Contents

#### **Preface XI**

	- **Malignant Pleural Mesothelioma 93**  Giulia Pasello and Adolfo Favaretto

Preface

different perspectives.

summarized at the end of this chapter.

Malignant mesothelioma (MM) is a highly invasive tumor arising from the mesothelial cells of serosal surfaces. It shows an extremely poor progression and is diagnosed mostly in locally advanced or metastatic stage, thus drastically limiting its treatment options. Past asbestos exposure has been shown to be the most important predictor of MM, although other environmental and genetic factors like Simian Virus-40 (SV-40)

This book brings together the knowledge of experts in the filed of malignant mesothelioma who provide their invaluable insights into this deadly disease from

The book starts with a *tour de force* account of MM epidemiology in South Africa (SA) by scholars who have spent major part of their professional careers working in this field. In a gripping *tell-a-tale*, they recall how South Africa benefitted financially from the exploitation of its asbestos mineral reserves, but at a huge cost of human lives due to asbestos related diseases, including MM and lung cancer. South Africa plays a historically important role in our understanding of epidemiology of MM, thanks mainly to the seminal work by Dr. J. C. Wagner who showed definitive link between asbestos exposure and mesothelioma. In this chapter, the authors give a detailed account of the cases of mesothelioma in South Africa meticulously linking them to different forms of asbestos exposure (both occupational and non-occupational). They further dissect the carcinogenic potentials of the most common asbestos fibers mined in SA. There are many important lessons to be learnt from this SA experience, aptly

In the next chapter, Yasumitsu Nishimura et al. describe in detail the anti-tumor immunity and immunological alterations in MM, a hitherto neglected but nevertheless important aspect of MM-geneis. The authors show that exposure to asbestos might cause a suppressive effect on anti-tumor immunity in addition to the tumorigenic effect on mesothelial cells. This 'immunological' insight could not have come at a better time as only recently it is shown that blockade of PD-1, an inhibitory receptor expressed by T cells, gives promising therapeutic results in patients of many advanced

cancers (Suzanne L. Topalian et al., and Julie R. Brahmer et al.; NEJM, 2012).

infection and genetic predisposition might also play important roles.
