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Bongiovanni et al. J Cancer Metastasis Treat 2022;8:44 https://dx.doi.org/10.20517/2394-4722.2022.78 Page 9 of 12

[70]
mPFS and mOS were 7.5 and 14.7 months, respectively .

CONCLUSION
For decades, no progress whatsoever has been made in MPM, and many trials have failed to demonstrate
the efficacy of new treatments . A better knowledge of tumor biology and its interactions with immune
[71]
cells and tumor microenvironment has recently led to a therapeutic paradigm shift in MPM, with the
entrance to the clinic of the first chemotherapy-free regimen based on the association of nivolumab plus
ipilimumab [10,72] . Based on this, immunotherapy is no longer regarded as “Cinderella” and has became the
“Princess” therapy in MPM, giving new lifeblood to the clinical research on this tumor.

Certainly, much has to be gained to overcome the immune resistance to ICI; along this line, new ICI-based
regimens or other agents such as anti-angiogenic compounds or cancer vaccines are currently under active
investigation and will hopefully play a leading role in the treatment of mesothelioma [73,74] .

Finally, the “one size fits all” approach is not recommended for patients with MPM; therefore, the
identification of validated biomarkers is mandatory to select patients for the best treatment based on the
characteristics of their tumor and the associated microenvironment.

DECLARATIONS
Acknowledgments
This work was partly supported thanks to the contribution of Ricerca Corrente by the Italian Ministry of
Health within the research line L1P.

Authors’ contributions
Wrote and revised the text: Bongiovanni A
Revised the text: Frassoldati A
Wrote and revised the text: Calabrò L
All authors provided comments on the initial version and approved the final draft of the manuscript.

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
Bongiovanni A. has served as advisor for Novartis/AAA and he has received funds from Amgen for a
translational study. Frassoldati A. declare no conflict of interest; Calabrò L. has served as consultant or
advisor to Bristol-Myers Squibb, Merck Sharp and Dohme, and received compensated educational activities
from Bristol Myers Squibb, Astrazeneca, Sanofi.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.