Diagnosis

Treatment

Document Overview

Design and created by Guideline Central in participation with the American Society of Clinical Oncology.

Treatment of Malignant Pleural Mesothelioma

American Society of Clinical Oncology

Publication Date: Jan 8, 2025

Page Last Updated: May 13, 2026

Recommendation Rating Definitions

Quality of Evidence
Term		Definitions
H	- High	We are very confident that the true effect lies close to that of the estimate of the effect
M	- Moderate	We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
L	- Low	Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect.
VL	- Very Low	We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect.
Ins	- Insufficient	Evidence is insufficient to discern the true magnitude and direction of the net effect. Further research may better inform the topic. Reliance on consensus opinion of experts may be reasonable to provide guidance on the topic until better evidence is available.

Strength of Recommendation
Term		Definitions
S	- Strong	In recommendations for an intervention, the desirable effects of an intervention outweigh its undesirable effects. In recommendations against an intervention, the undesirable effects of an intervention outweigh its desirable effects. All or almost all informed people would make the recommended choice for or against an intervention.

C W	- Conditional - Weak	In recommendations for an intervention, the desirable effects probably outweigh the undesirable effects, but appreciable uncertainty exists. In recommendations against an intervention, the undesirable effects probably outweigh the desirable effects, but appreciable uncertainty exists. Most informed people would choose the recommended course of action, but a substantial number would not.
GPS	Good Practice Statement	Good practice statements represent the consensus of the Expert Panel and are used when high quality indirect evidence is available, but it would not be a good use of the Expert Panel’s resources to conduct a formal systematic review
NR	- Not Rated

Brozek JL, Akl EA, Compalati E, et al: Grading quality of evidence and strength of recommendations in clinical practice guidelines part 3 of 3. The GRADE approach to developing recommendations. Allergy 66:588-95, 2011

Document Overview

Document Title: Treatment of Malignant Pleural Mesothelioma

Authoring Society: American Society of Clinical Oncology

Document Publication Date: Jan 8, 2025

Page Last Reviewed/Updated: May 13, 2026

Document Type: Guideline

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: ascopubs.org/doi/10.1200/JCO-24-02425

Source Citation: Kindler HL, Ismaila N, Bazhenova L, et al. Treatment of Pleural Mesothelioma: ASCO Guideline Update. J Clin Oncol. 2024 Jan 08. doi: 10.1200/JCO.24.02425
Kindler HL, Ismaila N, Armato III SG, et al. Treatment of Malignant Pleural Mesothelioma: ASCO Practice Guideline. J Clin Oncol. 2018 Jan 18. doi: 10.1200/JCO.2017.76.6394

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Document Objectives: To provide evidence-based recommendations to practicing physicians and others on the management of malignant pleural mesothelioma.

Scope: Assessment and Screening, Diagnosis, Management

Keywords: Malignant Pleural Mesothelioma, mesothelioma

Target Patient Population: Patients with malignant pleural mesothelioma

Target Provider Population: Medical, surgical, and radiation oncologists; oncology nurses and physician assistants; pulmonologists; radiologists; pathologists

Inclusion Criteria: Male, Female, Adolescent, Adult, Child, Older Adult

Health Care Settings: Ambulatory, Hospital, Outpatient, Radiology Services

Intended Users: Nurse, Nurse Practitioner, Physician, Physician Assistant

Recommendation Development Processes & Methodology

PICO Questions

What is the optimal approach to obtain an accurate diagnosis of mesothelioma?
What initial assessment is recommended before initiating any therapy for mesothelioma?
What is the appropriate first- and second-line systemic treatment of patients with mesothelioma?
What is the appropriate role of surgical cytoreduction in the management of mesothelioma?
When should radiation be recommended for mesothelioma?

Supplemental Methodology Resources: Data Supplement Methodology Supplement

Number of Source Documents: 222

Literature Search Start Date: Monday, January 1, 1990

Literature Search End Date: Sunday, December 31, 2017

Includes peer/external review process?: Yes

Includes public comment process?: No

Methodologist involvement?: Yes

Patient involvement?: Yes

Includes multi-disciplinary group?: Yes

Includes systematic review?: Yes

Grades quality of strength of evidence?: Yes

Grades quality of strength of recommendation?: Yes

Discloses funding source?: Yes

Discloses conflicts of interest?: Yes

Includes benefits/harms analysis with recommendations?: Yes

Identifies study selection process?: Yes

Identifies study selection criteria?: Yes

Identifies methods used to evaluate and analyze the evidence?: Yes

Identifies key questions addressed by the systematic review?: Yes

Identifies search strategy?: Yes

Treatment of Malignant Pleural Mesothelioma

Diagnosis

Summary of Recommendations on Diagnosis and Staging

Diagnosis

Recommendation 1.1

Recommendation 1.2

Recommendation 1.3

Recommendation 1.4

Recommendation 1.5

Recommendation 1.6

Recommendation 1.7

Recommendation 1.8

Recommendation 1.9

Recommendation 1.10

Recommendation 1.11

Recommendation 1.12

Recommendation 1.13

Recommendation 1.14

Recommendation 1.15

Recommendation 1.16

Treatment

Summary of Recommendations on Surgery

Surgery

Recommendation 2.1

Recommendation 2.2

Recommendation 2.3

Recommendation 2.4

Recommendation 2.5

Recommendation 2.6

Recommendation 2.7

Recommendation 2.8

Recommendation 2.9

Recommendation 2.10

Recommendation 2.11

Recommendation 2.12

Recommendation 2.13

Recommendation 2.14

Recommendation 2.15

Recommendation 2.16

Immunotherapy

Recommendation 3.1

Recommendation 3.2

Recommendation 3.3

Recommendation 3.4

Recommendation 3.5

Recommendation 3.6

Recommendation 3.7

Recommendation 3.8

Recommendation 3.9

Recommendation 3.10

Chemotherapy

Recommendation 4.1

Recommendation 4.2

Recommendation 4.3

Recommendation 4.4

Recommendation 4.5

Recommendation 4.6

Recommendation 4.7

Recommendation 4.8

Recommendation 4.9

Recommendation 4.10

Recommendation 4.11

Recommendation 4.12

Recommendation 4.13

Recommendation 4.14

Recommendation 4.15

Recommendation 4.16

Recommendation 4.17

Recommendation 4.18

Recommendation 4.19

Radiation Therapy

Recommendation 5.1

Recommendation 5.2

Recommendation 5.3

Recommendation 5.4

Recommendation 5.5

Recommendation 5.6

Recommendation 5.7

Recommendation 5.8

Recommendation 5.9