Khosla D, Singh PK, Chhabria BA, Kataria V, Singh N, Kapoor R. Malignant pleural mesothelioma: The disdained member of thoracic oncology! World J Exp Med 2024; 14(3): 91739 [DOI: 10.5493/wjem.v14.i3.91739]
Corresponding Author of This Article
Divya Khosla, MD, Associate Professor, Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Room No 54, Radiotherapy and Oncology Office, Ground Floor, Nehru Hospital Extension, Chandigarh 160012, India. dr_divya_khosla@yahoo.com
Research Domain of This Article
Oncology
Article-Type of This Article
Editorial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Divya Khosla, Vaishali Kataria, Rakesh Kapoor, Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
Pawan Kumar Singh, Department of Pulmonary and Critical Care Medicine, Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak 124001, India
Bharath A Chhabria, Department of Pulmonary and Critical Care Medicine, Ramaiah Memorial Hospital, Bengaluru 560054, India
Navneet Singh, Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
Co-first authors: Divya Khosla and Pawan Kumar Singh.
Author contributions: Khosla D and Singh PK contributed to conceptualization, manuscript preparation, writing, and editing and were responsible for the integrity of article; Chhabria BA and Kataria V contributed to literature search, manuscript writing, and editing; Singh N and Kapoor R reviewed and approved the manuscript.
Conflict-of-interest statement: All authors declare no conflicts of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Divya Khosla, MD, Associate Professor, Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Room No 54, Radiotherapy and Oncology Office, Ground Floor, Nehru Hospital Extension, Chandigarh 160012, India. dr_divya_khosla@yahoo.com
Received: January 3, 2024 Revised: July 17, 2024 Accepted: July 30, 2024 Published online: September 20, 2024 Processing time: 238 Days and 11.9 Hours
Abstract
Pleural mesothelioma is a very aggressive malignancy that arises from the pleural mesothelial cell lining and is linked strongly to prior asbestos exposure. The ban on asbestos has helped to lower the incidence, but in developing countries like India, it is expected to rise. It has an extended latency period usually progressing over decades and presents with nonspecific symptoms. It has a median survival ranging between 10-22 months. The diagnosis of malignant pleural mesothelioma is challenging and is done using computed tomography (CT), magnetic resonance imaging, or positron emission tomography-CT, with the last two predicting the resectability of the tumor better than CT alone. A pleural biopsy along with an array of immunohistochemical markers, such as p16, BRCA1 associated protein 1, and claudin-4, are required for a definitive diagnosis. Several genetic alterations have prognostic significance as well. The current histological subtype identification is indispensable for decision making because of the new therapeutic avenues being explored. The combination of nivolumab and ipilimumab-based immunotherapy outperformed platinum and pemetrexed-based chemotherapy in terms of survival benefit and improved quality of life especially for non-epithelioid subtypes. However, the latter continues to be a robust treatment option for patients with the epithelioid subtype. Surgery is recommended for resectable cases with radiotherapy being indicated in neoadjuvant, adjuvant, and palliative settings along with systemic treatment. This review article provides an overview of epidemiology, etiology, clinical manifestations, diagnostic approaches (including immunohistochemical and genetic markers), staging, and multidisciplinary approaches to current treatment for malignant pleural mesothelioma using surgery, chemotherapy, immunotherapy, and radiotherapy. It also sheds light on some recent studies (EMPHACIS, CALGB30901, Checkmate-743, etc.) that have led to significant developments in recent years with clinically meaningful results.
Core Tip: This review article highlights the importance of preventive measures, early and accurate detection using imaging, histopathological markers, and multidisciplinary approaches for the treatment of malignant pleural mesothelioma using surgery, systemic chemotherapy, immunotherapy, and radiotherapy. Recent novel developments in systemic treatment have expanded the therapy armamentarium, and more work needs to be done in order to frame tailored therapies for this aggressive tumor presenting in late stages and associated with a poor prognosis due to limited treatment options. It is also essential to translate these evolving treatment options into increased overall survival along with improved quality of life.
