Sarcomatoid Predominant Malignant Pleural Mesothelioma: An Institutional Approach and Experience

Sarcomatoid-predominant malignant pleural mesothelioma is an especially difficult tumor to control. Thoracic surgeons at UCLA seeking to improve the poor prognosis that comes with this incredibly aggressive cancer looked at the treatment of non-mesothelioma pleural sarcomas, which is typically treated with chemotherapy followed by surgery and radiation.

Doctors identified four patients with sarcomatoid-predominant malignant pleural mesothelioma who had received pre-operative therapy before undergoing the lung-sparing pleurectomy/decortication procedure. Three of these patients utilized Ifosfamide/Adriamycin and one patient Cisplatin/Pemetrexed/ Veglin. Three-fourths of these patients were found to have pathological responses with 80-99% necrosis, or tumor death, which is not often seen with standard Cisplatin and Pemetrexed.

Multimodality approaches that utilize Ifosfamide/Adriamycin seem to be the optimal treatment strategy for sarcomatoid-predominant malignant pleural mesothelioma patients. In addition, patients who originally are not eligible for surgery may become so if they see 80% or higher necrosis and remain free of metastatic growth following chemotherapy.