The Evolving Role of Chemotherapy in the Management of Pleural Malignancies: Current Evidence and Future Directions

Our plain-English summary of The Evolving Role of Chemotherapy in the Management of Pleural Malignancies: Current Evidence and Future Directions, by Y. Semenova, Z. Burkitbayev, N. Kalibekov, et al (Cancers, 2025).

The study

• Authors: Y. Semenova, Z. Burkitbayev, N. Kalibekov, A. Digay, B. Zhaxybayev, O. Shatkovskaya, S. Khamzina, D. Zharlyganova, Z. Kuanysh, A. Manatova
• Journal: Cancers
• Published: 2025;17(13)
• Type of article: Review
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Pleural malignancies represent a clinically devastating group of oncological disorders, most commonly arising from metastatic disease, with lung and breast cancers being the most frequent primary sites. Malignant pleural mesothelioma is a primary malignancy of the pleura and occurs less often than metastatic pleural disease. Pleural malignancies often present with malignant pleural effusion, which typically indicates advanced-stage disease and is associated with poor overall prognosis. Treatment of pleural malignancies includes both palliative and definitive approaches. Palliative interventions primarily aim to relieve symptoms and improve quality of life. Definitive treatments include systemic chemotherapy, targeted therapy, and immunotherapy, depending on the type and molecular profile of the underlying tumor. In mesothelioma, platinum-based chemotherapy in combination with pemetrexed remains the cornerstone of treatment, while the combination of nivolumab and ipilimumab is recommended as first-line therapy for unresectable disease. For metastatic disease, systemic therapy is typically tailored to the primary tumor's characteristics. Intrapleural administration of chemotherapeutic agents is one of the therapeutic strategies and hyperthermic intrathoracic chemotherapy and pressurized intrathoracic aerosol chemotherapy are the most recent innovations that are under active investigation. This review provides an up-to-date synthesis of systemic chemotherapy strategies for pleural malignancies, their integration with targeted and immune-based therapies, and recent advances in intrapleural chemotherapy modalities. It also explores existing knowledge gaps and outlines directions for future research and potential changes in clinical practice.

In plain English

This article reviewed published research on chemotherapy for malignant pleural disease, meaning cancer in the lining around the lungs. It covered malignant pleural mesothelioma, which starts in the pleura, and the more common spread of other cancers, mainly lung and breast cancer, to the pleura. The authors searched Web of Science, ScienceDirect and MEDLINE/PubMed. They grouped the studies into three themes: chemotherapy through the bloodstream, combinations with targeted drugs and immunotherapy, and chemotherapy placed directly in the chest cavity, including heated (HITOC) and pressurized aerosol (PITAC) methods. The article did not state how many studies it included. One trial it described, of 456 mesothelioma patients, reported a median survival of 12.1 months with cisplatin plus pemetrexed, against 9.3 months with cisplatin alone. The authors concluded that platinum plus pemetrexed remains the cornerstone of mesothelioma treatment. They also concluded that HITOC and PITAC show promise but need more evidence, noting that most HITOC studies were small and retrospective. The authors suggested that targeted screening of people with occupational asbestos exposure may be warranted, while noting that low-dose CT screening for mesothelioma remains investigational.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Review of published literature (database search with inductive thematic analysis); the number of included studies and the search dates are not reported
• Who was studied: Published studies of patients with malignant pleural disease: malignant pleural mesothelioma and pleural metastases from lung, breast, ovarian, gastrointestinal and thymic cancers and lymphomas
• Exposure: Not an exposure study; the review concerns treatments (systemic chemotherapy, targeted therapy, immunotherapy, intrapleural chemotherapy). Asbestos appears in two places. The introduction discusses mesothelioma incidence and continued asbestos use in developing countries. The future-directions section suggests that targeted screening of people with occupational asbestos exposure may be warranted.
• Main results:
  • In the EMPHACIS trial as described by the review (456 mesothelioma patients), cisplatin plus pemetrexed gave a median overall survival of 12.1 months, against 9.3 months for cisplatin alone
  • In the CheckMate 743 trial as described by the review, median overall survival in unresectable mesothelioma was 18.1 months with nivolumab plus ipilimumab, against 14.1 months with chemotherapy
  • In the CheckMate 743 trial, patients with nonepithelioid (sarcomatoid or biphasic) mesothelioma had a median survival of 18.1 months with immunotherapy, against 8.8 months with chemotherapy
  • In the MAPS trial as described by the review, adding bevacizumab to pemetrexed and cisplatin was associated with a median overall survival of 18.8 months, against 16.1 months for chemotherapy alone
  • In the IND.227/KEYNOTE-483 trial as described by the review, median overall survival was 17.3 months with pembrolizumab plus chemotherapy, against 16.1 months with chemotherapy alone
  • The authors stated that low-dose CT has been proposed for high-risk groups, but its role in mesothelioma screening remains investigational
• The authors' conclusion: The authors concluded that platinum-based chemotherapy with pemetrexed remains the cornerstone of mesothelioma treatment and that nivolumab plus ipilimumab has transformed the field. They also concluded that HITOC and PITAC have shown promise but need further evidence before routine use.
• Limitations the authors state:
  • The authors stated that most HITOC studies are small, retrospective and often lack control groups
  • The authors stated that the evidence for PITAC is even more limited, consisting mostly of small retrospective case series
  • The authors stated that there is not enough evidence to support routine use of biomarkers to predict response to targeted therapy or immunotherapy in mesothelioma

Topics

Medical terms in this study, explained in our Lexicon: Chemotherapy, Pleural Mesothelioma, Pleura, Pleural Effusion, Prognosis, Palliative Care, Quality of Life, Targeted Therapy.

Related studies

• Chemotherapy for malignant pleural mesothelioma: a review of current management and a look to the future — A.K. Nowak (2012)
• Tumour treating fields therapy for glioblastoma: current advances and future directions — O. Rominiyi, A. Vanderlinden, et al. (2021)
• Raltitrexed: current clinical status and future directions — E. Van Cutsem, D. Cunningham, et al. (2002)
• Biomarkers in malignant pleural mesothelioma: current status and future directions — T. Ahmadzada, G. Reid, et al. (2018)
• The Current Treatment Landscape of Malignant Pleural Mesothelioma and Future Directions — B. Bertin, M. Zugman, et al. (2023)
• Peritoneal mesothelioma: current status and future directions — T.C. Chua, C.H. Chong, et al. (2012)

Browse more research in Cancers, or return to medical research.