Pleural Mesothelioma: From Diagnosis to Treatment

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: 30 June 2026 | Viewed by 29

Special Issue Editors


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Guest Editor
Medical Oncology Unit, Cliniche Humanitas Gavazzeni, Via Mauro Gavazzeni, 21, 24125 Bergamo, Italy
Interests: pleural mesothelioma; tumor treating fields; immunotherapy; radiotherapy; multimodality treatment
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Guest Editor
1. Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
2. Department of Oncology, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
Interests: pleural mesothelioma; immunotherapy; multimodality treatment; phase I trials
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Pleural mesothelioma (PM) is an incurable cancer related to asbestos exposure. Despite the existence of established international guidelines, many areas of uncertainty and unmet needs remain in diagnostic and therapeutic management.

One major issue in developing effective treatments for PM is its inherent molecular and histological heterogeneity. There are difficulties associated with histological classification, and the epithelioid subtype is particularly heterogeneous. Moreover, the histopathological classification only accounts for a fraction of inter-patient molecular heterogeneity.

Due to the pattern of local spread, few patients are candidates for multimodality treatment including surgery, and thus most receive only systemic therapy. High-level evidence on the role of loco-regional therapies remains lacking. Overall, drug therapy options are still limited. Immunotherapy with immune checkpoint inhibitors is the treatment backbone for unresectable PM, although only a subset of patients achieve prolonged benefit; reliable biomarkers for patient selection and stratification are not yet available. Strategies to overcome treatment resistance in pleural mesothelioma patients are based on combination immunotherapy regimens, including alternative checkpoint inhibitors beyond those acting on the PD- 1/PD-L1 and CTLA- 4 axes, angiogenesis inhibitors, and chemotherapy. Unlike many cancers driven by genetic alterations that activate growth-regulating kinases, PM is mainly characterized by loss of tumor suppressor genes, and approaches that target these mechanisms remain elusive, even though initial evidence of activity is emerging.

This Special Issue will highlight the current state of the art in PM, focusing on the most critical areas in diagnosis and treatment, and on future prospects for improving patient outcome.

Dr. Giovanni Luca Ceresoli
Dr. Paolo Andrea Zucali
Guest Editors

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Keywords

  • pleural mesothelioma
  • histological classification
  • molecular characteristics
  • immunotherapy
  • chemotherapy
  • radiotherapy
  • surgery
  • targeted therapy
  • emerging therapies

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Published Papers (1 paper)

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Review

22 pages, 346 KB  
Review
Perioperative Treatments in Pleural Mesothelioma: State of the Art and Future Directions
by Luigi Giovanni Cecchi, Marta Aliprandi, Fabio De Vincenzo, Matteo Perrino, Nadia Cordua, Federica Borea, Alessandro Bertocchi, Antonio Federico, Giuseppe Marulli, Armando Santoro, Giovanni Luca Ceresoli and Paolo Andrea Zucali
Cancers 2025, 17(19), 3199; https://doi.org/10.3390/cancers17193199 - 30 Sep 2025
Abstract
Pleural Mesothelioma (PM) remains a challenging malignancy associated with asbestos exposure and characterized by poor prognosis. This review aims to consolidate recent findings on the efficacy of perioperative therapies encompassing chemotherapy, surgery, and emerging immunotherapy strategies. Current management strategies debate the role of [...] Read more.
Pleural Mesothelioma (PM) remains a challenging malignancy associated with asbestos exposure and characterized by poor prognosis. This review aims to consolidate recent findings on the efficacy of perioperative therapies encompassing chemotherapy, surgery, and emerging immunotherapy strategies. Current management strategies debate the role of surgery in early-stage patients, particularly due to the limited success of solitary treatment modalities and significant rates of postoperative complications. Retrospective studies indicate that multimodal treatment, incorporating surgical resection with perioperative chemotherapy, can enhance overall survival (OS), especially in favorable prognostic subsets. However, significant randomized trials, notably the MARS and MARS 2 trials, revealed that the addition of aggressive surgical strategies like extrapleural pneumonectomy (EPP) did not confer survival benefits and was accompanied by heightened morbidity. In light of persistent challenges, integrating perioperative chemotherapy—primarily with platinum-based regimens—has shown improved disease control outcomes. Neoadjuvant chemotherapy permits real-time assessment of tumor responsiveness, providing valuable clinical insights for surgical candidacy. The role of immunotherapy, particularly immune checkpoint inhibitors (ICIs), is also under active exploration, with preliminary results suggesting promising activity and manageable safety profiles. In conclusion, while current protocols primarily recommend surgery for a select group of patients, ongoing investigations into neoadjuvant approaches, adjuvant therapies, and novel immunotherapeutic strategies are crucial for developing effective, personalized treatment paradigms for PM. Future efforts should prioritize clinical trials that integrate these therapies within a structured multidisciplinary approach to optimize patient outcomes. Full article
(This article belongs to the Special Issue Pleural Mesothelioma: From Diagnosis to Treatment)
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