Standards of care in mesothelioma treatment


The UK has the highest incidence of mesothelioma in the world, but services vary across the country partly due to uneven geographical distribution of cases. The Mesothelioma UK-funded national organisational audit has highlighted challenges in accessing diagnostic procedures such as thoracoscopy, as well as identifying examples of best practice, including access to clinical trials and specialist therapeutic procedures. To ensure equitable and optimal patient care, cancer alliances should have established referral pathways to specialist multidisciplinary team (MDT) services for discussion of all mesothelioma patients.

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  1. 1.

    Cancer Research UK. Mesothelioma Statistics. Accessed April 2020.

  2. 2.

    Royal College of Physicians. National Mesothelioma Audit report 2020 (for the audit period 2016–18). (Royal College of Physicians, London, 2020).

  3. 3.


  4. 4.

    Vogelzang, N. J., Rusthoven, J. J., Symanowski, J., Denham, C., Kaukel, E., Ruffie, P. et al. Phase III study of pemetrexed in combination with cisplatin versus cisplatin alone in patients with malignant pleural mesothelioma. J. Clin. Oncol. 21, 2636–2644 (2003).

    CAS  Article  Google Scholar 

  5. 5.

    Zalcman, G., Mazieres, J., Margery, J., Greillier, L., Audigier-Valette, C., Moro-Sibilot, D. 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).

    CAS  Article  Google Scholar 

  6. 6.

    Treasure, T., Lang-Lazdunski, L., Waller, D., Bliss, J. M., Tan, C., Entwisle, J. et al. Extra-pleural pneumonectomy versus no extra-pleural pneumonectomy for patients with malignant pleural mesothelioma: clinical outcomes of the Mesothelioma and Radical Surgery (MARS) randomised feasibility study. Lancet Oncol. 12, 763–772 (2011).

    Article  Google Scholar 

  7. 7.

    Clive, A. O., Taylor, H., Dobson, L., Wilson, P., de Winton, E., Panakis, N. et al. Prophylactic radiotherapy for the prevention of procedure-tract metastases after surgical and large-bore pleural procedures in malignant pleural mesothelioma (SMART): a multicentre, open-label, phase 3, randomised controlled trial. Lancet Oncol. 17, 1094–1104 (2016).

    Article  Google Scholar 

  8. 8.

    Bayman, N., Appel, W., Ashcroft, L., Baldwin, D. R., Bates, A., Darlison, L. et al. Prophylactic irradiation of tracts in patients with malignant pleural mesothelioma: an open-label, multicenter, phase III randomized trial. J. Clin. Oncol. 37, 1200–1208 (2019).

    CAS  Article  Google Scholar 

  9. 9.

    Woolhouse, I., Bishop, L., Darlison, L., De Fonseka, D., Edey, A., Edwards, J. et al. British Thoracic Society Guideline for the investigation and management of malignant pleural mesothelioma. Thorax 73, i1–i30 (2018).

    Article  Google Scholar 

  10. 10.

    Royal College of Physicians, Mesothelioma UK. National Mesothelioma Audit organisational audit report 2019. (Royal College of Physicians, London, 2020).

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We thank the Royal College of Physicians and Mesothelioma UK for running and funding the national mesothelioma audits and organisational audit respectively.

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S.V.H. wrote the initial draft paper with significant comments and contributions from the other authors (A.C.B., L.D., P.B.).

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Correspondence to Susan V. Harden.

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Harden, S.V., Darlison, L., Beckett, P. et al. Standards of care in mesothelioma treatment. Br J Cancer (2020).

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