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Alexander Davis,1,2 Helen Ke,3 Steven Kao,1,3,4 Nick Pavlakis4– 6 1Department of Medical Oncology, Chris O’Brien Lifehouse, Camperdown, NSW, Australia; 2Department of Medical Oncology, Western Cancer Centre, Dubbo, NSW, Australia; 3Asbestos Diseases Research Institute, Rhodes, NSW, Australia; 4School of Medicine, University of Sydney, Camperdown, NSW, Australia; 5Department of Medical Oncology, Royal North Shore Hospital, St Leonards, NSW, Australia; 6Department of Medical Oncology, Genesis Care, St Leonards, NSW, AustraliaCorrespondence: Nick Pavlakis, Department of Medical Oncology, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia, Tel +612 9463 1172, Fax +612 9463 1092, Email nick.pavlakis@sydney.edu.auAbstract: The treatment paradigm for malignant pleural mesothelioma (MPM) has changed little in the last 18 years. Radical intent treatment, consisting of surgical resection, radiotherapy and chemotherapy, has been offered to a highly select few; however, there is little randomised evidence to validate this approach. Prior to 2020 chemotherapy with platinum and an anti-folate was the only intervention with randomised evidence to demonstrate improved overall survival (OS) in MPM. No systemic therapy had been demonstrated to improve OS in the second line setting until 2020. The publication of the Checkmate 743 trial in 2021 demonstrated a survival benefit of combination immunotherapy over standard chemotherapy in newly diagnosed patients with MPM. This finding was shortly followed by the CONFIRM trial which demonstrates a modest but significant survival benefit of second line nivolumab versus placebo in patients having previously received standard chemotherapy. The results of these trials, recent biomarker directed therapy and chemotherapy adjuncts are discussed within this review. The integration of immunotherapy for the few patients in whom radical surgical therapy is intended is currently the subject of clinical trials and offers the prospect of improving outcomes in this rare but devastating disease.Keywords: immune checkpoint inhibitors, immunotherapy, malignant pleural mesothelioma, mesothelioma radiotherapy, mesothelioma surgery, trimodality therapy |
