers to produce cement, chrysotile fibers do not claim that pleurakanker cause. The European experts argue that that risk is still very likely (but difficult to express in figures given the relatively low incidence of mesothelioma Fri).
As a reminder, exposure to asbestos fibers can cause three types of diseases:

* Pulmonary fibrosis (asbestosis) with progressive evolution to respiratory failure,
* Bronchuskanker (but we know that smoking is an important risk factor is asbestos),
* Pleurakanker of mesothelioma

Exposure to asbestos has been sometimes very short and sometimes very long ago (up to 40 years ago). The number of cases pleurakanker increases by 25% per 3 years!

When to consult?

The main sign of an outpouring of mesothelioma is fluid between the lung two membranes (pleural effusion or pleurisy). Possible symptoms are pain and burden breathing.

But other diseases, including lung infections, can cause a pleural effusion. Given that the effects of asbestos are manifest until years later, it is important to investigate if the lungs are believed to have ever been in contact with asbestos. This goes for people who years ago for a very short time or been exposed to asbestos.

What are the investigations?

The diagnosis is made with an ordinary X-ray of the lungs and a CT scan. In those studies can assess the level of local invasion. A biopsy with reduction of tissue samples is necessary to guarantee a diagnosis. A biopsy is taken under general anesthesia (or sedation) during a short hospital stay. The study of tissue samples may take several days.

What is the treatment?

Pleurakanker If the diagnosis is made, it is unfortunately too late.
Usually one can only palliative (treatment not the cause of the disease heals) treat (chemotherapy, surgery), which mainly seeks to relieve the pain, which may be severe. The patient dies after several months. Hence the importance of screening as it sounds ever to have had contact with asbestos!

Pleural mesothelioma, the most common form of mesothelioma by far and makes 75% of all cases of pleural mesothelioma affects the respiratory system to said areas of the body such as the lungs more precisely, attacks the cancer of the lining of the lungs called the pleura and ribs. Hence the name pleural mesothelioma, the main cause of pleural mesothelioma, asbestos exposure, only a few months after the deadly exposed to asbestos dust and fibers without protection can lead to pleural mesothelioma thirty to fifty years later. Older men in age sixty to seventy are most at risk to asbestos because it was the generation that have worked with asbestos with little protection against dust and fibers due to the long latency period of pleural mesothelioma (30-50 years).

These men very only to discover they have the deadly cancer currently many of these men are lodging million dollar lawsuits against the company exposed them to asbestos. Asbestos fibers get into the lining of the lungs caused by inhalation and in the lung, the symptoms associated with pleural mesothelioma are submitted, are persistent cough, difficulty swallowing, swelling of the face, the weight loss, fever, rasping and coughing up blood patients also experience short breath expands, because the tumor on the lining of the lungs, which leaves less room for the lungs to some patients work properly, also begin to feel severe pain in the chest and this is similar at the spread of cancer cells, many of these symptoms to diseases and conditions that are far more than mesothelioma.

Pleural mesothelioma, that means the joint is often very difficult to diagnosed until it is too late, the treatment of pleural mesothelioma is limited and so far there is no real cure research is conducted in all laboratories in the United States and many pharmaceutical companies are also testing for new treatments for mesothelioma. Treatments include chemotherapy, radiotherapy and surgery A patient’s age, medical history, weight and other factors into account before treatment made the rule of survival is much more likely if pleural mesothelioma is treated aggressively in its early stages, because if the cancer develops mature and it is very difficult to heal.

Pleural Mesothelioma is the most common, its incidence being 9 times higher than the peritoneal mesothelioma. It is more common in men than in women, being the age of onset of symptoms between 50 to 70 years with a latency period of 20 to 40 years. In 80% of cases the etiology is exposure to asbestos dust. Other possible causes of mesothelioma are radiation therapy and polio vaccines contaminated with simian virus SV40. The pleural mesothelioma is about 3% of malignant neoplasms of the pleura, and when the diagnosis is made rapidly and its course is invariably fatal, usually during the next two years.

The most common clinical presentation is diffuse chest pain, which occasionally can be pleuritic or radiating to the shoulder accompanied by pleural effusions. Dyspnea, cough, weakness, malaise and fatigue are usually in advanced stages of disease. In 89% of cases, the abnormal electrocardiogram abnormalities being more frequent sinus tachycardia (42%), ventricular or atrial arrhythmias (17%) and blockage of a branch bundle (30%)

The most common radiographic finding is of an irregular opacity in the lung periphery, associated with ipsilateral pleural effusion, with evidence of deflation, contraction of the hemithorax committed and no shift of the mediastinum to the opposite side, despite significant pleural effusions (*) The diagnosis should be suspected when pleural thickening is found surrounding the lung trap and secured to the mediastinum.