MesotheliomaSupport: Credential-policy fix: reviewedBy→editor in JSON-LD; reframe 3 body sections from editorial clinical recommendation to attributed (treatment intro, PD-L1 claim, FAQ imaging recommendation) per CLEO #9875 Decision 1 (event #9904)

2026-05-27T17:27:25Z

Credential-policy fix: reviewedBy→editor in JSON-LD; reframe 3 body sections from editorial clinical recommendation to attributed (treatment intro, PD-L1 claim, FAQ imaging recommendation) per CLEO #9875 Decision 1 (event #9904)

MesotheliomaSupport: New wiki page: Mesothelioma Brain Metastasis — Harary 2026 first genetic profiling (RAD51C/NF2/TP53), Miller 2014 2.7% pooled prevalence, RTOG 90-05 + NRG CC001 radiation framework, CheckMate-743 systemic therapy. CLEO PASS #9794 (#9784)

2026-05-27T15:16:09Z

New wiki page: Mesothelioma Brain Metastasis — Harary 2026 first genetic profiling (RAD51C/NF2/TP53), Miller 2014 2.7% pooled prevalence, RTOG 90-05 + NRG CC001 radiation framework, CheckMate-743 systemic therapy. CLEO PASS #9794 (#9784)

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← Older revision		Revision as of 17:27, 27 May 2026
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	== How Is Mesothelioma Brain Metastasis Treated? ==		== How Is Mesothelioma Brain Metastasis Treated? ==

	~~Radiation~~ therapy is the ~~workhorse of~~ local management for mesothelioma brain metastasis~~, with the~~ choice between whole-brain radiotherapy (WBRT) and stereotactic radiosurgery (SRS) ~~driven by~~ lesion number, lesion size, performance status, and overall systemic disease control.		Published case reports and trial data identify radiation therapy as the primary local management approach for mesothelioma brain metastasis. The choice between whole-brain radiotherapy (WBRT) and stereotactic radiosurgery (SRS) depends on lesion number, lesion size, performance status, and overall systemic disease control — factors described in the Harary 2026 series and the RTOG 90-05 and NRG CC001 trials referenced below.<ref name="harary_2026" />

	=== Stereotactic Radiosurgery — RTOG 90-05 Dose-Size Framework ===		=== Stereotactic Radiosurgery — RTOG 90-05 Dose-Size Framework ===
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	Systemic therapy for mesothelioma is determined by the primary disease site and histology, not by the presence of brain metastasis per se. For unresectable malignant pleural mesothelioma, the standard first-line regimen since October 2020 has been '''nivolumab plus ipilimumab''', established by the Phase III CheckMate-743 trial published by Baas and colleagues in ''The Lancet'' in 2021.<ref name="baas_2021" /> The trial randomized 605 patients to nivolumab 3 mg/kg every two weeks plus ipilimumab 1 mg/kg every six weeks for up to two years versus platinum (cisplatin or carboplatin) plus pemetrexed for up to six cycles. Median overall survival was '''18.1 months with nivolumab plus ipilimumab versus 14.1 months with chemotherapy''' (hazard ratio 0.74, 96.6% confidence interval 0.60 to 0.91, p=0.0020); two-year overall survival was 41% versus 27%.<ref name="baas_2021" /> Case 1 in Harary 2026 received nivolumab plus ipilimumab postoperatively despite having pericardial rather than pleural primary disease — an off-label use reflecting the absence of regulatory-approved regimens for pericardial mesothelioma.<ref name="harary_2026" />		Systemic therapy for mesothelioma is determined by the primary disease site and histology, not by the presence of brain metastasis per se. For unresectable malignant pleural mesothelioma, the standard first-line regimen since October 2020 has been '''nivolumab plus ipilimumab''', established by the Phase III CheckMate-743 trial published by Baas and colleagues in ''The Lancet'' in 2021.<ref name="baas_2021" /> The trial randomized 605 patients to nivolumab 3 mg/kg every two weeks plus ipilimumab 1 mg/kg every six weeks for up to two years versus platinum (cisplatin or carboplatin) plus pemetrexed for up to six cycles. Median overall survival was '''18.1 months with nivolumab plus ipilimumab versus 14.1 months with chemotherapy''' (hazard ratio 0.74, 96.6% confidence interval 0.60 to 0.91, p=0.0020); two-year overall survival was 41% versus 27%.<ref name="baas_2021" /> Case 1 in Harary 2026 received nivolumab plus ipilimumab postoperatively despite having pericardial rather than pleural primary disease — an off-label use reflecting the absence of regulatory-approved regimens for pericardial mesothelioma.<ref name="harary_2026" />

	For older or frailer patients, dose-reduced platinum-pemetrexed remains an alternative. Case 2 in Harary 2026 received '''carboplatin AUC 3.5 plus pemetrexed 400 mg/m<sup>2</sup>''' for three cycles — both doses reduced from the standard adult regimen (carboplatin AUC 5–6 and pemetrexed 500 mg/m<sup>2</sup>) consistent with geriatric oncology dose-reduction practice.<ref name="harary_2026" /> PD-L1 tumor proportion score ~~does~~ not ~~consistently predict~~ immunotherapy benefit in mesothelioma; tumor mutational burden is ~~generally~~ low. Case 2's PD-L1 tumor proportion score of 40% characterized as "low" by the authors is consistent with the limited utility of this biomarker in mesothelioma decision-making.		For older or frailer patients, dose-reduced platinum-pemetrexed remains an alternative. Case 2 in Harary 2026 received '''carboplatin AUC 3.5 plus pemetrexed 400 mg/m<sup>2</sup>''' for three cycles — both doses reduced from the standard adult regimen (carboplatin AUC 5–6 and pemetrexed 500 mg/m<sup>2</sup>) consistent with geriatric oncology dose-reduction practice.<ref name="harary_2026" /> PD-L1 tumor proportion score has not shown consistent predictive value for immunotherapy benefit in mesothelioma clinical trials; tumor mutational burden in mesothelioma is characterized as low in the published literature.<ref name="baas_2021" /> Case 2's PD-L1 tumor proportion score of 40% characterized as "low" by the authors is consistent with the limited utility of this biomarker in mesothelioma decision-making.

	== What Is the Prognosis for Mesothelioma Brain Metastasis? ==		== What Is the Prognosis for Mesothelioma Brain Metastasis? ==
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	=== Can mesothelioma spread to the brain? ===		=== Can mesothelioma spread to the brain? ===

	Yes, although it is uncommon. Pooled autopsy data from seven studies totaling 655 mesothelioma patients identified central nervous system metastases in 2.7% (18 patients), with individual study rates ranging from 0% to 3.8%.<ref name="miller_2014" /> Clinical incidence on brain imaging is generally lower because most patients die of advanced thoracic or peritoneal disease before central nervous system spread becomes evident, and routine brain imaging is not part of standard mesothelioma staging or surveillance. ~~New~~ or ~~progressive~~ neurological symptoms ~~in a mesothelioma patient should prompt~~ contrast-enhanced brain magnetic resonance imaging.		Yes, although it is uncommon. Pooled autopsy data from seven studies totaling 655 mesothelioma patients identified central nervous system metastases in 2.7% (18 patients), with individual study rates ranging from 0% to 3.8%.<ref name="miller_2014" /> Clinical incidence on brain imaging is generally lower because most patients die of advanced thoracic or peritoneal disease before central nervous system spread becomes evident, and routine brain imaging is not part of standard mesothelioma staging or surveillance. Miller et al. concluded that clinicians should consider and identify central nervous system involvement in mesothelioma patients with new or evolving neurological symptoms, noting that early identification may allow for palliative intervention; contrast-enhanced brain magnetic resonance imaging is the standard evaluation in this setting.<ref name="miller_2014" />

	=== How common is brain metastasis from mesothelioma? ===		=== How common is brain metastasis from mesothelioma? ===
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	"description": "Mesothelioma brain metastasis is rare (2.7% pooled prevalence). Harary 2026 reports first genetic profiling — NF2, TP53, RAD51C — with WBRT and SRS dosing data.",		"description": "Mesothelioma brain metastasis is rare (2.7% pooled prevalence). Harary 2026 reports first genetic profiling — NF2, TP53, RAD51C — with WBRT and SRS dosing data.",
	"author": {"@type": "Person", "name": "Rod De Llano"},		"author": {"@type": "Person", "name": "Rod De Llano"},
	"~~reviewedBy~~": {"@type": "Person", "name": "David Foster"},		"editor": {"@type": "Person", "name": "David Foster"},
	"publisher": {"@type": "Organization", "name": "WikiMesothelioma"},		"publisher": {"@type": "Organization", "name": "WikiMesothelioma"},
	"datePublished": "2026-05-27",		"datePublished": "2026-05-27",
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	"acceptedAnswer": {		"acceptedAnswer": {
	"@type": "Answer",		"@type": "Answer",
	"text": "Yes, although it is uncommon. Pooled autopsy data from seven studies totaling 655 mesothelioma patients identified central nervous system metastases in 2.7% (18 patients), with individual study rates ranging from 0% to 3.8%. ~~New~~ or ~~progressive~~ neurological symptoms ~~in a mesothelioma patient should prompt~~ contrast-enhanced brain magnetic resonance imaging."		"text": "Yes, although it is uncommon. Pooled autopsy data from seven studies totaling 655 mesothelioma patients identified central nervous system metastases in 2.7% (18 patients), with individual study rates ranging from 0% to 3.8%. Miller et al. concluded that clinicians should consider and identify central nervous system involvement in mesothelioma patients with new or evolving neurological symptoms, noting that early identification may allow for palliative intervention; contrast-enhanced brain magnetic resonance imaging is the standard evaluation in this setting.<ref name="miller_2014" />"
	}		}
	},		},

Mesothelioma Brain Metastasis - Revision history

MesotheliomaSupport: Credential-policy fix: reviewedBy→editor in JSON-LD; reframe 3 body sections from editorial clinical recommendation to attributed (treatment intro, PD-L1 claim, FAQ imaging recommendation) per CLEO #9875 Decision 1 (event #9904)

MesotheliomaSupport: New wiki page: Mesothelioma Brain Metastasis — Harary 2026 first genetic profiling (RAD51C/NF2/TP53), Miller 2014 2.7% pooled prevalence, RTOG 90-05 + NRG CC001 radiation framework, CheckMate-743 systemic therapy. CLEO PASS #9794 (#9784)