Immunotherapy has reshaped the first-line treatment of pleural mesothelioma, an aggressive asbestos-related cancer. The combination of nivolumab and ipilimumab became a standard of care on the strength of the CheckMate-743 trial, which showed a median overall survival of 18.1 months versus 14.1 months with chemotherapy, and improved two-year survival — a meaningful gain in a disease where untreated survival is measured in months. Chemotherapy combined with immunotherapy is also an option, and the 2025 ASCO guideline reflects immunotherapy's central role. Emerging approaches under investigation include mesothelin-targeted CAR-T cells, dendritic cell vaccines, and combinations of checkpoint inhibitors with anti-VEGF agents.
Further reading: CheckMate-743 nivolumab-ipilimumab; 2025 ASCO pleural mesothelioma guideline update (Kindler et al., JCO 2025); immunotherapy reviews (Fennell et al., Nature Reviews Clinical Oncology 2022).