An update in malignant peritoneal mesothelioma diagnosis and treatment—a narrative review

Background and Objective: Malignant peritoneal mesothelioma (MPM) poses a multitude of treatment challenges due to its insidious presentation, frequently advanced disease at the time of presentation, resistance to treatments and high rate of recurrence. Since MPM’s discovery in the 1700s and the recognition of the association between mesothelioma and asbestos in the mid-20th century, the treatment and detection landscape have changed and improved for all cancer types. Despite tremendous medical advancements elsewhere, patients with MPM continue to have relatively poor prognoses. The objective of this review is to summarize current practices and present recent advances in therapy. Methods: An initial query of PubMed articles was performed in 2021 using terms including mesothelioma, malignant mesothelioma, and peritoneal mesothelioma; additional queries were performed in 2022 and 2023 using the same search terms. Subsequently, a search of the Clinicaltrials.gov database was performed as well to assess for ongoing to trials. Articles written in English from 1840–2023 were included in the study. Key Content and Findings: Pre-operative assessment of the disease burden has improved with advancement in imaging techniques that allow better characterization of intra- and extra-peritoneal disease. For surgical candidates, cytoreductive surgery and heated intraperitoneal chemotherapy continue to remain mainstays of therapy. For non-surgical candidates, Pemetrexed-based regimens have been widely incorporated as a primary chemotherapeutic option for the treatment of mesothelioma given its improvement in overall survival. With advances in medical therapy, improvements in outcomes have been seen with chemotherapy in conjunction with immunotherapy, chimeric antigen receptor (CAR)-T, photodynamic, or oncolytic virus therapy. Conclusions: MPM is a rare and fatal disease, primarily treated surgically, with high rates of recurrence resulting in overall poor outcomes. However, with advances in detection and characterization of disease, and improvements in targeted therapy, outcomes can improve.