The Evolving Role of Chemotherapy in the Management of Pleural Malignancies: Current Evidence and Future Directions
Semenova Y. Burkitbayev Z. Kalibekov N. Digay A. Zhaxybayev B. Shatkovskaya O. Khamzina S. Zharlyganova D. Kuanysh Z. Manatova A.
July 2025Multidisciplinary Digital Publishing Institute (MDPI)
Cancers
2025#17Issue 13
Pleural malignancies represent a clinically devastating group of oncological disorders, most commonly arising from metastatic disease, with lung and breast cancers being the most frequent primary sites. Malignant pleural mesothelioma is a primary malignancy of the pleura and occurs less often than metastatic pleural disease. Pleural malignancies often present with malignant pleural effusion, which typically indicates advanced-stage disease and is associated with poor overall prognosis. Treatment of pleural malignancies includes both palliative and definitive approaches. Palliative interventions primarily aim to relieve symptoms and improve quality of life. Definitive treatments include systemic chemotherapy, targeted therapy, and immunotherapy, depending on the type and molecular profile of the underlying tumor. In mesothelioma, platinum-based chemotherapy in combination with pemetrexed remains the cornerstone of treatment, while the combination of nivolumab and ipilimumab is recommended as first-line therapy for unresectable disease. For metastatic disease, systemic therapy is typically tailored to the primary tumor’s characteristics. Intrapleural administration of chemotherapeutic agents is one of the therapeutic strategies and hyperthermic intrathoracic chemotherapy and pressurized intrathoracic aerosol chemotherapy are the most recent innovations that are under active investigation. This review provides an up-to-date synthesis of systemic chemotherapy strategies for pleural malignancies, their integration with targeted and immune-based therapies, and recent advances in intrapleural chemotherapy modalities. It also explores existing knowledge gaps and outlines directions for future research and potential changes in clinical practice.
chemotherapy , hyperthermic intrathoracic chemotherapy , immunotherapy , malignant pleural effusion , malignant pleural mesothelioma , pleural metastases , pressurized intrathoracic aerosol chemotherapy , targeted therapy
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Department of Surgery, School of Medicine, Nazarbayev University, Astana, 010000, Kazakhstan
Chairman of the board, National Research Oncology Center, Astana, 020000, Kazakhstan
Department of Multidisciplinary Surgery, National Research Oncology Center, Astana, 020000, Kazakhstan
Vice-Chairman of the board for Strategic Development, Scientific and Educational Activities, National Research Oncology Center, Astana, 020000, Kazakhstan
Department of Scientific Management, National Research Oncology Center, Astana, 020000, Kazakhstan
Department of Surgery
Chairman of the board
Department of Multidisciplinary Surgery
Vice-Chairman of the board for Strategic Development
Department of Scientific Management
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