A narrative review of current treatment strategies and emerging therapies in malignant pleural mesothelioma

Abstract

: Malignant pleural mesothelioma is a rare but extremely lethal disease for which there is no single curative therapy. Given this, a significant lack of consensus exists regarding optimal treatment strategies. Patients typically present late in the course of their disease, which has led many to advocate for palliative approaches to therapy, while others believe that macroscopic resection of disease in conjunction with multimodal therapy is preferable in highly selected individuals. Surgical strategies have recently evolved from the maximally invasive extrapleural pneumonectomy (EPP) to the more conservative extended pleurectomy and decortication. The addition of chemotherapy and radiotherapy to surgical interventions have allowed to extend progression-free survival, but this is still measured in months rather than years. Moreover, there is a lack of high-quality evidence to support all interventions, leading to variations in guidelines regarding trimodal therapy and a paucity of data demonstrating superiority of a single approach to care. Given this, new and promising treatment options are emerging which may allow to better control and treat malignant pleural mesothelioma. These include immunotherapy, virotherapy, T-cell therapies, and vaccines, among others. This paper therefore aims to give a comprehensive overview of current available treatments with a focus on surgical and trimodal therapies, as well as emerging treatment options for malignant pleural mesothelioma.