Pleural mesothelioma
ICD-10 C45 · ICD-11 2C26.0

Nonepithelioid Pleural Mesothelioma: Next Steps When First-Line Immunotherapy Has Not Controlled Disease

Clinical Scenario

This protocol applies to patients with newly diagnosed nonepithelioid (biphasic or sarcomatoid) pleural mesothelioma who had no medical contraindication to immunotherapy, received first-line immunotherapy, and have since experienced disease progression.

Prior Treatment — Goal Not Achieved

The recommended first-line approach for nonepithelioid pleural mesothelioma is immunotherapy — either ipilimumab plus nivolumab, or chemoimmunotherapy with pembrolizumab combined with pemetrexed plus platinum-based chemotherapy. When absence of disease progression is not maintained, this next-line protocol is indicated.

Next-Line Approach (Partial Overview)

After first-line immunotherapy, a platinum-based chemotherapy combination is among the options that may be considered — the full selection criteria, sequencing algorithm, and complete regimen details are available in the structured protocol.

Instant Access to Structured Evidence-Based Regimens

References

  1. In patients with newly diagnosed nonepithelioid mesothelioma, ipilimumab plus nivolumab immunotherapy should be offered as the recommended first-line treatment.
  2. In patients with nonepithelioid histology who have not received any prior systemic therapy, chemotherapy should not be offered unless there are medical contraindications to immunotherapy.
  3. In patients who have received first-line immunotherapy, pemetrexed plus platinum with or without bevacizumab may be offered as an initial chemotherapy treatment option.
DOI: 10.1200/JCO-24-02425
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