Immunotherapy In Malignant Pleural Mesothelioma

Malignant pleural mesothelioma (MPM) is a rare thoracic cancer that derives from the mesothelial cells of the pleura and is causally associated with exposure to asbestos. Because of its aggressiveness and resistance to therapies, MPM prognosis is extremely poor and the 5-year survival rate is approximately 10%. Despite its poor effectiveness, chemotherapy with cisplatin and pemetrexed has long remained the standard-of-care for upfront treatment with no second line therapy available. Recently, the approval of ipilimumab (anti-CTLA-4) plus nivolumab (anti-PD-1) for the first-line treatment of unresectable MPM has marked a significant milestone, in particular for the non-epithelioid MPM subtype, which is more resistant to chemotherapy and associated with a poorer outcome. However, most MPM patients are still resistant to cancer therapies. Beyond histologic subtypes, recent studies have highlighted extensive genetic variation and gene expression deregulation both between and within MPM patients. This molecular heterogeneity highlights the need for a personalized treatment approach. Therefore, both multiple therapeutic options and predictive biomarkers that can guide clinical decision-making are urgently needed. Tumor cell immunogenicity and tumor microenvironment composition (TME) are the major determinants of the success of immunotherapy. Despite the low tumor mutational burden, recent studies indicate that chromoanagenesis and chromotripsis are molecular features of MPM. Since chromosomal instability can lead to the expression of neo-antigens, it could also influence the efficacy of immune checkpoint inhibitors (ICIs). The immunosuppressive TME is an additional important hurdle that limits the efficacy of immunotherapy. The combination of ICIs with strategies to boost anti-tumor immunity by restraining immunosuppressive myeloid cells or by reprograming “cold tumor” into “hot tumor” is an active area of research. This Research Topic aims to discuss recent advances in understanding and targeting MPM immune microenvironment for therapeutic purposes along with potential predictive biomarkers to select patients who most likely will respond to immunotherapies. We are interested in basic and clinical studies that explore the crosstalk between tumor and immune cells in order to highlight new molecular targets, approaches, and combination treatments to enhance anti-tumor immunity in MPM and assess potential predictive biomarkers of response to immunotherapy.