Leveraging the pleural space for anticancer therapies in pleural mesothelioma

Lancet Respir Med. 2024 Jun;12(6):476-483. doi: 10.1016/S2213-2600(24)00111-5. Epub 2024 May 10.


Most patients with pleural mesothelioma (PM) present with symptomatic pleural effusion. In some patients, PM is only detectable on the pleural surfaces, providing a strong rationale for intrapleural anticancer therapy. In modern prospective studies involving expert radiological staging and specialist multidisciplinary teams, the population incidence of stage I PM (an approximate surrogate of pleura-only PM) is higher than in historical retrospective series. In this Viewpoint, we advocate for the expansion of intrapleural trials to serve these patients, given the paucity of data supporting licensed systemic therapies in this setting and the uncertainties involved in surgical therapy. We begin by reviewing the unique anatomical and physiological features of the PM-bearing pleural space, before critically appraising the evidence for systemic therapies in stage I PM and previous intrapleural PM trials. We conclude with a summary of key challenges and potential solutions, including optimal trial designs, repurposing of indwelling pleural catheters, and new technologies.

Publication types

  • Review

MeSH terms

  • Antineoplastic Agents / therapeutic use
  • Humans
  • Mesothelioma* / drug therapy
  • Mesothelioma* / pathology
  • Mesothelioma* / therapy
  • Mesothelioma, Malignant / drug therapy
  • Mesothelioma, Malignant / therapy
  • Pleura* / diagnostic imaging
  • Pleura* / pathology
  • Pleural Effusion, Malignant / therapy
  • Pleural Neoplasms* / drug therapy
  • Pleural Neoplasms* / pathology
  • Pleural Neoplasms* / therapy


  • Antineoplastic Agents