Davis Alexander, Ke Helen, Kao Steven, Pavlakis Nick
Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown, NSW, Australia.
Department of Medical Oncology, Western Cancer Centre, Dubbo, NSW, Australia.
Lung Cancer (Auckl). 2022 Mar 2;13:1-12. doi: 10.2147/LCTT.S288535. eCollection 2022.
The treatment paradigm for malignant pleural mesothelioma (MPM) has changed little in the last 18 years. Radical intent treatment, consisting of surgical resection, radiotherapy and chemotherapy, has been offered to a highly select few; however, there is little randomised evidence to validate this approach. Prior to 2020 chemotherapy with platinum and an anti-folate was the only intervention with randomised evidence to demonstrate improved overall survival (OS) in MPM. No systemic therapy had been demonstrated to improve OS in the second line setting until 2020. The publication of the Checkmate 743 trial in 2021 demonstrated a survival benefit of combination immunotherapy over standard chemotherapy in newly diagnosed patients with MPM. This finding was shortly followed by the CONFIRM trial which demonstrates a modest but significant survival benefit of second line nivolumab versus placebo in patients having previously received standard chemotherapy. The results of these trials, recent biomarker directed therapy and chemotherapy adjuncts are discussed within this review. The integration of immunotherapy for the few patients in whom radical surgical therapy is intended is currently the subject of clinical trials and offers the prospect of improving outcomes in this rare but devastating disease.
在过去18年里，恶性胸膜间皮瘤（MPM）的治疗模式变化不大。根治性治疗包括手术切除、放疗和化疗，仅适用于极少数经过严格筛选的患者；然而，几乎没有随机对照证据来证实这种治疗方法的有效性。在2020年之前，含铂和抗叶酸的化疗是唯一有随机对照证据表明能改善MPM患者总生存期（OS）的干预措施。直到2020年，尚无系统治疗被证明能在二线治疗中改善OS。2021年公布的Checkmate 743试验表明，对于新诊断的MPM患者，联合免疫疗法比标准化疗具有生存获益。不久之后，CONFIRM试验表明，在先前接受过标准化疗的患者中，二线使用纳武单抗对比安慰剂具有适度但显著的生存获益。本综述讨论了这些试验的结果、近期的生物标志物导向治疗和化疗辅助治疗。对于少数打算接受根治性手术治疗的患者，免疫疗法的整合目前正处于临床试验阶段，并为改善这种罕见但致命疾病的治疗结果带来了希望。
