The management of malignant pleural mesothelioma in the USA 2004-13—a decade of lost opportunity?

In a detailed, recently published, retrospective analysis, Saddoughi and colleagues (1) have studied the records of patients with malignant pleural mesothelioma (MPM) held in the National Cancer Database of USA from 2004 to 2013 with their main focus being an analysis of treatment trends. From a database of over 19,000 patients one of the most disappointing statistics was the finding that around 40% of patients with MPM received no active treatment. Of the remainder, in what must be assumed to be a palliative program, chemotherapy alone was given to 31%. No details were available on individual agents or duration of regime. Analysis of the demographics of this population suggest that many patients were actually potentially suitable for radical treatment as they were relatively fit and had potentially treatable disease. Over two thirds had a reported Charlson index of 0 and many had early clinical stage disease with 35–40% T1 or T2 and an estimated 50% were node negative