Prise en charge diagnostique et thérapeutique du mésothéliome pleural en 2023: Management of pleural mesothelioma in 2023

Abstract

Pleural mesothelioma (PM) is a rare tumor, usually due to previous asbestos occupational exposure. Its global prognosis is poor, without validated curative treatment to date. Diagnosis relies ideally on thoracoscopy with pleural biopsies, ± combined with talc pleurodesis. Surgery with curative intent, included with multimodal treatment, is restrained to highly selected patients. As frontline treatment, standard pemetrexed/ platinum-based chemotherapy was lightly improved by addition of bevacizumab. It is now challenged by the double-immunotherapy regiment combining Nivolumab + Ipilimumab, and perhaps soon by the combination standard chemotherapy + Pembrolizumab. No treatment is firmly validated beyond first line treatment, even if anti-PD-1/ PD-L1 ± anti-CTLA-4 antibodies also exhibited some promising results in this setting, 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 strongly encouraged. Other immuno therapies alone or combined with standard treatments and/or targeted therapies, multimodal strategies are currently assessed. In France, the national network of expert centers for PM management, « NETMESO » (labelled by INCA), aims at proposing an optimal management to all patients systematically discussed in regional (± national) MTB dedicated to MPM, and at stimulating clinical and translational research in collaboration with its partners including patients advocating associations.1877-1203/© 2023 SPLF. Published by Elsevier Masson SAS. All rights reserved.