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Expert Rev Respir Med. 2019 Feb;13(2):181-192. doi: 10.1080/17476348.2019.1563488. Epub 2018 Dec 30.

Immunotherapy strategies for mesothelioma - the role of tumor specific neoantigens in a new era of precision medicine.

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a Department of Medical Oncology , Sir Charles Gairdner Hospital , Nedlands , Australia.
b National Centre for Asbestos Related Disease , University of Western Australia , Nedlands , Australia.
c Department of Respiratory Medicine , Sir Charles Gairdner Hospital , Nedlands , Australia.
d Institute of Respiratory Health , University of Western Australia , Nedlands , Australia.


Immunotherapy has long been considered a potential therapy for malignant mesothelioma and is currently being pursued as such. Some of the early phase clinical trials involving immunomodulators have demonstrated encouraging results and numerous clinical trials are underway to further investigate this treatment approach in various treatment settings and larger patient cohorts. Areas covered: This review summarizes the current and emerging clinical evidence for checkpoint blockade and other immunotherapeutic strategies in mesothelioma. The mesothelioma tumor immune microenvironment and mutational landscape are also discussed, including their impact on treatment strategies. We also provide an evaluation of the current evidence for neoantigen targeted personalized immunotherapy. Expert opinion: Immune checkpoint inhibitors work by unleashing the host immune response against probable neoantigens. Despite impressive activity in a small subset of patients and the potential for prolonged responses, most patients experience treatment failure. Neoantigen vaccines provide a potential complementary therapeutic strategy by increasing the immunogenic antigen load, which can lead to an increased tumor specific immune response. Further research is needed explore this treatment option in mesothelioma and technological advances are required to translate this concept into clinical practice.


Mesothelioma; immune checkpoint blockade; immunotherapy; neoantigens; vaccines

[Indexed for MEDLINE]

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