Malignant Mesothelioma: Has Anything Changed?

Semin Respir Crit Care Med. 2019 Jun;40(3):347-360. doi: 10.1055/s-0039-1693406. Epub 2019 Sep 16.


Malignant pleural mesothelioma is a rare cancer associated with asbestos exposure and portends a dismal prognosis. Its worldwide incidence has been increasing, and treatment options are currently suboptimal and noncurative. However, since the turn of the century, several encouraging steps have been made toward improving outcomes for mesothelioma patients. An increased understanding of disease pathophysiology has led to more accurate diagnosis and staging, and the establishment of the standard of care first-line pemetrexed/platin doublet chemotherapy regimen in 2003 initially revolutionized treatment. While significant debate remains regarding the preferred approach to surgical and radiation therapy in the context of multimodal therapy, recent breakthroughs in immunotherapy offer hope for another paradigm shift in the near future. This review will summarize the current clinical approach to diagnosis, staging, and treatment of malignant pleural mesothelioma.

Publication types

  • Review

MeSH terms

  • Antineoplastic Agents, Immunological / therapeutic use
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Asbestos / adverse effects
  • Biomarkers, Tumor
  • Biopsy
  • CTLA-4 Antigen / antagonists & inhibitors
  • Catheters, Indwelling
  • Combined Modality Therapy
  • Humans
  • Immunohistochemistry
  • Lung Neoplasms / diagnosis
  • Lung Neoplasms / pathology
  • Lung Neoplasms / therapy*
  • Mesothelioma / diagnosis
  • Mesothelioma / pathology
  • Mesothelioma / therapy*
  • Mesothelioma, Malignant
  • Neoplasm Staging
  • Pleural Neoplasms / diagnosis
  • Pleural Neoplasms / pathology
  • Pleural Neoplasms / therapy*
  • Pneumonectomy / methods
  • Prognosis
  • Programmed Cell Death 1 Receptor / antagonists & inhibitors
  • Radiotherapy, Adjuvant
  • Thoracoscopy


  • Antineoplastic Agents, Immunological
  • Biomarkers, Tumor
  • CTLA-4 Antigen
  • Programmed Cell Death 1 Receptor
  • Asbestos