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Pleural mesothelioma

Nature Reviews Disease Primers volume 11, Article number: 56 (2025) Cite this article

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Abstract

Mesothelioma is a lethal cancer caused by exposure to asbestos, which arises predominantly in the pleural lining of the thoracic cavity or, less commonly, in the peritoneum, pericardium or tunica vaginalis. The incidence of mesothelioma increased globally during the late twentieth century, correlating with the use of asbestos, and it continues to rise in some regions. Asbestos tumorigenesis involves fibre persistence that leads to DNA damage mediated by chronic inflammation. The genomic landscape of mesothelioma is predominantly characterized by tumour suppressor alterations, most frequently occurring in BAP1, CDKN2A, CDKN2B, MTAP, NF2 and TP53. Patients with mesothelioma commonly present with fatigue, dyspnoea and/or cough caused by pleural effusion, pain and reduced appetite with weight loss. Imaging, cytology, histology and immunohistochemistry are used in diagnosis and support tumour staging. Genetic tests are relevant to reveal disease predispositions. Mesotheliomas are classified on the basis of histology into three distinct subtypes: epithelioid (the most common subtype with the best prognosis), biphasic and sarcomatoid (worst prognosis). Chemotherapy has been the standard of care for the past two decades but immune checkpoint inhibition targeting PD1 and CTLA4 is now considered to be the first-line treatment, showing improvement compared with chemotherapy. Few randomized trials have investigated the role of surgery and radiotherapy and none has found a clear benefit over systemic therapies. Mesothelioma is associated with considerable negative effects on quality of life in physical and emotional domains and also substantially affects patients’ families and caregivers.

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Fig. 1: Common mesothelioma sites.
Fig. 2: Global incidence of mesothelioma.
Fig. 3: Key pathways affected in mesothelioma cells.
Fig. 4: Pathological features of mesothelioma.
Fig. 5: Diagnostic pathway for mesothelioma.

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Author information

Authors and Affiliations

  1. University of Leicester, Leicester, UK

    Dean A. Fennell

  2. University Hospitals of Leicester NHS Trust, Leicester, UK

    Dean A. Fennell

  3. Division of Cancer Biology, Aichi Cancer Center Research Institute, Nagoya, Japan

    Yoshitaka Sekido

  4. Department of Thoracic Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands

    Paul Baas

  5. Department of Pulmonology, The Leiden University Medical Center, Leiden, The Netherlands

    Paul Baas

  6. Department of Pathology, University of Chicago, Chicago, IL, USA

    Aliya N. Husain

  7. Clinic of Oncology, Cantonal Hospital Fribourg, Fribourg, Switzerland

    Alessandra Curioni-Fontecedro

  8. Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland

    Alessandra Curioni-Fontecedro

  9. Academic Division of Thoracic Surgery, The Royal Brompton Hospital, London, UK

    Eric Lim

  10. National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK

    Eric Lim

  11. Department of Thoracic Surgery, Universitätsspital Zürich, Zurich, Switzerland

    Isabelle Opitz

  12. New York Proton Center, New York, NY, USA

    Charles B. Simone II

  13. Curtin Medical School, Curtin University, Perth, Western Australia, Australia

    Fraser Brims

  14. Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia

    Fraser Brims

  15. Institute for Respiratory Health, Perth, Western Australia, Australia

    Fraser Brims

  16. The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Hong Kong SAR, People’s Republic of China

    Martin Chi-sang Wong

  17. School of Public Health, Fudan University, Hong Kong SAR, People’s Republic of China

    Martin Chi-sang Wong

  18. Centre for Health Education and Health Promotion, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, People’s Republic of China

    Martin Chi-sang Wong

  19. The Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China

    Martin Chi-sang Wong

  20. Department of Global Health, School of Public Health, Peking University, Beijing, People’s Republic of China

    Martin Chi-sang Wong

Authors
  1. Dean A. Fennell
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  2. Yoshitaka Sekido
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  3. Paul Baas
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  4. Aliya N. Husain
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  5. Alessandra Curioni-Fontecedro
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  6. Eric Lim
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  7. Isabelle Opitz
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  8. Charles B. Simone II
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  9. Fraser Brims
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  10. Martin Chi-sang Wong
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Contributions

Introduction (D.A.F.); Epidemiology (M.C.W.); Mechanisms/pathophysiology (Y.S. and A.C.-F.); Diagnosis, screening and prevention (A.N.H. and I.O.); Management (D.A.F., P.B., C.B.S., E.L. and I.O.); Quality of life (F.B.); Outlook (D.A.F.); overview of the Primer (D.A.F.).

Corresponding authors

Correspondence to Dean A. Fennell or Martin Chi-sang Wong.

Ethics declarations

Competing interests

D.A.F.: grants from Aldeyra, Astex Therapeutics, Bayer, BMS, Boehringer Ingelheim, Owkin; non-financial support from BerGenBio, Clovis, Eli Lilly, MSD, Roche and Tesaro GSK; personal fees from Aldeyra, Cambridge Clinical Laboratories, Ikena, Opna Bio, Owkin, RS Oncology, Roche, MSD, during the conduct of the study; I.O.: Roche (institutional grant), AstraZeneca (advisory board), MSD (advisory board), BMS (advisory board), Medtronic (institutional grant and advisory board), Intuitive (proctorship and speaker’s fee), Sanofi (speaker’s fee), Regeneron (advisory board), XVIVO (institutional grant), Siemens (speaker’s fee), Astellas (speaker’s fee). I.O. is the International Director for AATS, a member of the Thoracic Clinical Practice Standards Committee and the Thoracic Education Committee of AATS, an ESTS board member, an iMig board member and The Journal of Thoracic and Cardiovascular Surgery Associate Editor. The other authors declare no competing interests.

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Peer review information

Nature Reviews Disease Primers thanks G. Ceresoli; S.-C. Chu; J. Van Meerbeeck, who co-reviewed with J. Raskin; L. Mutti; and A. Scherpereel for their contribution to the peer review of this work.

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Fennell, D.A., Sekido, Y., Baas, P. et al. Pleural mesothelioma. Nat Rev Dis Primers 11, 56 (2025). https://doi.org/10.1038/s41572-025-00640-3

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