Second-Line Treatment for Epithelioid Pleural Mesothelioma After First-Line Therapy Progression
This protocol addresses the management of newly diagnosed pleural mesothelioma of the epithelioid histologic subtype in patients whose disease has progressed despite first-line systemic therapy.
Clinical Scenario
The patient population is defined by two features: newly diagnosed pleural mesothelioma and confirmed epithelioid histologic subtype. This protocol applies once first-line systemic treatment has been initiated and disease control has not been maintained.
First-Line Therapy — Failure Condition
First-line systemic therapy for this population includes ipilimumab plus nivolumab; or pembrolizumab combined with pemetrexed plus platinum-based chemotherapy; or pemetrexed plus platinum-based chemotherapy with or without bevacizumab.
Escalation to this second-line protocol is indicated when the first-line regimen fails to achieve or sustain stable or responding disease — that is, when disease progression occurs.
Second-Line Approach — Overview
Second-line systemic therapy is available for this setting. The choice of approach depends on what the patient received in the first line — in particular, whether prior treatment was immunotherapy-based or chemotherapy-based. The full regimen details and selection algorithm are in the complete protocol.
References
DOI: 10.1200/JCO-24-02425
- In patients with newly diagnosed epithelioid mesothelioma, ipilimumab plus nivolumab immunotherapy should be offered as a first-line systemic treatment option.
- In patients with epithelioid histology, pemetrexed plus platinum-based chemotherapy with or without bevacizumab may be offered as a first-line systemic treatment option.
- In patients who have received first-line immunotherapy, pemetrexed plus platinum with or without bevacizumab may be offered as an initial chemotherapy treatment option.
- In patients previously treated with chemotherapy, double-agent immunotherapy may be offered as a treatment option.
- In patients previously treated with chemotherapy, single-agent immunotherapy may be offered as a treatment option.
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