Expert review of respiratory medicine
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Malignant pleural mesothelioma is a highly invasive tumor arising from the mesothelial cells of serosal surfaces. Several chemotherapeutic agents have been tested for the treatment of this disease and doublet cisplatin with antifolates has been demonstrated to have significant efficacy in Phase III studies. ⋯ Targeted therapies are being developed in oncology and emerging evidence suggests that they offer disease control in several tumors. This article reviews the knowledge on the malignant pleural mesothelioma molecular pathway and focuses on results of clinical trials conducted on this devastating disease.
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Expert Rev Respir Med · Apr 2010
ReviewProlonged glucocorticoid treatment and secondary prevention in acute respiratory distress syndrome.
Experimental and clinical evidence has demonstrated a strong association between dysregulated systemic inflammation and progression of acute respiratory distress syndrome (ARDS). In ARDS, glucocorticoid receptor-mediated downregulation of inflammation is essential to restore homeostasis and decrease morbidity and mortality. ⋯ Treatment was also associated with a marked reduction in the risk of death (relative risk: 0.68; 95% CI: 0.56-0.81; p < 0.001) and a sizable increase in mechanical ventilation-free days (weighted mean difference: 6.58 days; 95% CI: 2.93-10.23; p < 0.001); and intensive care unit-free days (weighted mean difference: 7.02 days; 95% CI: 3.20-10.85; p < 0.001). We recommend that prolonged methylprednisolone treatment, at an initial dose of 1 mg/kg/day in early ARDS and 2 mg/kg/day in unresolving ARDS, be delivered as an infusion to avoid glycemic variability, and that infection surveillance be strictly implemented to identify infections in the absence of fever.