The Evolving Landscape of Treatment against Unresectable Malignant Pleural Mesothelioma (MPM): Novel Options and Future Outlook

Dear Colleagues,

After a long period of nihilism and a lack of additional therapeutic options beyond pemetrexed and platinum, recent years have witnessed extraordinary progress in the research landscape of malignant pleural mesothelioma (MPM), leading to a rapidly evolving therapeutic scenario. 

As in other cancers, immunotherapy with immune checkpoint inhibitors has represented a turning point in the therapeutic algorithm of unresectable MPM, with the combination of nivolumab and ipilimumab showing a significant survival benefit over standard chemotherapy in the first-line setting. However, there is increasing evidence that only a subset of patients can achieve the highest benefit, depending on specific cellular features of the tumor microenvironment. Therefore, stratified approaches to immunotherapy, including co-inhibition of checkpoint receptors and combinations with chemotherapy or other agents, are needed to improve clinical outcomes further.

Despite preclinical data supporting the role of VEGF pathway inhibition in mesothelioma, this strategy has shown conflicting results in MPM, and it is unclear where it may fit in the new treatment paradigm. Innovative approaches such as tumor treating fields have also shown preliminary promising results.

Finally, high inter-patient genetic and phenotypic heterogeneity of MPM have thus far been major hurdles for developing effective targeted treatments. Large-scale genomic profiling studies have revealed the complex genomic architecture of this disease, paving the way to a personalized therapy in molecularly selected MPM populations.

For this Special Issue, we welcome original and review papers that deal with novel therapeutic options in unresectable MPM. We are especially looking for papers that provide insights into recent developments in immunotherapy, angiogenesis inhibition, personalized (targeted) therapies, and other innovative approaches.

Dr. Maurizio D'Incalci
Dr. Giovanni Luca Ceresoli
Guest Editors

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