New Era for Malignant Pleural Mesothelioma: Updates on Therapeutic Options

Malignant pleural mesothelioma (MPM) is a rare malignancy with few treatment options. Recent advances have led to US Food and Drug Administration approvals and changes in the standard of care with a novel biomedical device approved for use with platinum-pemetrexed, and also for immunotherapy agents to be included as a frontline treatment option in unresectable disease. Although predictive biomarkers for systemic therapy are not currently in use in clinical practice, it is essential to correctly identify the MPM histology to determine an optimal treatment plan. Patients with nonepithelioid MPM may have a greater magnitude of benefit to dual immunotherapy checkpoint inhibitors and this regimen should be preferred in the frontline setting for these patients. However, all patients with MPM can derive benefit from immunotherapy treatments, and these agents should ultimately be used at some point during their treatment journey. There are ongoing studies in the frontline unresectable setting that may further define the frontline therapy space, but a critical area of research will need to focus on the immunotherapy refractory population. This review article will describe the new developments in the areas of biology with genomics and chromothripsis, and also focus on updates in treatment strategies in radiology, surgery, radiation, and medical oncology with cellular therapies. These recent innovations are generating momentum to find better therapies for this disease. (c) 2022 by American Society of Clinical Oncology

Automated summary

Malignant pleural mesothelioma (MPM) is a rare malignancy with limited treatment options. Recent advances have led to changes in treatment standards, including the use of a novel biomedical device in combination with platinum-pemetrexed and the inclusion of immunotherapy as a frontline treatment option. Proper identification of the MPM histology is crucial in determining the optimal treatment plan. Immunotherapy can benefit all MPM patients and should be considered at some point during treatment. Ongoing research is focusing on defining frontline therapy in the unresectable setting and addressing immunotherapy refractory cases.