The emergence of positive data from trials like PATINA creates a dilemma for oncologists treating patients who are already stable on an older maintenance therapy. The consensus suggests not altering a successful regimen to avoid disrupting patient stability, revealing a cautious approach to integrating new evidence into established care.

Contrary to its role in lung cancer, PD-L1 expression does not predict benefit from immunotherapy in mesothelioma. Data from major trials shows similar outcomes regardless of PD-L1 status, leading clinicians to omit this test entirely and streamline treatment decisions.

Modern practice is shifting away from routine Prophylactic Cranial Irradiation (PCI) for extensive-stage small cell lung cancer. This change is driven by a key Japanese study where patients, screened with baseline MRI, showed a survival trend favoring observation with serial MRIs over PCI, challenging a long-standing treatment paradigm.

The advent of highly sensitive PSMA PET imaging identifies metastases in many patients previously considered to have only biochemical relapse (BCR). However, experts argue against a knee-jerk reaction to treat. Many of these patients, particularly those with slow PSA doubling times, can be safely observed, challenging the assumption that visible disease always requires immediate intervention.

The primary delay in diagnosing mesothelioma isn't lab work, but repeated, non-diagnostic pleural fluid taps. Educating pulmonologists and thoracic surgeons to proceed to a pleural biopsy faster when suspicion is high can significantly shorten the time to diagnosis and treatment.

For patients with very high-burden or symptomatic mesothelioma, clinicians may deviate from standard guidelines. They may choose chemo-immunotherapy to maximize the chance of a rapid response, viewing it as their single best opportunity to control the disease, especially if the patient's condition is precarious.

The EMBARK trial demonstrated an overall survival (OS) benefit, yet experts argue this doesn't automatically make treatment mandatory. For asymptomatic patients with a long life expectancy, factors like treatment-free survival and quality of life are critical considerations, challenging the primacy of OS as the sole decision-driver in this population.

Frontline treatment selection hinges on histology. Non-epithelioid mesothelioma responds poorly to chemotherapy, making dual immunotherapy (Nivo/Ipi) the clear choice. For epithelioid cases, chemo-immunotherapy is a strong option, especially for symptomatic patients, due to its higher and faster response rate.

Experts are divided on the optimal strategy for CT-DNA negative patients post-surgery. One side advocates for monitoring to spare patients from unnecessary treatment toxicity, while the other questions if this delay is non-inferior to immediate adjuvant therapy, a critical question not yet answered by trials.