{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T20:55:10Z","timestamp":1793048110626,"version":"4.5.0"},"reference-count":67,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T00:00:00Z","timestamp":1770076800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000780","name":"European Union","doi-asserted-by":"crossref","award":["PNRR-TR1-2023-12377418"],"award-info":[{"award-number":["PNRR-TR1-2023-12377418"]}],"id":[{"id":"10.13039\/501100000780","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Current Oncology"],"abstract":"<jats:p>Immunotherapy has significantly reshaped the management of malignant pleural mesothelioma (MPM), offering new therapeutic opportunities after decades in which platinum\u2013pemetrexed chemotherapy represented the only systemic option. However, clinical benefit remains markedly heterogeneous, with outcomes strongly influenced by histologic subtype, patient characteristics, and real-world treatment conditions. Evidence from monotherapy trials has been inconsistent, whereas combination approaches\u2014particularly nivolumab plus ipilimumab\u2014have demonstrated improved survival compared with chemotherapy, mainly in non-epithelioid tumors. Nevertheless, real-world data consistently show lower efficacy and higher toxicity than registrational studies, especially among elderly and unselected populations. Recent translational work has highlighted the relevance of the tumor microenvironment and recurrent genomic alterations such as BAP1, NF2, and CDKN2A in shaping immune activity and potentially modulating response to immune checkpoint inhibitors. Transcriptomic signatures and circulating biomarkers\u2014including soluble mesothelin-related peptide\u2014have shown prognostic associations but no validated predictive value. Overall, current evidence suggests that sensitivity to immunotherapy in MPM arises from a complex interplay of genomic, immunologic, and clinical factors, and that no biomarker is yet suitable for guiding treatment decisions. Prospective studies integrating molecular and immune profiling will be essential to refine patient selection and advance toward a more rationally personalized use of immunotherapy<\/jats:p>","DOI":"10.3390\/curroncol33020093","type":"journal-article","created":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T13:58:49Z","timestamp":1770127129000},"page":"93","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Immune Checkpoint Inhibitors in Malignant Pleural Mesothelioma: Efficacy, Real-World Outcomes, and the Search for Predictive Biomarkers"],"prefix":"10.3390","volume":"33","author":[{"given":"Giusi","family":"Bond\u00ec","sequence":"first","affiliation":[{"name":"Department of Thoracic Surgery Unit, Policlinico-San Marco Hospital, University of Catania, 95124 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serafina","family":"Martella","sequence":"additional","affiliation":[{"name":"Respiratory Medicine Unit, Policlinico \u201cG. Rodolico-San Marco\u201d University Hospital, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-1314-8226","authenticated-orcid":false,"given":"Dimitrios","family":"Stylianakis","sequence":"additional","affiliation":[{"name":"School of Medicine, University Hospital and University of Crete, 70013 Iraklion, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Terminella","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery Unit, Policlinico-San Marco Hospital, University of Catania, 95124 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-2462-1613","authenticated-orcid":false,"given":"Filippo","family":"Lococo","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Unit, Fondazione Policlinico Universitario \u201cA. Gemelli\u201d IRCCS, 00168 Rome, Italy"},{"name":"Department of General Thoracic Surgery, Fondazione Policlinico Universitario \u201cA. Gemelli\u201d IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5541-2075","authenticated-orcid":false,"given":"Alessia","family":"Ciarrocchi","sequence":"additional","affiliation":[{"name":"Laboratory of Translational Research, Azienda Unit\u00e0 Sanitaria Locale-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0628-613X","authenticated-orcid":false,"given":"Alfonso","family":"Fiorelli","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Unit, University of Campania \u201cLuigi Vanvitelli\u201d, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3994-4837","authenticated-orcid":false,"given":"Giacomo","family":"Cusumano","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery Unit, Policlinico-San Marco Hospital, University of Catania, 95124 Catania, Italy"},{"name":"Department of General Surgery and Medical Surgical Specialties (CHIRMED), University of Catania, 95124 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,3]]},"reference":[{"key":"ref_1","unstructured":"IARC\/WHO (2026, January 25). 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