ESMO 2026 | How can IO and surgery reshape the mesothelioma treatment landscape?

So as you know pleural mesothelioma is a rare and aggressive cancer that is mainly related to asbestos exposure so in the last year we faced lots of news in this rare disease so actually one of the most important trials in the past year was the MARS 2 trial that was a surgical trial that compared the patient with resectable plural mesothelioma and randomized them after two cycles of chemotherapy to surgery extended pleural pleurolectomy the cortication followed by chemotherapy or chemotherapy alone and the trial was designed to show the superiority of the surgical arm unfortunately the trial was negative so there were no differences in terms of overall survival progression free survival in the arms and there was a trend towards a superiority of chemotherapy alone so that was quite a earthquake in oncology in for plural mesothelioma and so surgery is well discussed now in guidelines the new guidelines suggest that at least a careful patient selection for surgery or some guidelines state that surgery should not be offered to patients outside clinical trials the other big earthquake was that of immunotherapy so chemo immunotherapy or double immunotherapy are superior to chemotherapy alone that was the standard of care for more than 20 years in mesothelioma and these trials have led to the approval in most of the countries of the combination of nivolumab plus ipilimumab or the combination of chemotherapy plus pembrolizumab so these were the two biggest trials phase three trials and then there are other trials that suggest potential activities of even FURTHER agents in pre-treated patients great

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