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ESMO E-Learning: Malignant Pleural Mesothelioma

Learning objectives

  1. To understand that malignant pleural mesothelioma is an asbestos-related disease
  2. To provide an overview of pathophysiology in malignant pleural mesothelioma
  3. To provide an overview of current treatment options for malignant pleural mesothelioma
  4. To provide new research insights and treatment perspective in malignant pleural mesothelioma


Asbestos is widely used, and despite legislation it is still everywhere in the environment. In this E-Learning module, besides aetiology, the author explains pathophisiology, incidence, life expectancy, histology, staging, symptoms and symptom management, current treatments and latest research efforts in the managment of patients with malignant pleaural mesothelioma.

The author underlines that chemotherapy is a standard of care, surgery is an option in selected cases, new molecular treatments are upcoming, and it is foreseable that immunotherapy will have a role in mesothelioma treatment.

In terms of surgery, the author states that no randomised data support its use. Most data support it within tri-modality treatment. Surgery can be considered in selected patients, in particular in those with limited disease. In that regard, the author explains the results of extrapleural pneumonectomy and extended pleurectomy decortication procedures.

In most patients, palliative chemotherapy, in particular a combination of pemetrexed and platinum, is first-line treatment.

The author explains the role of palliative radiotherapy in symptom management. Radiotherapy in multimodality treatment is under debate. The author also tackles new radiotherapy techniques, such as intensity-modulated radiation therapy.

In order to explain the current standards of care, the author provides an overview of the treatments that are under clinical debate, such as a role of maintenance pemetrexed. Regarding second-line treatment, no randomised controlled trials support the use of chemotherapy after pemetrexed first-line. In terms of clinical debates, the author also explains the results of studies with anti-angiogenesis agents, in particular bevacizumab and nintedanib.

The last part of the module is dedicated to the overview of molecular alterations and their targeting, as well as to recent efforts in immunotherapy research. The author describes results from clinical studies with immune checkpoint inhibitors tested as monotherapy or in combination treatments. The findings from studies with cell-based therapy are also illustrated.

This E-Learning module is an excellent educational overview that provides a comprehensive state-of-the-art in terms of current treatment options and puts into perspective the research efforts in patients with malignant pleural mesothelioma.

This E-Learning module was published in 2019 and expired in 2021.

Last update: 09 Oct 2019

Prof. Aerts has reported:

Consultancy/Advisory Board: MSD, BMS, Amphera, Boehringer Ingelheim, Roche, Eli-Lilly, Takeda, Astra-Zeneca. Stock owner: Amphera B.V.

Patents: allogeneic tumour cell lysate.

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