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Page 10 of 12 Housman et al. J Cancer Metastasis Treat 2021;7:69 https://dx.doi.org/10.20517/2394-4722.2021.159

Finally, NCT04525859 at the Mount Sinai Hospital in New York is exploring the safety and efficacy of
preoperative injection of Poly-ICLC on recurrence-free survival. The study will also evaluate induced
serologic changes in circulating immune cells, including regulatory T-cells and natural killer cells.

CONCLUSION
While many aspects of treatment for MPM remain controversial, the literature shows that no benefit of EPP
over P/D can be consistently demonstrated. Whatever theoretical benefits of EPP as a more radical
procedure - if they exist - appear to be counterbalanced by a high frequency of complications, lower quality
of life, and perioperative death. Recurrence remains a problem in the treatment of MPM with both
techniques. To date, no study convincingly proves that EPP is more effective at preventing recurrence than
P/D.

Despite the absence of a randomized trial of surgical technique, P/D consistently displays lower morbidity
and mortality with similar, if not superior, long-term survival [10,14,37] . Whether this is because it confers an
oncologic benefit or simply avoids the hazards of EPP is unclear. Though further study is certainly
warranted, EPP is a procedure that should be considered in select patients and experienced centers.

DECLARATIONS
Authors’ contributions
Performed review of existing literature, evaluated existing studies, wrote and edited manuscript:
Housman B, Wolf AS

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
Both authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2021.

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