Mesothelioma and Immunotherapies

alignant pleural mesothelioma (MPM) is an asbestos-related cancer with a poor prognosis.Outcomes for MPM have not dramatically improved over the past 20 years due to its highly aggressive nature, the heterogeneity of the disease, the spectrum of histological subtypes and the limited therapeutic advances.Recently, immune checkpoint inhibitors (ICIs) have improved the outcomes in multiple malignancies, including a subset of MPM cases in the second-line setting and beyond, and more recently in the first-line setting.This article discusses the recent paradigm shift in MPM treatment with the addition of ICIs to the first-line treatment setting, based on the results of the Checkmate 743 study, which investigated ipilimumab plus nivolumab versus platinum-based chemotherapy (PC), and the Keynote 483 study, which investigated the addition of pembrolizumab to PC chemotherapy versus PC chemotherapy alone.We discuss the impact of ICIs on clinical outcomes in patients with MPM based on histological subtype and explore currently available biomarkers that may correlate with improved response to ICIs.Finally, we discuss future directions for improving MPM outcomes with tailored therapies based on therapeutic vulnerabilities and novel biomarkers. Highlights Immunotherapy, especially combinatory immunotherapy, has shown promise with prolonged survival for patients with advanced mesothelioma in the first-line setting (see the sections on 'Systemic treatment and immunotherapy debut' and 'Randomized immunotherapy trials of mesothelioma').