These NCCN Guidelines focus on MPM, which is the most common type of mesothelioma.
This Discussion text for MPM describes the recommendations in the algorithms in greater detail, for example, by including the clinical trial data and other references that support the NCCN Panel’s recommendations in the algorithms. Revisions for the 2018 update are described in this Discussion and outlined in the algorithm (see Summary of the Guidelines Updates in the NCCN Guidelines for Malignant Pleural Mesothelioma). For example, one of the recommended first-line combination chemotherapy regimens is carboplatin/pemetrexed (category 2A), and this regimen was revised by adding an option for bevacizumab with or without maintenance bevacizumab based on phase 2 trial data. Nivolumab with or without ipilimumab are options for subsequent systemic therapy regimens; the category for these regimens was revised to category 2B from category 2A based on updated trial data. The RT recommendations for MPM were also revised with the 2018 update. For example, the NCCN Panel has softened the recommendation for using prophylactic RT to prevent instrument-tract recurrence after pleural intervention based on recent trial data. The NCCN Guidelines now state that RT may prevent instrument-tract recurrence after pleural intervention. The cancer staging for MPM has also been updated for 2018 to reflect the new staging guidelines from the AJCC, which became effective on January 1, 2018.