Mesothelioma: lines of therapy
9 standard-of-care settings across 5 lines and 1 biomarker subgroup. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.
| Line | All comers |
|---|---|
| Screening, prevention and diagnosis | 1 |
| Advanced, first line | 3 |
| Maintenance | 1 |
| Second line | 1 |
| Other settings | 3 |
Screening, prevention and diagnosis
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | 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. | NCCN · MPM guideline | 68 |
Advanced, first line
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Unresectable | Nivolumab-ipilimumab or chemo-IO; TTFields. | NCCN Guidelines: Mesothelioma (Pleural) | 98 | |
| All comers | First line, non-epithelioid | Nivolumab + ipilimumab (CheckMate 743) preferred; pembrolizumab + platinum-pemetrexed alternative. | NCCN · 1 (preferred)ESMO-MCBS · 4 | 98 | |
| All comers | First line, epithelioid | Pembrolizumab + platinum-pemetrexed, nivolumab + ipilimumab, or platinum-pemetrexed ± bevacizumab, chosen by fitness and preference. | NCCN · 1 (chemo-IO and IO doublet); 2A (bevacizuma…ESMO-MCBS · 3 | 98 |
Maintenance
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Maintenance | Continue immunotherapy per regimen; TTFields (Optune Lua) with pemetrexed-platinum under HDE approval; no maintenance chemotherapy standard. | NCCN · 2B (TTFields) | 91 |
Second line
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | 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. | NCCN · 2A | 86 |
Other settings
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Surgery | Not recommended for cure outside trials after MARS 2; VATS pleurodesis or indwelling pleural catheter for effusion; extended P/D only in clinical trials. | NCCN · Selected centres/trials only | 53 | |
| All comers | Radiotherapy | Palliative for chest wall pain; prophylactic tract irradiation not beneficial (SMART/PIT trials); hemithoracic IMRT after surgery only in trials. | 91 | ||
| All comers | Peritoneal mesothelioma | Cytoreductive surgery with HIPEC in selected patients; systemic therapy extrapolated from pleural disease. | 60 |
Regimens in the library
Lines and subgroups are parsed from the setting text of each standard-of-care row and can misclassify an unusual phrasing; the row’s own setting is always shown. Guideline chips reflect the NCCN category and ESMO-MCBS grade recorded on the cancer page, checked on its stated date. Not medical advice.