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Updates in Management of Malignant Pleural Mesothelioma

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Opinion statement

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.

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Authors and Affiliations

  1. The Lung Unit, The Royal Marsden Hospital, London, UK

    Alexius John MBBS, FRACP, Hazel O’Sullivan MB, BCh, BAO & Sanjay Popat FRCP, PhD

  2. Department of Medical Oncology, Cork University Hospital, Cork, Ireland

    Hazel O’Sullivan MB, BCh, BAO

  3. The Institute of Cancer Research, London, UK

    Sanjay Popat FRCP, PhD

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AJ declares no conflicts of interest. HO’S has received honorarium from Amgen and AstraZeneca and expenses from Takeda, all outside the scope of the submitted work. SP reports consulting fees/honoraria from: Amgen, AstraZeneca, Bayer, Blueprint, BMS, Boehringer Ingelheim, Daiichi EQRX, Sankyo, GSK, Guardant Health, Incyte, Janssen, Lilly, Merck Serono, MSD, Novartis, Roche, Takeda, Pfizer, Seattle Genetics, and Turning Point Therapeutics.

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John, A., O’Sullivan, H. & Popat, S. Updates in Management of Malignant Pleural Mesothelioma. Curr. Treat. Options in Oncol. 24, 1758–1789 (2023). https://doi.org/10.1007/s11864-023-01148-2

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