Management of malignant pleural mesothelioma

Malignant mesothelioma is a highly fatal malignancy that may become more prevalent in the Asia–Pacific region over the next decades. We review clinical aspects of this disease, including presentation, diagnosis, staging and management. A small proportion of patients will be suitable for aggressive trimodality therapy (extra‐pleural pneumonectomy, chemotherapy and radiotherapy) with the aim of cure or achieving prolonged palliation. However, most patients will present with advanced disease and so are only suitable for palliation. We review palliative therapy with an emphasis on the practical aspects of chemotherapy as well as palliative procedures such as pleurodesis. The future direction of clinical research in mesothelioma is discussed.