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What is Malignant Pleural Mesothelioma?

Malignant mesothelioma (MPM) is a rare, severe cancer of the pleural surface associated with exposure to asbestos. Median survival for MPM patients is a mere 8-14 months, there are few biomarkers and no treatment is available. It is hoped that, eventually, the incidence of MPM will decrease and remain low and stable, given that most countries have banned the use of asbestos, but at the same time, the incidence in Europe is still increasing. The exact molecular mechanisms that explain the carcinogenicity of asbestos are unknown. Standard therapeutic strategies for MPM include surgery, often combined with chemotherapy and/or radiotherapy, in a small percentage of eligible patients, and chemotherapy for tumors deemed unresectable with or without adjuvant radiotherapy. In recent years, many new therapeutic avenues are being explored.

These drugs include angiogenesis inhibitors, synthetic lethal therapy, miRNA substitution, cancer therapies, and the rapidly growing field of immunotherapy alone or in combination with chemotherapy. Particularly promising are the multiple options offered by immunotherapy: immune checkpoint inhibitors, tumor vaccines, and therapies that take advantage of tumor-specific antigens, such as specific therapeutic antibodies or advanced cell-based therapies represented by CAR-T cells. This review comprehensively presents both old and new treatment options in MPM, focusing on the results of several recent and ongoing clinical trials in the field, including the most recent data presented at international meetings (AACR, ASCO, ESMO) this year, and concludes that More work needs to be done within the framework of personalized therapies to identify reliable targets and new biomarkers to influence MPM management.

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