An Update on Emerging Therapeutic Options for Malignant Pleural Mesothelioma

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 a...

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Bibliographic Details
Published in:Lung cancer (Auckland) 2022-01, Vol.13, p.1-12
Main Authors: Davis, Alexander, Ke, Helen, Kao, Steven, Pavlakis, Nick
Format: Article
Language:English
Subjects:
Cancer
Care and treatment
Chemotherapy
Folic acid
Health aspects
immune checkpoint inhibitors
Immunotherapy
malignant pleura mesothelioma
Mesothelioma
mesothelioma radiotherapy
mesothelioma surgery
Pemetrexed
Pharmaceutical industry
Povidone
Radiotherapy
Review
trimodality therapy
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Summary: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.
ISSN:1179-2728
1179-2728
DOI:10.2147/LCTT.S288535