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Fitzgerald et al. J Cancer Metastasis Treat 2021;7:54 Journal of Cancer
DOI: 10.20517/2394-4722.2021.97
Metastasis and Treatment

Review Open Access

Treatment of unresectable malignant pleural
mesothelioma in 2021: emerging standards in

immunotherapy

1
Bailey G. Fitzgerald , Lee M. Krug 1,2
1
Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
2
AstraZeneca, Gaithersburg, MD 20878, USA.
Correspondence to: Dr. Lee M. Krug, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl., New York, NY 10029, USA.
E-mail: lee.krug@mssm.edu

How to cite this article: Fitzgerald BG, Krug LM. Treatment of unresectable malignant pleural mesothelioma in 2021: emerging
standards in immunotherapy. J Cancer Metastasis Treat 2021;7:54. https://dx.doi.org/10.20517/2394-4722.2021.97

Received: 15 Apr 2021 First Decision: 25 May 2021 Revised: 9 Jun 2021 Accepted: 29 Jun 2021 First online: 5 Aug 2021

Academic Editor: Lucio Miele Copy Editor: Xi-Jun Chen Production Editor: Xi-Jun Chen

Abstract
Patients with unresectable malignant pleural mesothelioma (MPM) have historically poor outcomes and
treatment, and their treatments have been limited to palliative chemotherapy. Recent efforts to improve prognosis
for these patients by adding angiogenesis inhibitors to chemotherapy led to significant benefits. However, the
emergence of immunotherapy combinations for the front-line treatment has upended the standard of care and has
led to the first new FDA approvals for the treatment of MPM in nearly two decades. This review aims to cover the
main clinical trials in unresectable MPM with VEGF inhibitors and immunotherapy which have led to paradigm
shifts in current practice. Ongoing clinical trials exploring the combination of chemo and immunotherapies show a
great deal of promise, and continued support for ambitious, large-scale well-designed trials remain vital for defining
the future outcomes of patients diagnosed with MPM.

Keywords: Malignant pleural mesothelioma, VEGF, chemotherapy, immunotherapy, PD-L1, CTLA-4

INTRODUCTION
Treatment of unresectable malignant pleural mesothelioma (MPM) remains a challenging problem, and
outcomes are most often disappointing. In cases where a patient is considered as a surgical candidate,

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0
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adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
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