Malignant pleural mesothelioma is a rare cancer that is caused by inhaling asbestos fibers. Historically, the prognosis for this disease has been poor due to the lack of effective treatments. Since 2004, approved treatments for unresectable malignant pleural mesothelioma were primarily limited to systemic chemotherapy regimens. For years, treatment studies offered only relatively modest adjustments to the baseline chemotherapy treatment with insignificant results. Until recently, progress against this deadly disease was relatively stagnant, with chemotherapy being the only US Food and Drug Administration (FDA)–approved treatment.

The year 2021, however, offered new hope for patients with malignant pleural mesothelioma. A total of five randomized treatment studies were reported, potentially offering additional treatment options for patients who once had very limited choices. Of these five studies, phase III of CheckMate 743, an immunotherapy combination treatment, reported significant and clinically meaningful improvements in overall survival versus standard-of-care chemotherapy, leading to a new FDA approval for previously unresectable malignant pleural mesothelioma. Several ongoing randomized phase III trials seek to further validate the effectiveness of combination therapies against this rare disease.

In addition, advances in experimental treatments such cellular therapy and precision medicine continue to progress and are beginning to emerge as potential treatment options for patients with mesothelioma. The next generation of clinical trials for this disease will likely focus on these types of treatments and hold great promise for this hard-to-treat cancer.

Only your doctor can determine what treatment may be right for you. Be sure to discuss all of your occupational exposures with your doctor to help him or her obtain a proper diagnosis and develop the correct treatment plan for you.

If you or a loved one are a current or former railroad worker diagnosed with malignant pleural mesothelioma, please contact us today to discuss your legal rights.



  1. Kindler HL, Ismaila N, Armato SG III, et al: Treatment of malignant pleural mesothelioma: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol 36:1343-1373, 2018.
  2. Baas P, Scherpereel A, Nowak AK, et al: First-line nivolumab plus ipilimumab in unresectable malignant pleural mesothelioma (CheckMate 743): A multicentre, randomised, open-label, phase 3 trial. Lancet 30:375-386, 2021.
  3. Hedy Lee Kindler: Systemic Therapy for Mesothelioma: Turning the Corner, JCO Oncology Practice, 2021.
  4. Zalcman G, Mazieres J, Margery J, et al: Bevacizumab for newly diagnosed pleural mesothelioma in the Mesothelioma Avastin Cisplatin Pemetrexed Study (MAPS): A randomised, controlled, open-label, phase 3 trial. Lancet 387:1405-1414, 2016.
  5. Dudek AZ, Wang X, Gu L, et al: Randomized phase 2 study of maintenance pemetrexed versus observation for patients with malignant pleural mesothelioma without progression after first line chemotherapy: Cancer and Leukemia Group B 30901 (Alliance). Clin Lung Cancer 21:553-561, 2020.
  6. Fennell DA, Ewings S, Ottensmeier C, et al: Nivolumab versus placebo in patients with relapsed malignant mesothelioma (CONFIRM): A multicentre, double-blind, randomized, phase 3 trial. Lancet Oncol 22:1530-1540, 2021.
  7. De Gooijer CJ, van der Noort V, Stigt JA, et al.: Switch-maintenance gemcitabine after first-line chemotherapy in patients with malignant mesothelioma (NVALT19): An investigator-initiated, randomized, open-label, phase 2 trial. Lancet Respir Med 9:585-592, 2021.
  8. Fennell DA, Casbard A, Porter C, et al: A randomized phase II trial of oral vinorelbine as second-line therapy for patients with malignant mesothelioma. J Clin Oncol 39, 2021 (suppl 15; abstr 8507)
  9. Pinto C, Zucali PA, Pagano M, et al: Gemcitabine with or without ramucirumab as second-line treatment for malignant pleural mesothelioma (RAMES): A randomized, double-blind, placebo-controlled phase 2 trial. Lancet Oncol 22:1438-1447, 2021