Abstract
Simple SummaryPlatin-based chemotherapy with pemetrexed has been the backbone of meaningful treatment in pleural mesothelioma for the last 16 years, alongside vinorelbine and gemcitabine, which show only modest response. Recently, a nivolumab and ipilimumab combination was approved, and it offers improvement in survival rate and quality of life. With the identification and understanding of novel biomarkers, many treatment options are currently being evaluated.Pleural mesothelioma is an aggressive malignancy arising from pleural mesothelial cell lining, predominantly associated with prior exposure to asbestos. The ban on asbestos use has led to its lower incidence in many countries, but globally the disease burden is expected to rise. Therefore, well-planned research is needed to develop more effective, tolerable and affordable drugs. The development of novel treatment has been too slow, with only two regimens of systemic therapy with robust phase 3 data approved formally to date. The treatment scenario for resectable disease remains controversial. However, recent developments in the understanding of disease and clinical trials have been encouraging, and may add better treatment options in the coming years. In this review, we discuss the current treatment options for pleural mesothelioma and shed light on some recent studies and ongoing trials.
Highlights
Malignant pleural mesothelioma (MPM) arises due to chronic inflammation and malignant cellular proliferation of the mesothelial cell lining of the pleura
On the basis of multiple phase 2 studies and a meta-analysis that found no significant difference in overall survival (OS) or PFS, carboplatin and pemetrexed represent a good option with less non-hematological toxicity [111–113]
There are challenges in investigating pleural mesothelioma that are not limited to low incidence, individual heterogeneity of disease, lack of well-designed randomized trials, and non-standardized treatment approach, especially in the resectable stage
Summary
Malignant pleural mesothelioma (MPM) arises due to chronic inflammation and malignant cellular proliferation of the mesothelial cell lining of the pleura. In 70–80% of the cases, there is a known history of exposure to asbestos, a natural mineral historically used for multiple industrial and household purposes [1]. The long period of latency causes the disease onset 20–50 years after exposure. Even though the mining and industrial use of asbestos has been banned or strictly regulated in many countries, including those in the European Union, Russia, Kazakhstan and China contribute to more than 80% of the global production. Global consumption remains high in swing states, where the import and usage of asbestos without adequate safety equipment will inevitably lead to a rise in global disease burden in the coming decades [2–4]. Well-conducted clinical trials, investment in research, and development of new and more effective drugs that are affordable globally are the current requirements to improve the treatment landscape in mesothelioma
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