This review article describes current diagnostic and treatment modalities for malignant pleural mesothelioma (MPM).
Few randomized trials in MPM have demonstrated improved survival with current therapies. A randomized trial of first-line chemotherapy with and without bevacizumab in unresectable MPM is the only randomized trial of a new treatment regimen to demonstrate a survival benefit since cisplatin with pemetrexed became the standard of care for unresectable MPM in 2003. Unfortunately, in unresectable MPM, first-line chemotherapy alone or in combination with bevacizumab has demonstrated only limited improvements in overall survival. Recently, in nonrandomized observational studies, multimodality treatments with chemotherapy, surgery, radiation, and novel therapies have been associated with prolonged survival in select patients. Currently, there are no FDA approved second-line therapies, and clinical trial enrollment is recommended for second-line treatment.
MPM remains difficult to treat and has an overall poor prognosis despite current multimodality treatment. Thoracoscopy with multiple pleural biopsies can provide adequate tissue specimens for diagnostic testing to distinguish histologic MPM subtypes and perform molecular profiling, which influence prognosis and treatment options. In early clinical trials, immunotherapies and therapies directed against cancer-associated antigens and oncogenic alterations are emerging as promising future treatments.
NYU Pulmonary Oncology Research Team (NYU PORT), Division of Pulmonary, Critical Care, and Sleep Medicine, NYU School of Medicine, NYU Langone Health, New York, New York, USA
Correspondence to Daniel Katzman, MD, NYU Pulmonary Oncology Research Team (NYU PORT), Division of Pulmonary, Critical Care, and Sleep Medicine, NYU School of Medicine, NYU Langone Health, 462 1st Avenue, A605-606, New York, NY 10016, USA. E-mail: Daniel.Katzman@nyumc.org