Table 1.

New strategies currently under investigation in malignant pleural mesothelioma treatment

Systemic treatments
Strategy under investigation	Biomarker
Arginine deiminase	ASS1 deficiency
EZH2, PARP or HDAC inhibitors	BAP-1 mutations
CDK4/6 inhibitors	CDKN2A mutations
Mesothelin-targeted therapy	Mesothelin overexpression
FAK inhibitors	NF-2 mutations
PI3K/mTOR inhibitors	PI3K/AKT/mTOR pathway activation
Immune checkpoint inhibitors (single-agent or combinations)	Not established
Adoptive immunotherapy	Overexpressed differentiation antigens
New chemotherapy drugs (trabectedin, lurbinectedin)	No druggable alterations
Loco-regional treatments
Tumour treatment fields (TTF)
Intracavitary therapies
Neoadjuvant radiation therapy.

ASS1, Argininosuccinate Synthase 1; BAP1, BRCA 1-Associated Protein 1; CDK4/6, Cyclin-Dependent Kinase 4/6; CDKN2A, Cyclin-Dependent Kinase inhibitor 2A; EZH2, Enhancer of Zeste Homolog 2; HDAC, Histone DeACetylases; mTOR, mammalian Target Of Rapamycin; NF-2, NeuroFibromin-2; PARP, Poly ADP-Ribose Polymerase; PI3K, PhosphoInositide 3-Kinase.