Recent Advances in Mesothelioma

Abstract

Purpose of Review Pleural mesothelioma (PM) is a rare but fatal cancer of the pleural surface. Most patients have a poor prognosis, despite treatment advances which have improved outcomes. Recent research has focused on improving diagnosis, prognostication and monitoring through radiological, histological and molecular techniques. This review will cover its clinical implications and highlight areas where practice is changing. Recent Findings Changes in tumour classification and histological reporting have formalised the differentiation between benign, pre-malignant and malignant pleural disease. CT and thoracic ultrasound (TUS) have good diagnostic yields for pleural biopsy, but PET-CT does not increase diagnostic yield for repeat sampling. immunohistochemistry (IHC) staining for BAP1 and MTAP/CDKN2A pathological samples can increase diagnosis rates, while serum mesothelin shows promise for disease monitoring. Phase 3 RCT results mean dual immunotherapy is the new standard of care, whereas there is no role for extended pleurectomy decortication surgery for PM. Summary Best practice for PM diagnosis and management is changing at pace. Key areas for future research involve improving PM diagnostics, therapeutics and targeted therapies. An awareness of active research and clinical trials is essential for clinicians to seek for the best outcomes for their patients.