Immunotherapy for malignant mesothelioma: reality check.

INTRODUCTION: Initial data of immune based therapy showed promise for improving malignant mesothelioma (MM) treatment. However, the results of such treatments have neither been predictable nor consistent and recent clinical studies of immune checkpoint inhibitors in MM have dampened initial enthusiasm. Areas covered: We comprehensively discuss the basis, modalities and updated results of immunotherapy in MM. An online search was conducted for relevant literature and abstracts of recent meetings. Expert commentary: Although initial studies have demonstrated proof of principle that manipulating the immune checkpoint axis holds promise in MM, results of some recent large studies using checkpoint inhibitors have been disappointing. This is not surprising given the low mutational load in MM and suggests that single agent immunotherapy has limited benefit in this disease. We believe that in order to demonstrate durable survival benefits, they will need to be used in combination approaches with other immunotherapies, vaccines or chemotherapy.