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ESMO 2026 | Germline testing and BAP1 mutations predict mesothelioma prognosis
Paolo Bironzo, MD, PhD, University of Turin, Turin, Italy, discusses evolving guidelines for germline testing in patients with mesothelioma, noting that ASCO recommendations now suggest testing for all patients given that nearly 10 percent carry pathogenic germline variants associated with improved prognosis. Recent evidence suggesting that molecular features, including BAP1 status and specific mutations combined with clinical variables, may provide superior prognostic prediction compared to clinical variables alone, representing a step toward personalized treatment and patient management. This interview took place at the European Society for Medical Oncology (ESMO) 2026 Congress in Madrid, Spain.
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Transcript
Guidelines are changing also in in this way so for example the ascot guidelines suggest germline testing for all patients with mesothelioma because we know that nearly 10 percent of patients carry pathogenic germline variants in this disease and they are associated with better prognosis so the question is is it discalable in all contexts in all countries we do not have an answer now on which patients should be tested globally and how should they should be test with which kind of testing nowadays we know that some of these molecular features may give us some prognostic RELEVANCE there is a recent paper on the jto that suggests the clinical variables along with bap1 status and some of these mutations may predict prognosis better than clinical variables alone and this would be from from my point of view another step forward to personal personalized treatment and the management of the patients in the next few years...
Guidelines are changing also in in this way so for example the ascot guidelines suggest germline testing for all patients with mesothelioma because we know that nearly 10 percent of patients carry pathogenic germline variants in this disease and they are associated with better prognosis so the question is is it discalable in all contexts in all countries we do not have an answer now on which patients should be tested globally and how should they should be test with which kind of testing nowadays we know that some of these molecular features may give us some prognostic RELEVANCE there is a recent paper on the jto that suggests the clinical variables along with bap1 status and some of these mutations may predict prognosis better than clinical variables alone and this would be from from my point of view another step forward to personal personalized treatment and the management of the patients in the next few years.
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