Mésothéliome pleural malin : la chimiothérapie est-elle la seule option thérapeutique ?

Malignant pleural mesothelioma (MPM) is a rare cancer with bad prognosis and increasing incidence, usually induced by previous asbestos exposure. To date, there is no curative treatment of MPM. MPM patients exhibit a high resistance to chemotherapy, even if this is the current standard first-line treatment (platinium and pemetrexed doublet) for all the international guidelines, and very few patients are potential candidates to « radical surgery » as previously defined (extrapleural pneumonectomy) and not validated. However, facing the very poor results of chemotherapy, many trials explore other therapeutic tools (immunotherapy…) or strategies combining the chemotherapy with other treatments: targeted therapies, radiotherapy, multimodal approach including extended pleurectomy/decortication (eP/D), a debulking surgery for MPM, with lower morbi-mortality rates than EP/D but without curative intent except in very early and rare stages of this cancer. Therefore it has been suggested that eP/D could be interesting if combined with an intrapleural treatment such as chemotherapy, photodynamic therapy… These innovative therapies, summarized here, must be validated by prospective multicentric clinical trials, with the help in France of the national network of expert centers for MPM (« MESOCLIN ») to ease the inclusion of patients.