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Review
. 2025 Jun 25.
doi: 10.1245/s10434-025-17358-x. Online ahead of print.

Consensus Guideline for the Management of Peritoneal Mesothelioma

Leanne M Brown  1 , Sarah G Wilkins  1 , Varun V Bansal  1 , David G Su  1 , Jorge Gomez-Mayorga  2 , Kiran K Turaga  3 , Craig G Gunderson  1 , Byrne Lee  4 , Garrett M Nash  5 , John L Hays  6 , Kanwal P Raghav  7 , Aliya L Husain  8 , Michael D Kluger  9 , Marjorie G Zauderer  10 , Hedy L Kindler  8 , H Richard Alexander  11 ; Peritoneal Surface Malignancies (PSM) Consortium Group
Collaborators, Affiliations
Review

Consensus Guideline for the Management of Peritoneal Mesothelioma

Leanne M Brown et al. Ann Surg Oncol. .

Abstract

Background: Treatment of peritoneal mesothelioma (PeM) poses significant challenges owing to its rare incidence, heterogeneity, and limited clinical evidence. This manuscript describes results from a national consensus aimed at addressing management of PeM.

Methods: An update of the 2018 Chicago Consensus Guidelines was conducted using a Modified Delphi technique, encompassing two rounds of voting. The levels of agreement for various pathway blocks were assessed.

Results: 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 5/6 and 6/6 pathway blocks in rounds I and II, respectively. Observation was recommended for benign neoplasms, with guidance for interventions in the presence of symptoms or concerning clinicopathologic features. For malignant pathology, management was outlined based on 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 limited availability of data and inconclusive findings regarding optimal systemic therapy timing. There was unanimous support for considering clinical trial enrollment.

Conclusions: Given 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.

Keywords: Cytoreductive surgical procedures; Guidelines; Mesothelioma; Peritoneal surface malignancies; Peritoneal surface neoplasms.

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Conflict of interest statement

Disclosures: Kanwal Raghav has received advisory board or consulting fees from AstraZeneca, Bayer, Eisai, Daiichi Sankyo, Seattle Genetics, outside the submitted work. John Hays has received advisory board or consulting fees from AstraZeneca, Merck, Tesaro, Clovis Oncology, Deciphera, Ipsen, outside of the submitted work. Marjorie Zauderer has received consulting fees from Ikena, Takeda, GlaxoSmithKline, Alderya Therapeutics, and Novocure, outside of the submitted work. Hedy Kindler has received fees from AstraZeneca, Bayer, Ingelheim, Bristol-Myers Squibb, Kyowa, Merck, Novocure, Paredox Therapeutics, Deciphera, Inhibrx, Inventiva, Aduro, Glaxo Smith Kline, Harpoon, Lilly, Polaris, Verastem, Tesaro, outside the submitted work. Other authors have no relevant financial disclosures. Declaration of Generative AI and AI-assisted technologies in the writing process: During the preparation of this work the authors used a large language model (ChatGPT V3.5) to revise the manuscript text for coherence and clarity. After using this service, the authors reviewed and edited the content as needed and take full responsibility for the content of the publication.

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