Immunothérapie et autres stratégies dans le traitement du mésothéliome pleural: Immunotherapy and other strategies in the treatment of pleural mesothelioma

Abstract

Management of malignant pleural mesothelioma (MPM), a rare tumor, usually due to previous asbestos exposure, with a globally poor prognosis and no validated curative treatment to date, is highly evolving. Recent major improvements in a better knowledge of MPM pathogenesis stimulate the search of new treatments, strategies and biomarkers to drive precision medicine in the future. Multimodal treatment and surgery with curative intent, included was well as radiotherapy, are highly discussed and restrained to selected patients, even if these indications could change with the combination of immunotherapies. As front line treatment, standard chemotherapy doing quite poorly, even if slightly improved by addition of bevacizumab, is now highly challenged by an immunotherapy combining nivolumab + ipilimumab. Therapeutic options beyond first line treatment are limited even if anti-PD-1/PD-L1 ± anti-CTLA-4 antibodies also exhibited promising results in phase II and III trials. Thus the search of new treatments, strategies and biomarkers is a crucial goal, and recruitment of patients in clinical trials is strongly encouraged. Other immunotherapies alone or combined with standard treatments and/or targeted therapies, multimodal strategies including intrapleural therapy are currently assessed.In France, the national cancer institute INCa labelled the national network of expert centers for MPM NETMESO (combining MESOCLIN and MESOPATH) and requests that to all patients should be discussed during regional (± national) NETMESO multidisciplinary board MPM at least at the time of diagnosis, in order to propose them an optimal management and to join clinical research studies.© 2022 SPLF. Published by Elsevier Masson SAS. All rights reserved.