Prise en charge diagnostique et thérapeutique du mésothéliome pleural malin en 2022

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. 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 immunotherapies 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 “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: the Mesopath group, the French Thoracic Cooperative Intergroup (IFCT), and patients advocating associations.1877-1203/© 2022 SPLF. Published by Elsevier Masson SAS. All rights reserved.