Pembrolizumab with pemetrexed and cisplatin for untreated advanced malignant pleural mesothelioma [ID4044]

Malignant pleural mesothelioma is a cancer affecting the membranes lining the outer surface of the lungs and the inside of the chest wall (the pleura).

It is a highly aggressive tumour; the majority of people with this condition present and are diagnosed in the advanced stages of the disease and most have a poor prognosis.

Pleural mesothelioma can be divided into 3 histologic subtypes epithelioid sarcomatoid and a combination of epithelioid and sarcomatoid known as biphasic.

Malignant pleural mesothelioma accounts for approximately 96% of all mesothelioma diagnoses.(1) Most cases are linked to exposure to asbestos in the workplace.

People typically present with the condition 20 to 50-years after exposure and over half of all diagnoses are in people aged 75 and older.1 Between 2016 and 2018 approximately 6950 people were diagnosed with pleural mesothelioma in UK (approximately 2300 per year) and 83% of diagnoses were in men.(1)The aim of treatment is to prolong life expectancy reduce tumour size and improve symptoms.

NICE technology appraisal guidance 818 (2022) recommends nivolumab with ipilimumab as an option in adults with untreated unresectable malignant pleural mesothelioma if they have an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1.

NICE technology appraisal guidance 135 (2008) recommends pemetrexed with cisplatin as a treatment option for people with untreated malignant pleural mesothelioma for whom surgical resection is inappropriate.

For people who are not fit enough to receive chemotherapy best supportive care is used to control disease symptoms.References1. Royal College of Physicians (2020). National Mesothelioma Audit.