Friday, October 14, 2005
The current New England J of Medicine has a review of advances in malignant mesothelioma. It was interesting to note the different tone in this review vs. the recent cholangiocarcinoma review--much more optimistic. I don't know whether this represents a real difference in the outlook for these diseases or the disposition of the authors. Nevertheless things aren't great--rates of mesothelioma are rising in most of the world (although they may have peaked in the US) & median survival is 1 year. The "big" development in chemotherapy is adding pemetrexed to cisplatin which yields an objective response of 41% & extends life by less than 3 months. Ugh. As usual there are glosses of multiple novel agents, biologic therapies, etc. which may or may not pan out. This context didn't get the section on "palliation" much column space, which is fine as this is from the NEJM "medical progress" series, but the authors did make the interesting point that the legal process surrounding asbestos compensation often heightens the anger & fear surrounding the patients' lethal diagnosis.