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Malignant pleural mesothelioma (MPM) is a rare tumour due to occupational asbestos exposure. The incidence of MPM will continue to increase until 2020-2030. The incidence reaches 100 cases/million/year in occupationally exposed populations as opposed to 1 case/million/year in the general population, leading to 800 to 1,000 cases per year in France. The molecular carcinogenesis of MPM is incompletely understood but alterations to genes NF2, c-met, WT1 RASSF and p16 have been described. These genes are involved in cell invasion and motility, cell division and apoptosis control. Histological diagnosis remains difficult and depends on immunohistochemical analysis as described by the French Mesopath group. Clinical diagnosis relies on thoracoscopy and large pleural biopsies, with increasing use of CT-PET for the evaluation of disease extent. Therapeutic strategy includes prophylactic irradiation following drainage or thoracoscopy to prevent tumour nodule development along drainage channels and puncture sites. In selected patients, extensive extra-pleural pneumonectomy can be performed with curative intent. First line chemotherapy is based on a combination of pemetrexed and cisplatin that has demonstrated an improvement in overall survival and quality of life in phase 3 trials. Antiangiogenic agents such as bevacizumab (Avastatin) may be of interest but need to be tested in phase 3 trials. The Mesothelioma Avastatin Pemetrexed Study (MAPS) is ongoing, coordinated by the French Thoracic Cancer Intergroup (IFCT).

Background: Metastatic bronchial carcinoid tumours are rare but some patients have a prolonged survival. A new functional imagery now makes it possible to supplement the assessment of the extent of disease., Observation: A 57 year old patient was referred for dyspnoea on exertion revealing an upper left lobar tumour, with carcinoid syndrome. The assessment enabled to find out a bronchial carcinoid tumour with liver and bone metastases, highlighted by positron-emission tomography and pentetreotide SPECT. A chemotherapy proved to be ineffective and upper left lobectomy was carried out because of the risk of pulmonary atelectasis. The patient was treated by somatostatin analogues then underwent liver transcatheter arterial chemo-embolization. The patient was alive 44 months after diagnosis (56 months after first computed tomography)., Conclusion: Metastatic bronchial carcinoid tumours are rare. They keep a metastatic potential, the histological type remaining the major prognosis factor. Carcinoid syndrome is suggestive. The assessment of extra-thoracic disease extent benefits by contribution of new functional imagery techniques such as the pentetreotide SPECT and positron-emission tomography. The management is essentially symptomatic since there is no effective chemotherapy. However survival can be prolonged, even in multimetastatic patients.

An increasing knowledge of cell signal transduction pathways has led to a better understanding of multi-step bronchial carcinogenesis. This new data has been used to design new drugs targeting specific proteins involved in epithelial cell transformation. New biotherapies are a major part of the evolving strategies to fight lung cancer and actually represent a true revolution for subsets of patients. Future treatments in lung cancer patients will be tailored on the basis of routine molecular analysis of surgical and bronchoscopic biopsy specimens. Tyrosine-kinase EGFR inhibitors and VEGF inhibitors are the first molecules in this new class of therapies for lung cancer. Their mechanism of action and the resistance mechanisms that occur with these new drugs continue to be analysed, and this knowledge will help to improve the targeting of therapeutic regimes. In the same way, a better knowledge of the molecular resistance mechanisms to classical chemotherapy agents (platinum compounds, anti-metabolite agents or tubulin-interacting agents) will lead to a tailored use of these drugs, based again on the molecular characteristics of tumor specimens. The surprisingly long survivals observed among subsets of 'molecular-selected' patients, treated with frontline EGFR tyrosine-kinase inhibitors (TKIs) in still limited prospective clinical trials, could herald significant improvement in the global efficacy of lung cancer therapeutics.