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Page 10 of 11 Fitzgerald et al. J Cancer Metastasis Treat 2021;7:54 https://dx.doi.org/10.20517/2394-4722.2021.97

Although outside of the scope of this review, other novel approaches under investigation seek to capitalize
on increasing knowledge of MPM biology and its immune microenvironment. Anti-tumor vaccines are in
development and are under early phase investigation in combination with checkpoint inhibition
(NCT04040231). CAR-T therapies targeting the cell surface antigen mesothelin also represent an exciting
area of innovation, and may be used to potentiate anti-tumor effect of immune checkpoint inhibitors in
future studies (NCT02414269, NCT03126630).

There is also a large unmet need to define optimal treatment in patients with poor performance status
(ECOG 2) as these patients have been universally excluded from the trials which have to date lead to FDA
approvals. Finally, there also remains a significant unmet need to define biomarkers that can reliably
identify patients who can benefit disproportionately from immunotherapy or other targeted therapies.

DECLARATIONS
Authors’ contributions
Made substantial contributions to conception and writing of the article: Fitzgerald BG, Krug LM

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
Lee M. Krug: AstraZeneca employee and stock holder.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2021.

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