Mésothéliome pleural : algorithme thérapeutique

Abstract

Pleural mesothelioma (PM) is a quite rare tumor, usually due to previous asbestos exposure. Its global prognosis is poor, without validated curative treatment to date. Diagnosis relies ideally on thoracoscopy with pleural biopsies, ± combined with (immediate) talc pleurodesis. Surgery with curative intent, included with multimodal treatment and restrained to highly selected patients, was recently rechallenged. As frontline treatment, standard pemetrexed/platinum-based chemotherapy was lightly improved by addition of bevacizumab. It is currently challenged by the immunotherapy combination of Nivolumab + Ipilimumab, and perhaps soon by combinations of chemotherapy + immunotherapy. No standard treatment is firmly validated beyond first line treatment, even if anti-PD-1/PD-L1 ± anti-CTLA-4 checkpoint inhibitors also exhibited some interesting results in this setting, in phase II and III clinical trials. Therefore, 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 management, “NETMESO” (labelled by INCa), aims at proposing an optimal management to all patients systematically discussed in regional (± national) MTB dedicated to PM, and at stimulating clinical and translational research in collaboration with its partners including patients advocating associations.