Prise en charge diagnostique et thérapeutique du mésothéliome pleural malin en 2021: Diagnostic and therapeutic management of malignant pleural mesothelioma in 2021

Abstract

Malignant pleural mesothelioma (MPM) is a rare tumor, usually due to previous asbestos 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. Radiotherapy is also of limited indication in MPM. As front line treatment, standard chemotherapy doing quite poorly, even if slightly improved by addition of bevacizumab, is now challenged by an immunotherapy combining Nivolumab + Ipilimumab. 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 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 network of expert centers for MPM “NETMESO” (labelled by INCa, and combining MESOCLIN and MESOPATH), 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: Mesobank, IFCT… and patients associations.© 2021 SPLF. Published by Elsevier Masson SAS. All rights reserved.