Diagnostic and Therapeutic Pathway in Diffuse Malignant Peritoneal Mesothelioma

Simple Summary Mesothelioma is a rare cancer that originates in mesothelial surfaces of the peritoneum, pleura, and other sites. Diffuse malignant peritoneal mesothelioma (DMPM) corresponds to approximately 15% of all mesotheliomas. Cytoreductive surgery and HIPEC is the current standard of care, allowing the achievement of a median OS of at least 4 years. However, patient selection and perioperative management remain challenging. This paper outlines the diagnostic and therapeutic pathways of DMPM. Diffuse malignant peritoneal mesothelioma (DMPM) is a rare form of mesothelioma that carries a very poor prognosis. The 5-year overall survival is about 20% (+/- 5.9). Survival is optimal for patients suitable for cytoreductive surgery (CRS) with Hyperthermic Intraperitoneal Chemotherapy (HIPEC), with a median OS ranging from 34 to 92 months. However, selecting patients for surgery remains a complex task and requires a careful preoperative workup, rational analysis of prognostic profiles, and risk prediction models. Systemic chemotherapy could be offered: (1) in the adjuvant setting for high-risk patients; (2) for patients not eligible for CRS; and (3) for those with recurrent disease. It mainly includes the combination of Platin compound with Pemetrexed or immunotherapy. The biology of DMPM is still largely unknown. However, progress has been made on some fronts, such as telomere maintenance mechanisms, deregulation of apoptosis, tyrosine kinase pathways, and mutation of BRCA1-associated protein 1 (BAP1). Future perspectives should include translational research to improve our understanding of the disease biology to identify druggable targets. We should also clear the role of immune checkpoint inhibitors and investigate new locoregional technologies, such as pressurized intraperitoneal aerosol chemotherapy (PIPAC) or normothermic intraperitoneal chemotherapy (NIPEC).

Automated summary

Diffuse malignant peritoneal mesothelioma (DMPM) is a rare cancer that originates in the peritoneum and has a poor prognosis. Cytoreductive surgery and HIPEC are currently the standard treatments, but selecting suitable patients and managing the perioperative period is challenging.