Treatment of Newly Diagnosed Nonepithelioid (Biphasic or Sarcomatoid) Pleural Mesothelioma Without Prior Systemic Therapy

This protocol covers patients with newly diagnosed pleural mesothelioma whose tumour has a nonepithelioid histologic subtype — specifically biphasic or sarcomatoid — and who have received no prior systemic therapy and have no medical contraindication to immunotherapy.

Histologic subtype is central to treatment selection in this setting: nonepithelioid tumours are managed differently from epithelioid disease, and the absence of prior treatment or contraindications to immunotherapy directly shapes which approach is recommended.

For this patient group, immunotherapy-based treatment is the recommended first-line approach, with chemotherapy reserved only for specific circumstances. The full protocol also addresses what systemic options are available should disease progress after prior treatment lines — the complete algorithm, regimen details, and sequencing guidance are behind the link below.