Consensus guideline for the management of peritoneal mesothelioma

The treatment of peritoneal mesothelioma (PeM) poses significant challenges because of its rare incidence, heterogeneity, and limited clinical evidence. This commentary describes results from a national consensus aimed at addressing the management of PeM. An update of the 2018 Chicago consensus guidelines was conducted with a modified Delphi technique, which encompassed two rounds of voting. The levels of agreement for various pathway blocks were assessed. Of 101 participants responding in the first round of modified Delphi voting, 95 (94%) responded in the second round. Over 90% consensus was achieved in five of six and six of six pathway blocks in rounds 1 and 2, respectively. Observation was recommended for benign neoplasms, with guidance for interventions in the presence of symptoms or concerning clinicopathological features. For malignant pathology, management was outlined on the basis of a multidisciplinary assessment of patient characteristics, disease histology, and predictive success of medical and surgical interventions. Additional emphasis was placed on multimodal therapy for intermediate-risk and appropriate high-risk patients. A rapid review demonstrated the limited availability of data and inconclusive findings regarding optimal systemic therapy timing. There was unanimous support for considering clinical trial enrollment. Given the limited evidence, the consensus-driven pathway provides essential guidance regarding the management of PeM. To further direct clinical care, additional dedicated research to generate higher quality evidence is needed.