bims-mesote 2025-08-03 papers

Issue of 2025–08–03
four papers selected by
Laura Mannarino, Humanitas Research

Ann Thorac Surg. 2025 Jul 26. pii: S0003-4975(25)00686-1. [Epub ahead of print]

Why Surgery has a role in Pleural Mesothelioma.

DOI: https://doi.org/10.1016/j.athoracsur.2025.07.011

Cancers (Basel). 2025 Jul 16. pii: 2360. [Epub ahead of print]17(14):

Effectiveness of Surgical Treatment on Survival of Patients with Malignant Pleural Mesothelioma.

Renata Báez-Saldaña, María Esther Marmolejo-Torres, Marco Antonio Iñiguez-García, Aída Jiménez-Corona, Juan Alberto Berrios-Mejía.

Background: The benefit of surgery for malignant pleural mesothelioma is highly debated, as few robust clinical trials show its effectiveness. Objective: To examine the long-term survival of patients with malignant pleural mesothelioma who underwent surgical treatment combined with neoadjuvant chemotherapy versus those who received chemotherapy alone. Methods: We analyzed a historical cohort of 122 patients diagnosed with mesothelioma, confirmed through histopathological examination. We compared the clinical and laboratory characteristics of the surgery and chemotherapy groups at baseline. We calculated Kaplan-Meier survival curves and used Cox's proportional hazards model to evaluate the relationship between surgery and mortality. Results: Surgery was performed in 16 out of 122 cases. Pleurectomy/decortication (PD) represented 8 cases, while extrapleural pneumonectomy (EPP) accounted for the remaining 8 cases. At five years, survival rates for those who underwent surgery compared to chemotherapy alone were 53% (95% CI 15-81%) versus 23% (95% CI 10-40%), respectively. Survival among those who had PD was 67%, compared to 40% for those who had EPP. Surgical treatment was associated with improved survival, with a hazard ratio (HR) of 0.34 (95% CI 0.19-0.61) after adjusting for factors such as age over 65, the duration from symptom onset to diagnosis, hemoglobin levels below 10 g, a neutrophil-to-lymphocyte ratio over 6, and ECOG scores greater than 2. Conclusions: Mesothelioma surgery, whether it be PD or EPP, enhances patients' survival compared to chemotherapy. PD produces better outcomes than EPP.

Keywords: extrapleural pneumonectomy; malignant pleural mesothelioma; pleurectomy/decortication; surgery; survival

DOI: https://doi.org/10.3390/cancers17142360

Int J Mol Sci. 2025 Jul 16. pii: 6848. [Epub ahead of print]26(14):

Genetic Landscape of a Pleural Mesothelioma in a Child Affected by NF2-Related Schwannomatosis.

Marzia Ognibene, Gianluca Piccolo, Marco Crocco, Marco Di Duca, Antonio Verrico, Marta Molteni, Ferruccio Romano, Valeria Capra, Andrea Rossi, Federico Zara, Patrizia De Marco, Claudia Milanaccio.

We report the first case of pleural mesothelioma (PM) occurring in a child affected by NF2-related schwannomatosis (NF2-SWN) and without any history of environmental exposure to asbestos. Mesothelioma is a rare secondary tumor in brain cancer patients and the association with NF2-SWN has been described only in a few anecdotal cases and never in the pediatric field. NF2-SWN is an autosomal dominant disease caused by inactivating germline mutations of the NF2 tumor suppressor gene, one of the most common mutations associated with human primary mesothelioma too. By MLPA assay, array-CGH analysis, and NGS on blood and tumor DNA, we determined the mutation profile of this rare NF2-driven PM and we identified several atypical chromosomal aberrations in tumor cells, suggesting a different genomic signature between pediatric and adult mesothelioma.

Keywords: NF2-related schwannomatosis; cancer-related genes; chromosomal aberrations; neurofibromatosis type 2; pediatric pleural mesothelioma

DOI: https://doi.org/10.3390/ijms26146848

Crit Rev Oncol Hematol. 2025 Jul 23. pii: S1040-8428(25)00252-5. [Epub ahead of print]215 104864

Towards a new approach in pleural mesothelioma: Perioperative immunotherapy and its implications.

Paolo Ambrosini, Alessia Stanzi, Giuseppe Lo Russo, Piergiorgio Solli, Mario Occhipinti.

Pleural mesothelioma is a rare malignancy that has historically had a poor prognosis, even with systemic chemotherapy. Although immune checkpoint inhibitors have improved survival rates for patients with advanced, unresectable disease, their role in perioperative management is unclear. We conducted a review of early-phase trials and case series examining the use of immune checkpoint blockade alone or in combination with platinum-based chemotherapy and surgery for pleural mesothelioma. We then contrasted these findings with established perioperative immunotherapy paradigms in non-small cell lung cancer. For pleural mesothelioma, feasibility studies have reported a major pathological response in up to 25 % of patients, a median progression-free survival of 14-19 months and sporadic instances of a pathological complete response. These studies have also reported acceptable toxicity and surgical timings. In contrast, non-small cell lung cancer trials have demonstrated consistent major pathological response rates of over 50 %, significant event-free survival benefits and validated complete response endpoints. These divergent outcomes reflect differences in tumor microenvironment, mutational burden, histological subtypes and predictive biomarkers between the two diseases. Our analysis highlights the need for standardized pathological endpoints, refined patient selection criteria and larger randomized studies to optimize the sequencing and combination of immunotherapy, chemotherapy and surgery in pleural mesothelioma. Such efforts are essential for integrating perioperative immune strategies into multimodal care and improving long-term outcomes.

Keywords: Adjuvant; Biomarkers; Immunotherapy; Mesothelioma; Microenvironment; Neoadjuvant

DOI: https://doi.org/10.1016/j.critrevonc.2025.104864