Malignant Mesothelioma Clinical and Molecular Insights
Summary
Malignant mesothelioma is an aggressive cancer arising from the mesothelial surfaces of the pleura, peritoneum and, more rarely, pericardium. Its incidence remains linked to historical asbestos exposure, yet latency periods and tumour heterogeneity present ongoing challenges. Clinically, it is classified into epithelioid, sarcomatoid and biphasic subtypes, each differing in prognosis and treatment response. Therapeutic options have gradually expanded beyond chemotherapy to include targeted immunotherapies and personalised approaches. On the molecular level, recent efforts have revealed diverse genomic and epigenomic profiles that underlie interpatient and intratumour heterogeneity, driving the development of morphomolecular classifications. Integrating multiomic data with histology and immune context has begun to inform risk stratification, guide novel therapeutic strategies and refine staging systems for more precise clinical management.
Research from Nature Portfolio
Recent studies employing integrated multiomic analyses have redefined mesothelioma classification by unveiling four complementary molecular axes: tumour ploidy, cell morphology, adaptive immune response and CpG island methylation patterns. This framework captures major interpatient variations and links extreme phenotypes to functional specialisations, offering a foundation for morphomolecular staging. In parallel, deconvolution of bulk tumour data into epithelioid-like and sarcomatoid-like components has illuminated the spectrum of intratumoural heterogeneity. This gradient-based model correlates component proportions with patient prognosis and highlights distinct oncogenic pathways, epigenetic regulators and immune-stromal interactions. Together, these advances underpin a shift from purely histological to integrated histo-molecular stratification, informing the selection of immunotherapies and targeted agents.
Malignant Mesothelioma Clinical and Molecular Insights publication trend
The graph below shows the total number of articles in malignant mesothelioma clinical and molecular insights across all publications each year (not limited to Nature Index journals).
Technical terms
Malignant mesothelioma: A cancer of the mesothelial lining, most commonly of the pleura, often linked to asbestos exposure.
Epithelioid: A histological subtype characterised by cells resembling epithelium, generally associated with a more favourable prognosis.
Sarcomatoid: A histological subtype with spindle-shaped cells, associated with more aggressive behaviour.
Multiomic analysis: An integrative approach combining genomic, transcriptomic and epigenomic data to characterise tumour biology.
Organoid: A three-dimensional cell culture model that replicates key structural and genetic features of the original tumour.
Pleurectomy decortication: A surgical procedure removing the pleural lining and visible tumour while preserving lung parenchyma.
References
- Organoids derived from patients provide a new opportunity for research and individualized treatment of malignant peritoneal mesothelioma. Molecular Cancer (2024).
- Extended pleurectomy decortication and chemotherapy versus chemotherapy alone for pleural mesothelioma (MARS 2): a phase 3 randomised controlled trial. The Lancet Respiratory Medicine (2024).
- Multiomic analysis of malignant pleural mesothelioma identifies molecular axes and specialized tumor profiles driving intertumor heterogeneity. Nature Genetics (2023).
- Dissecting heterogeneity in malignant pleural mesothelioma through histo-molecular gradients for clinical applications. Nature Communications (2019).
About these summaries
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