INNOVATIVE APPROACHES IN IMMUNOTHERAPY FOR MALIGNANT MESOTHELIOMA

Abstract

Introduction: Malignant mesothelioma (MM) is a rare and aggressive tumor, often related to asbestos exposure, with a predilection for the pleura (MPM). Its diagnosis is usually late, and the prognosis is poor. Immunotherapy, especially with immune checkpoint inhibitors, has been studied as a promising alternative to conventional chemotherapy. Objective: To analyze recent advances in the use of immunotherapy in the treatment of malignant pleural mesothelioma, focusing on efficacy, limitations, and future perspectives. Method: An integrative literature review was carried out using the PubMed-MEDLINE database, with a time frame from 2019 to 2024. The PVO strategy was used (Population: patients with malignant mesothelioma; Variable: immunotherapy; Outcome: clinical efficacy). Articles in English, with full text available and a focus on immunotherapy were included. After applying the inclusion and exclusion criteria, 20 studies were selected and analyzed. Results: Of the 20 studies analyzed, 40% investigated immune checkpoint inhibitors (anti-PD-1, anti-CTLA-4), with emphasis on the combination of nivolumab + ipilimumab, which showed an improvement in overall survival compared to chemotherapy alone. Approximately 20% addressed biomarkers such as PD-L1 for patient selection. Another 15% discussed combined therapies with chemotherapy and immunotherapy, while 10% explored emerging therapies. Limitations such as primary resistance, toxicity and high cost were recurrent in the studies. Conclusion: Immunotherapy, especially the combination of checkpoint inhibitors, represents an important advance in the treatment of malignant pleural mesothelioma, offering better survival in unresectable cases. However, tumor heterogeneity and therapeutic resistance still limit its full efficacy. The identification of biomarkers and personalization of treatment emerge as promising strategies to optimize clinical results.