{
  "abstract": "Pleural mesothelioma (PM) is a rare and aggressive cancer with limited treatment options and poor prognosis. Unlike other thoracic cancers responding well to immunotherapy, PM typically lacks key predictive biomarkers such as Programmed Death-Ligand 1 (PD-L1) tumor expression. Nonetheless, immune checkpoint inhibitors (ICIs) have shown clinical activity in PM, particularly in non-epithelioid subtypes. However, only a subset of patients benefits from this approach, and resistance remains a major challenge. A growing body of evidence suggests that tumor microenvironment (TME) plays a central role in shaping this resistance. In PM, the TME is notably immunosuppressive, dominated by regulatory T cells, myeloid-derived suppressor cells, and tumor-associated macrophages. These elements act as a shield against immune activation, limiting the efficacy of ICIs. Novel therapeutic strategies aimed at depleting or modulating suppressive immune populations within the TME are emerging as promising avenues to overcome resistance and enhance the effectiveness of ICIs. In this narrative review, we examine the unique features of the TME in PM, its role in immunotherapy resistance, and emerging strategies aimed at harnessing or remodeling the TME to improve patient outcomes.",
  "abstract_shown": true,
  "affiliations": [
    "SSD Mesotelioma, Melanoma e Tumori Rari, IRCCS AOU SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.",
    "DISSTE - Dipartimento per lo Sviluppo Sostenibile e la Transizione Ecologica, Università del Piemonte Orientale, Vercelli, Italy.",
    "SC Infrastruttura Ricerca Formazione e Innovazione, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), IRCCS AOU SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.",
    "UO Tumori Polmonari, Oncologia Medica, AOM - IRCCS Ospedale Policlinico San Martino, Genova, Italy.",
    "DiSIT- Dipartimento di Scienze e Innovazione Tecnologica, Università del Piemonte Orientale, Alessandria, Italy.",
    "SSD Laboratori di Ricerca, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), IRCCS AOU SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.",
    "UOC Clinica di Oncologia Medica, AOM - IRCCS Ospedale Policlinico San Martino, Genova, Italy.",
    "DIMI - Dipartimento di Medicina Interna e Specialità Mediche, Università degli Studi di Genova, Genova, Italy.",
    "UOC Bioterapie, AOM - IRCCS Ospedale Policlinico San Martino, Genova, Italy.",
    "SC Chirurgia Toracica, IRCCS AOU SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.",
    "SC Malattie Apparato Respiratorio, IRCCS AOU SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.",
    "UO Oncologia Medica, Azienda Ospedaliero Universitaria Policlinico \"G. Rodolico-S. Marco\", Catania, Italy.",
    "SC Sperimentazioni Cliniche, Istituto Nazionale Tumori IRCCS - Fondazione G. Pascale, Napoli, Italy.",
    "UOC Anatomia Patologica, Azienda Ospedaliero Universitaria Policlinico \"G. Rodolico-S.Marco\", Catania, Italy.",
    "UOC Chirurgia Toracica, Azienda Ospedaliero Universitaria Policlinico \"G.Rodolico-S. Marco\", Catania, Italy.",
    "SC Chirurgia Toracica, AOM - IRCCS Ospedale Policlinico San Martino, Genova, Italy."
  ],
  "article_type": "research support, non u.s. gov't",
  "arxiv": null,
  "author_total": 17,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Luigi Cerbone"
    },
    {
      "affs": [
        0,
        2
      ],
      "name": "Alessia Garau"
    },
    {
      "affs": [
        3
      ],
      "name": "Andrea Balossino"
    },
    {
      "affs": [
        4,
        5
      ],
      "name": "Simona Martinotti"
    },
    {
      "affs": [
        4,
        5
      ],
      "name": "Elia Ranzato",
      "orcid": "0000-0002-7600-8215"
    },
    {
      "affs": [
        6,
        7
      ],
      "name": "Carlo Genova"
    },
    {
      "affs": [
        8
      ],
      "name": "Valentina Rigo"
    },
    {
      "affs": [
        9
      ],
      "name": "Stefano Meda"
    },
    {
      "affs": [
        10
      ],
      "name": "Silvia Ravera"
    },
    {
      "affs": [
        11
      ],
      "name": "Hector Josè Soto Parra"
    },
    {
      "affs": [
        12
      ],
      "name": "Maria Carmela Piccirillo"
    },
    {
      "affs": [
        13
      ],
      "name": "Alessandra Gurrera"
    },
    {
      "affs": [
        14
      ],
      "name": "Alberto Terminella"
    },
    {
      "affs": [
        15
      ],
      "name": "Mattia Manitto"
    },
    {
      "affs": [
        8
      ],
      "name": "Michela Croce"
    },
    {
      "affs": [
        3
      ],
      "name": "Simona Coco"
    },
    {
      "affs": [
        0
      ],
      "name": "Federica Grosso"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/3e9yz4pctc7pz.bib",
  "cited_by": 0,
  "doi": "10.3389/fimmu.2026.1814514",
  "fulltext_url": "https://europepmc.org/articles/PMC13681453",
  "id": "3e9yz4pctc7pz",
  "issns": [
    "1664-3224"
  ],
  "landing_url": "https://www.frontiersin.org/articles/10.3389/fimmu.2026.1814514/full",
  "language": "eng",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2740|Occupational and environmental lung diseases"
    ]
  ],
  "openalex": "W7220690873",
  "pdf_url": "https://europepmc.org/articles/PMC13681453?pdf=render",
  "pmcid": "PMC13681453",
  "pmid": "42903807",
  "published": "2026-10-06",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/3e9yz4pctc7pz.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:15Z",
      "native_id": "10.3389/fimmu.2026.1814514",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fimmu.2026.1814514/full"
    },
    {
      "first_seen": "2026-10-30T12:19:57Z",
      "native_id": "MED:42903807",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42903807"
    }
  ],
  "subjects": [
    {
      "field": "biology",
      "origin": "issn:1664-3224",
      "subfield": "immunology"
    }
  ],
  "title": "Reprogramming the tumor microenvironment in mesothelioma: from immune suppression to therapeutic opportunity",
  "title_text": "Reprogramming the tumor microenvironment in mesothelioma: from immune suppression to therapeutic opportunity",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:19:57Z",
  "url": "https://research.draconitic.com/paper/3e9yz4pctc7pz",
  "venue": "Frontiers in Immunology",
  "versions": []
}