Аннотация
Relevance: Malignant pleural mesothelioma is a rare and highly aggressive tumor, most commonly associated with asbestos exposure. Because of its long latency period and nonspecific early symptoms, it is often diagnosed at an advanced, inoperable stage. In such cases, treatment usually includes palliative chemotherapy and/or radiotherapy; however, their effectiveness remains limited, and the overall prognosis is poor. Histological subtype significantly influences treatment response and survival, with epithelioid variants generally associated with better outcomes. Although rare cases of prolonged remission after immunotherapy have been reported, current treatment strategies primarily focus on prolonging survival and improving quality of life, underscoring the need for more effective therapeutic approaches.The study aimed to describe a clinical case of a patient with inoperable malignant pleural mesothelioma and to discuss the limitations of currently available therapeutic approaches.Materials and methods: A clinical case of a 55-year-old woman with stage IV sarcomatoid pleural mesothelioma is presented. Clinical data were obtained from the medical records of the Kazakh Institute of Oncology and Radiology (Almaty, Kazakhstan). The diagnosis was confirmed by computed tomography, positron emission tomography combined with computed tomography (CT, PET/CT), and histological and immunohistochemical examinations. A multidisciplinary tumor board reviewed the case and prescribed individualized treatment, taking into account the disease course and local drug availability.Results: First-line treatment with cisplatin, pemetrexed, and bevacizumab achieved a partial metabolic response after four cycles. Maintenance bevacizumab and radiotherapy provided temporary disease stabilization. After progression in March 2023, second-line treatment with gemcitabine, carboplatin, and pembrolizumab was initiated, resulting in a metabolic response with a >30% reduction in lesion activity after four cycles. However, disease progression was confirmed again in October 2023. Overall survival was 28 months.Conclusion: This case demonstrates that an individualized multimodal treatment approach may provide meaning ful disease control and prolonged survival in advanced sarcomatoid pleural mesothelioma, even in the setting of limited therapeutic options.