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Updated: Aug 7, 2025

Generation and Expansion of Primary, Malignant Pleural Mesothelioma Tumor Lines
Published on: April 21, 2022
The Evolving Role of Immune-Checkpoint Inhibitors in Malignant Pleural Mesothelioma
Maxime Borgeaud1, Floryane Kim1, Alex Friedlaender1,2
1Oncology Department, University Hospital Geneva (HUG), 1205 Geneva, Switzerland.
Abstract:
Malignant pleural mesothelioma (MPM) is a rare cancer usually caused by asbestos exposure and associated with a very poor prognosis. After more than a decade without new therapeutic options, immune checkpoint inhibitors (ICIs) demonstrated superiority over standard chemotherapy, with improved overall survival in the first and later-line settings. However, a significant proportion of patients still do not derive benefit from ICIs, highlighting the need for new treatment strategies and predictive biomarkers of response. Combinations with chemo-immunotherapy or ICIs and anti-VEGF are currently being evaluated in clinical trials and might change the standard of care in the near future. Alternatively, some non-ICI immunotherapeutic approaches, such as mesothelin targeted CAR-T cells or denditric-cells vaccines, have shown promising results in early phases of trials and are still in development. Finally, immunotherapy with ICIs is also being evaluated in the peri-operative setting, in the minority of patients presenting with resectable disease. The goal of this review is to discuss the current role of immunotherapy in the management of malignant pleural mesothelioma, as well as promising future therapeutic directions.
Insights
Immune checkpoint inhibitors (ICIs) improve survival for malignant pleural mesothelioma (MPM) patients. New strategies, including combination therapies and novel immunotherapies, are under investigation to enhance treatment efficacy for this rare cancer.
Area of Science:
- Oncology
- Immunotherapy
- Thoracic Cancers
Background:
- Malignant pleural mesothelioma (MPM) is a rare, aggressive cancer often linked to asbestos exposure.
- Prognosis for MPM is historically poor, with limited therapeutic advancements for over a decade.
- Immune checkpoint inhibitors (ICIs) have emerged as a superior treatment option compared to chemotherapy, improving overall survival.
Purpose of the Study:
- To review the current role of immunotherapy in managing malignant pleural mesothelioma.
- To discuss emerging and future therapeutic strategies for MPM.
- To highlight the need for predictive biomarkers for ICI response.
Main Methods:
- Review of current clinical trial data and literature on immunotherapy for MPM.
- Analysis of established and investigational immunotherapeutic approaches.
- Evaluation of combination therapies and peri-operative immunotherapy.
Main Results:
- ICIs have demonstrated improved survival outcomes in first- and later-line settings for MPM.
- A substantial patient subset does not respond to ICIs, necessitating further research.
- Clinical trials are exploring chemo-immunotherapy, ICI-anti-VEGF combinations, CAR-T cells, and dendritic cell vaccines.
Conclusions:
- Immunotherapy, particularly ICIs, has significantly impacted MPM management.
- Future directions include combination therapies, novel immunotherapeutic agents, and peri-operative immunotherapy.
- Identifying biomarkers for ICI response remains crucial for optimizing patient selection and treatment outcomes.
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