An Update on Emerging Therapeutic Options for Malignant Pleural Mesothelioma

Abstract

The treatment paradigm for malignant pleural mesothelioma (MPM) has changed little in the last 18 years. Radical intent treatment, consisting of surgical resection, radiotherapy and chemotherapy, has been offered to a highly select few; however, there is little randomised evidence to validate this approach. Prior to 2020 chemotherapy with platinum and an anti-folate was the only intervention with randomised evidence to demonstrate improved overall survival (OS) in MPM. No systemic therapy had been demonstrated to improve OS in the second line setting until 2020. The publication of the Checkmate 743 trial in 2021 demonstrated a survival benefit of combination immunotherapy over standard chemotherapy in newly diagnosed patients with MPM. This finding was shortly followed by the CONFIRM trial which demonstrates a modest but significant survival benefit of second line nivolumab versus placebo in patients having previously received standard chemotherapy. The results of these trials, recent biomarker directed therapy and chemotherapy adjuncts are discussed within this review. The integration of immunotherapy for the few patients in whom radical surgical therapy is intended is currently the subject of clinical trials and offers the prospect of improving outcomes in this rare but devastating disease.

Factors affecting the life expectancy in malignant pleural mesothelioma: Our 10 years of studies and experience

“…Treatment methods such as immunotherapy, immune checkpoint inhibitor treatments, new targeted immune treatments, and tumor treating fields are also being developed. [ 11 ] Epithelioid type and an early-stage disease show a solid survival chance following a surgical treatment. [ 12 ] In addition to its high aggressiveness, the mean overall survival (OS) time of MPM (regardless of tumor stage) is 9 to 17 months (averagely 12 months).…”

LA-ICP-MS analysis reveals differences in chemotherapeutic drug distribution in surgically resected pleural mesothelioma

“…Pt compounds have been used for cancer treatment since the 1970s and even nowadays, in the era of targeted therapies and immunotherapies, they form the backbone of systemic therapy in several solid tumors including PM [10]. Nevertheless, their contribution to OS improvement remains moderate [23]. Importantly, a pivotal cause of therapeutic resistance may be the insufficient drug penetration into the tumor tissue itself [12].…”

A glimpse into the role of debulking surgery and hyperthermic intrathoracic chemotherapy (HITHOC) in the management of malignant pleural mesothelioma

“…However, in the last 10 years, different surgical positive experiences have been reported in Europe, China and the United States, and the use of HITHOC for MPM has also been expanded. As a result of this increase, many systematic reviews have been recently published and all of them confirm a longer survival when HITHOC is added to P/D (35)(36)(37). In a recent systematic review and meta-analysis (8), 762 patients treated with HITHOC have been compared to the control group that did not receive HITHOC.…”

“…Several systematic reviews and meta-analyses have concluded that EPP was associated with more postoperative mortality and morbidity in comparison with P/D. It was also concluded that EPD decreased mortality and morbidity by 2.5 folds and that it improved survival (15,22,(34)(35)(36)(37). MPM symptomatically; however, several studies observed that its surgical complications risks weigh more than the possible benefits and that VATS pleurodesis is a more effective and less invasive method (3) (Figure 3).…”