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

A special issue of Cancers (ISSN 2072-6694).

Deadline for manuscript submissions: closed (1 June 2023) | Viewed by 2691

Special Issue Editors


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Guest Editor
Laboratory of Cancer Pharmacology, Humanitas Research Hospital, Humanitas University, 20072 Pieve Emanuele (MI), Italy
Interests: cancer pharmacology; preclinical and clinical drug development

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Guest Editor
Department of Medical Oncology, Cliniche Humanitas Gavazzeni, 24125 Bergamo, Italy
Interests: malignant pleural mesothelioma; lung cancer; prostate cancer; renal cancer

Special Issue Information

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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Keywords

  • malignant pleural mesothelioma
  • immunotherapy
  • angiogenesis inhibition
  • genomic profiling
  • targeted therapy
  • tumor treating fields
  • personalized therapy

Published Papers (1 paper)

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12 pages, 1405 KiB  
Article
Feasibility of Tumor Treating Fields with Pemetrexed and Platinum-Based Chemotherapy for Unresectable Malignant Pleural Mesothelioma: Single-Center, Real-World Data
by Tugce Kutuk, Haley Appel, Maria Carolina Avendano, Federico Albrecht, Paul Kaywin, Suyen Ramos, Melanie E. Suarez-Murias, Minesh P. Mehta and Rupesh Kotecha
Cancers 2022, 14(8), 2020; https://doi.org/10.3390/cancers14082020 - 16 Apr 2022
Cited by 7 | Viewed by 2211
Abstract
Purpose: The objectives of this study were to evaluate the implementation, device usage rates, clinical outcomes, and treatment-related toxicities associated with TTFields and pemetrexed plus platinum-based chemotherapy in patients with unresectable MPM, outside the initial trial results. Methods: Consecutive patients with unresectable MPM [...] Read more.
Purpose: The objectives of this study were to evaluate the implementation, device usage rates, clinical outcomes, and treatment-related toxicities associated with TTFields and pemetrexed plus platinum-based chemotherapy in patients with unresectable MPM, outside the initial trial results. Methods: Consecutive patients with unresectable MPM were enrolled onto an FDA-required HDE protocol from 2019 to 2021. All patients were treated with a protocol-defined regimen of continuous TTFields (150 kHz) and pemetrexed plus platinum-based chemotherapy. Results: Five patients with unresectable MPM were enrolled. The median number of 4-week TTFields cycles was 5 (range: 2–7 cycles). Median TTFields device usage in the first 3 months was 12.5 h per day (range: 5–16.8 h), representing 52% (21–70%) of the potential daily duration. The median follow-up was 5.4 months (range: 1.1–20.9 months). Treatment-related dermatitis was the only side effect associated with TTFields and was reported as grade 1–2 in all patients; no patient had grade 3+ device-related toxicities. Conclusions: This study represents the first results of real-world implementation of TTFields for MPM. In comparison to the initial clinical trial (STELLAR), compliance rates were lower, although skin-related toxicities appeared similar. Further initiatives and guidelines should be developed to manage treatment-related dermatitis and improve device usage. Full article
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