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ELCC 2025 | Does cytoreductive surgery have a role in pleural mesothelioma?
Jo Raskin, MD, Antwerp University Hospital (UZA), Edegem, Belgium, comments on the role of cytoreductive surgery in pleural mesothelioma. Following on from the results of the MARS 2 trial (NCT02040272), there is need for patient selection, particularly for epithelioid patients with localized disease. Current staging systems may not accurately reflect the true extent of disease, and improved staging and adjuvant treatments, such as immunotherapy, are needed to enhance outcomes. This interview took place at the European Lung Cancer Congress (ELCC) 2025 in Paris, France.
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Transcript
Well, the role of cytoreductive surgery in mesothelioma is very controversial, especially after the MARS 2 trial. There is some criticism about the MARS 2 trial, like incorrect staging and the high number of patients who died postoperatively compared to surgical series and also compared to the EORTC 1205 trial. So there’s believers and non-believers. We still believe in it...
Well, the role of cytoreductive surgery in mesothelioma is very controversial, especially after the MARS 2 trial. There is some criticism about the MARS 2 trial, like incorrect staging and the high number of patients who died postoperatively compared to surgical series and also compared to the EORTC 1205 trial. So there’s believers and non-believers. We still believe in it. But I think that patient selection is key. So we need to limit ourselves to the epitheloid patients with T1, T2, perhaps T3. But we know that the clinical staging and the pathological staging often do not match. So we are a bit too optimistic in the clinical staging. This must improve, perhaps with the TNM9. And also we need better new adjuvant treatments by adding probably immunotherapy to chemotherapy.
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