Role of induction and adjuvant systemic treatment in mesothelioma: narrative review

Objective: This review will focus on the issues of integrating chemotherapy and immunotherapy in the definitive management of mesothelioma as either induction or adjuvant therapy. Background: While surgery is considered a primary treatment for mesothelioma, complete resection can rarely be obtained. Systemic therapy with chemotherapy and more recently, immunotherapy has been demonstrated to improve outcomes in advanced disease. Therefore, it is appropriate to consider the use of chemotherapy and/or immunotherapy as induction therapy or postoperatively. Additionally, factors such as surgical procedure, radiotherapy and various prognostic factors also need to be considered. Methods: A search of the English language literature was performed to identify prospective trials using current chemotherapy and immunotherapy regimens. In addition, literature was selectively reviewed for case series and database analyses that focused on the issue of the utility of induction or adjuvant therapy. Conclusions: There are numerous issues that complicate the interpretation of studies, including the variety of surgical procedures, prognostic factors and the nature of the trial design and reporting. Relatively few well designed studies have been performed and there is inadequate data at this time to support or refute the use of induction or adjuvant therapy. Current studies are focused on evaluating immunotherapy studies in this setting.