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Gene therapy for mesothelioma is in its infancy, yet the results of recent phase I clinical trials and ongoing preclinical studies offer significant promise for the future. Intrapleural and intratumoral injections of viral and nonviral vectors encoding therapeutic genes have proved safe in humans with evidence of intratumoral gene transfer and expression of therapeutic proteins. Anecdotal tumor responses have been seen in suicide gene therapy trials, either as a result of direct cytotoxicity or via induction of bystander immunologic phenomena. Our group is vigorously pursuing an immuno-gene therapy approach with an adenovirus expressing interferon-β. Expanding knowledge of the cellular and molecular abnormalities responsible for the carcinogenesis of mesothelioma has led to the development of new gene therapy approaches targeting oncoproteins and mutant tumor suppressor genes. Implementation of these experimental modalities on a routine basis for mesothelioma patients remains several years in the future. Nevertheless, the lack of significant benefit from standard anticancer treatments in the disease argues strongly for patient enrollment in clinical studies of various gene therapy approaches to determine safety, toxicity, and efficacy, as well as to guide future laboratory investigation.

Asbestos litigation is the longest running mass tort in United States history. Mesothelioma is its most conspicuous type of case. The economic aspects of these phenomena have had a major effect on the American economy.