Updates in Management of Malignant Pleural Mesothelioma

Curr Treat Options Oncol. 2023 Dec;24(12):1758-1789. doi: 10.1007/s11864-023-01148-2. Epub 2023 Nov 17.


Malignant pleural mesothelioma (MPM) is an aggressive asbestos-associated thoracic malignancy that is usually incurable. As demonstrated in the landmark MARS2 trial, surgical resection does not improve survival outcomes and its role in managing MPM is limited. Whilst platinum-pemetrexed chemotherapy in combination with bevacizumab was the standard first-line approach for unresectable disease, landmark phase 3 trials have now established the role of immune checkpoint inhibitors (CPIs) in the upfront management of unresectable disease: either nivolumab-ipilimumab or carboplatin-pemetrexed-pembrolizumab. Patient selection for optimal strategy remains an ongoing question. For relapsed disease novel genomic-based therapies targeting a range of aberrations including losses of the tumour suppressor genes BAP1, CDKN2A and NF2, are being evaluated. Nonetheless, the future of MPM therapeutics holds promise. Here we overview current treatment strategies in the management of MPM.

Keywords: Chemoimmunotherapy; Genomic driven therapy; Mesothelioma; Peri-operative therapy; Radiotherapy; Surgery.

Publication types

  • Review

MeSH terms

  • Antineoplastic Combined Chemotherapy Protocols / adverse effects
  • Humans
  • Lung Neoplasms* / pathology
  • Mesothelioma* / diagnosis
  • Mesothelioma* / etiology
  • Mesothelioma* / therapy
  • Mesothelioma, Malignant*
  • Pemetrexed / therapeutic use
  • Pleural Neoplasms* / diagnosis
  • Pleural Neoplasms* / etiology
  • Pleural Neoplasms* / therapy


  • Pemetrexed