Treatment of Clinical Early-Stage (T1–3N0) Epithelioid Pleural Mesothelioma in Surgical Candidates

This protocol addresses patients with clinical early-stage epithelioid pleural mesothelioma who are candidates for surgical intervention — specifically those with T1–3N0 disease, no extrathoracic spread, and favorable prognostic characteristics.

Clinical scenario: Clinical early-stage (T1–3N0) epithelioid pleural mesothelioma; no extrathoracic disease; favorable prognostic characteristics; surgical candidate.

In this population, the recommended framework is multimodality treatment. The approach centers on maximal surgical cytoreduction — with lung-sparing techniques as the preferred first choice — combined with pemetrexed/platinum-based chemotherapy that may be administered before or after the surgical procedure.

The complete treatment algorithm — including selection criteria for each surgical approach, sequencing decisions, additional systemic or locoregional options, and candidacy criteria — is available in the full structured protocol.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1200/JCO-24-02425

Surgical cytoreduction should only be offered to highly selected patients who have favorable prognostic characteristics including clinical early-stage (T1-3N0) epithelioid tumors.

A maximal cytoreduction (either lung-sparing or non–lung-sparing) should only be considered in patients who meet specific preoperative cardiopulmonary functional criteria, have no evidence of extrathoracic disease, and are able to receive multimodality treatment (adjuvant or neoadjuvant).

Maximal surgical cytoreduction involves either EPP or lung-sparing options (P/D, extended P/D). When offering maximal surgical cytoreduction, lung-sparing options should be the first choice, due to decreased operative and long-term risk.

In the context of multimodality treatment, four to six cycles of pemetrexed/platinum-based chemotherapy may be administered pre- or postoperatively.

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