Mesothelioma
Prepared with OnCo (onco.cc/prep/mesothelioma/). Orientation, not medical advice; your team knows your case.
My details
What I know, what is unclear, changes to discuss
Saved in this browserMy questions
27 on the sheet- 1.What is my exact diagnosis, stage, and grade, and which tests established them?
- 2.Which biomarkers have been tested on my tumour (for example Histology, BAP1, CDKN2A/MTAP deletion, Mesothelin, Histologydrives first-line choice), and what were the results?
- 3.Which subtype is my cancer, and does that change the recommended treatment?
- 4.Is germline (inherited) genetic testing recommended for me or my family?
- 5.For my situation (unresectable), which of the standard options do you recommend and why?
- 6.Am I a candidate for Nivolumab, Ipilimumab, Pembrolizumab or related drugs, and what side effects should I expect?
- 7.For my situation (diagnosis and staging), which of the standard options do you recommend and why?
- 8.For my situation (first line, non-epithelioid), which of the standard options do you recommend and why?
- 9.Am I a candidate for Nivolumab, Ipilimumab, Pembrolizumab, and what side effects should I expect?
- 10.How do the results of CheckMate 743 and IND.227 / KEYNOTE-483 apply to someone like me?
- 11.For my situation (first line, epithelioid), which of the standard options do you recommend and why?
- 12.Am I a candidate for Pembrolizumab, Nivolumab, Ipilimumab or related drugs, and what side effects should I expect?
- 13.How do the results of IND.227 / KEYNOTE-483 and MAPS apply to someone like me?
- 14.For my situation (maintenance), which of the standard options do you recommend and why?
- 15.Am I a candidate for Optune / Optune Pax (TTFields), and what side effects should I expect?
- 16.How do the results of STELLAR apply to someone like me?
- 17.For my situation (second line), which of the standard options do you recommend and why?
- 18.Am I a candidate for Nivolumab, Pemetrexed, and what side effects should I expect?
- 19.For my situation (surgery), which of the standard options do you recommend and why?
- 20.How do the results of MARS 2 apply to someone like me?
- 21.For my situation (radiotherapy), which of the standard options do you recommend and why?
- 22.For my situation (peritoneal mesothelioma), which of the standard options do you recommend and why?
- 23.Are there clinical trials I could join, for example of Synthetic lethality approaches, EB-MF-CAR-NK-01, Anetumab ravtansine, Antibody-drug conjugates for mesothelioma: why they have failed so far and how they could work?
- 24.Would a second opinion at a high-volume centre change anything, and can you help arrange it?
- 25.What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?
- 26.I read that “Sarcomatoid subtype”. How does that affect my plan?
- 27.I read that “No early detection despite known exposure”. How does that affect my plan?
The words I may hear
- Epithelioid vs sarcomatoid (biphasic) mesothelioma: Mesothelioma comes in a slower 'epithelioid' form and an aggressive 'sarcomatoid' form.
- Synthetic lethality: Two genes where losing either alone is fine but losing both kills the cell.
- Pleura: The two-layered lining around each lung.
- Pneumonectomy: Removing an entire lung.
- Pleurodesis and indwelling pleural catheter: Ways to stop fluid repeatedly collecting around the lung: either glue the two pleural layers together with talc, or leave a small tunnelled drain the patient empties at home.
- Malignant pleural effusion and ascites: Fluid that builds up around the lung (pleural effusion) or in the abdomen (ascites) because cancer cells irritate the lining and block lymph drainage; it causes breathlessness or a swollen, tight belly.
- Peritoneum and peritoneal metastases: The thin membrane lining the abdominal cavity and covering the bowel.
- Immune-related adverse events (irAEs): Immune-related adverse events (irAEs) are the autoimmune side effects of checkpoint inhibitors: colitis, thyroid problems, rash, hepatitis, pneumonitis.
Tests and results to bring
Diagnosis and staging: CT and PET/CT; thoracoscopic biopsy with IHC panel (calretinin, WT1, D2-40; BAP1 and MTAP loss support malignancy); histology and BAP1/MTAP status recorded for treatment planning.
Biomarker results to ask for: Histology (epithelioid vs sarcomatoid), BAP1, CDKN2A/MTAP deletion, Mesothelin, Histology (epithelioid vs non-epithelioid) drives first-line choice, BAP1 loss (diagnostic; germline BAP1 syndrome), CDKN2A/MTAP deletion (diagnostic; PRMT5-inhibitor target), Mesothelin (CAR-T, ADC, engager target), PD-L1 (weakly predictive), Soluble mesothelin-related peptides and fibulin-3 (research), Asbestos exposure history.
Scans and tests linked to this cancer: CT (computed tomography), Histopathology & immunohistochemistry, PET/CT, FAPI PET.
Bring copies of scan reports, pathology and blood results, and a list of every medicine and supplement.
The treatments I may be offered
- Surgery: Not recommended for cure outside trials after MARS 2; VATS pleurodesis or indwelling pleural catheter for effusion; extended pleurectomy/decortication (P/D) only in clinical trials. (Extended pleurectomy/decortication & radical mesothelioma surgery, MARS 2)
- Unresectable: Nivolumab-ipilimumab or chemo-IO; TTFields. (Nivolumab, Ipilimumab, Pembrolizumab, Optune / Optune Pax (TTFields))
- First line, non-epithelioid: Nivolumab + ipilimumab (CheckMate 743) preferred; pembrolizumab + platinum-pemetrexed alternative. (Nivolumab, Ipilimumab, CheckMate 743, Pembrolizumab, IND.227 / KEYNOTE-483, Histology → first-line choice in mesothelioma)
- First line, epithelioid: Pembrolizumab + platinum-pemetrexed, nivolumab + ipilimumab, or platinum-pemetrexed ± bevacizumab, chosen by fitness and preference. (Pembrolizumab, IND.227 / KEYNOTE-483, Nivolumab, Ipilimumab, Pemetrexed, MAPS)
- Radiotherapy: Palliative for chest wall pain; prophylactic tract irradiation not beneficial (SMART/PIT trials); hemithoracic IMRT after surgery only in trials. (IMRT / IGRT (modern external beam))
- Peritoneal mesothelioma: Cytoreductive surgery with HIPEC in selected patients; systemic therapy extrapolated from pleural disease. (HIPEC / PIPAC (intraperitoneal chemotherapy))
- Second line: Nivolumab (CONFIRM: OS benefit vs placebo) or nivolumab-ipilimumab if not given first line; platinum-pemetrexed rechallenge or gemcitabine/vinorelbine if IO given first; trials. (Nivolumab, Pemetrexed)
- Maintenance: Continue immunotherapy per regimen; TTFields (Optune Lua) with pemetrexed-platinum under HDE approval; no maintenance chemotherapy standard. (Optune / Optune Pax (TTFields), Tumour treating fields (TTFields), STELLAR)
From the standard of care recorded for this cancer; which apply depends on your stage and biomarkers. Ask which the team recommends and why.