**Chapter 6 79**

Biomarkers Progress and Therapeutic Implications in Malignant Mesothelioma *by Jordyn Feinstein and Muaiad Kittaneh*

### **Chapter 7 91**

Genetic Alterations of Malignant Pleural Mesothelima *by Benjamin Wadowski, David T. Severson, Raphael Bueno and Assunta De Rienzo*

Preface

Mesothelioma is a rare type of cancer belonging to those types of tumors for which there has been a lack of treatment advances in recent years. Overall, it is considered

This book presents a description of the most relevant topics on diagnosis, biomarkers, and treatment updates, including interesting discussion on prognostic features

an extended disease with very limited aggressive treatment approaches.

and novel therapies that are either approved or under clinical development.

markers and targeted therapies.

provide a clear and succinct overview of these topics.

Chapters provide insight into the current challenges in assessing predictive bio-

I thank the chapter authors for their valuable contributions and commitment to

**Sonia Maciá** Medical Director, Highlight Therapeutics,

Spain

Preface

Mesothelioma is a rare type of cancer belonging to those types of tumors for which there has been a lack of treatment advances in recent years. Overall, it is considered an extended disease with very limited aggressive treatment approaches.

This book presents a description of the most relevant topics on diagnosis, biomarkers, and treatment updates, including interesting discussion on prognostic features and novel therapies that are either approved or under clinical development.

Chapters provide insight into the current challenges in assessing predictive biomarkers and targeted therapies.

I thank the chapter authors for their valuable contributions and commitment to provide a clear and succinct overview of these topics.

**II**

**Chapter 6 79**

**Chapter 7 91**

Biomarkers Progress and Therapeutic Implications

Genetic Alterations of Malignant Pleural Mesothelima *by Benjamin Wadowski, David T. Severson, Raphael Bueno* 

in Malignant Mesothelioma

*and Assunta De Rienzo*

*by Jordyn Feinstein and Muaiad Kittaneh*

**Sonia Maciá** Medical Director, Highlight Therapeutics, Spain

**1**

Section 1

Introduction

Section 1 Introduction

**3**

**Chapter 1**

*Sonia Maciá*

**1. Introduction**

increase the risk of mesothelioma [1].

**Abstract**

Mesothelioma, a Review of

Mesothelioma is considered as a rare tumor originating in the mesothelial surfaces of pleura or, more rarely, in other sites such as peritoneum, which harbors a very poor prognosis. Despite clinical research efforts, lack of available therapies remains clear. Standard of care treatments and guidelines have not been evolved much along recent years. In this chapter, main guidelines will be reviewed, besides a systematic Pubmed review, with a focus on epidemiology, diagnosis tests, and approved local and systemic treatments, including most important advances. Searched terms included "mesothelioma," "ESMO and NCCN guidelines," "diagnosis," "surgery," "targeted therapy," "clinical trials," "palliative treatment," and "meta-analysis." First-line regimen recommendations have not evolved since the phase III pivotal study of cisplatin-pemetrexed was published, and this combination became the standard of care. Targeted therapies have brought disappointing results. However, recent clinical trial data with immunotherapies are bringing some light

**Keywords:** malignant mesothelioma, chemotherapy, pemetrexed, immunotherapy,

Malignant mesothelioma (MM) is a fatal disease which originates in the mesothelial surfaces of pleura or, more rarely, in other sites such as peritoneum. Most cases have been classically linked to asbestos exposure; however, ionizing radiation may also

Its prognosis is very poor and it is difficult to treat, mainly because most patients are diagnosed with advanced disease [1–3]. Despite clinical research efforts, lack of available therapies remains clear and median overall survival is still approximately 1 year, with only 10% patients alive 5 years after diagnosis. Standard of care treatments and guidelines have not been evolved much along recent years. In this chapter, NCCN and ESMO guidelines have been reviewed, besides an electronic search of the Pubmed database, with a focus on the phase II and III clinical trials, guidelines, meta-analysis, and systematic reviews regarding epidemiology, diagnosis tests, surgical approach, and approved local and systemic treatments, including most important advances. Searched terms included "mesothelioma," "ESMO and NCCN guidelines," "diagnosis," "surgery," "targeted therapy," "clinical trials," "palliative treatment," and "meta-analysis." First-line regimen recommendations have not evolved since the phase III pivotal study of cisplatin-pemetrexed was published, and this combination became the standard of care despite its modest benefit

Current Guidelines

and may become a new paradigm in the following years.

clinical trials, nivolumab, pembrolizumab, targeted therapy

## **Chapter 1**
