Key Points
➤ Mesothelioma should be reported as epithelial, sarcomatoid or biphasic,
because these subtypes have a clear prognostic significance.
➤ The optimal approach to mesothelioma measurement requires the
expertise of a radiologist to identify measurement sites on CT as per
modified RECIST for mesothelioma.
➤ When offering maximal surgical cytoreduction, lung-sparing options
(pleurectomy/decortication (P/D), extended P/D) should be the first
choice, due to decreased operative and long-term risk. Extrapleural
pneumonectomy (EPP) may be offered in highly selected patients when
performed in centers of excellence.
➤ Maximal surgical cytoreduction as a single modality treatment is generally
insufficient; additional anti-neoplastic treatment (chemotherapy and/or
radiation therapy) should be administered. It is recommended that this
treatment decision should be made with multidisciplinary input.
➤ Chemotherapy should be offered to patients with mesothelioma because it
improves survival and quality of life.
➤ The recommended first-line chemotherapy for patients with mesothelioma
is pemetrexed plus platinum. Patients should also be offered the option of
enrolling in a clinical trial.
➤ The addition of bevacizumab to pemetrexed-based chemotherapy improves
survival in select patients and therefore may be offered to patients with no
contraindications to bevacizumab.
➤ In patients who may not be able to tolerate cisplatin, carboplatin may be
offered as a substitute for cisplatin.
➤ Radiation therapy should be offered as an effective treatment modality to
palliate patients with symptomatic disease.
