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Indolent peritoneal mesothelioma: PI3K-mTOR inhibitors as a novel therapeutic strategy
  1. Saoirse O Dolly1,
  2. Cristina Migali1,
  3. Nina Tunariu1,
  4. Chiara Della-Pepa1,
  5. Shelize Khakoo1,
  6. Steve Hazell1,
  7. Johann S de Bono1,
  8. Stanley B Kaye1,2,
  9. Susana Banerjee1
  1. 1 Gynaecology Unit, Royal Marsden NHS Foundation Trust, London, UK
  2. 2 Drug Development Unit, Institute of Cancer Research, Surrey, UK
  1. Correspondence to Dr Susana Banerjee; Susana.Banerjee{at}


Peritoneal mesothelioma (MPeM) is a scarce abdominal-pelvic malignancy that presents with non-specific features and exhibits a wide clinical spectrum from indolent to aggressive disease. Due to it being a rare entity, there is a lack of understanding of its molecular drivers. Most treatment data are from limited small studies or extrapolated from pleural mesothelioma. Standard treatment includes curative surgery or pemetrexed-platinum palliative chemotherapy. To date, the use of novel targeted agents has been disappointing.

Described is the management of two young women with papillary peritoneal mesothelioma with widespread recurrence having received platinum-pemetrexed chemotherapy. Both patients obtained symptomatic and disease benefit with apitolisib, a dual phosphoinositide 3-kinase-mammalian target of rapamycin (PI3K-mTOR) inhibitor for subsequent relapses, with one patient having a partial response for almost 3 years. Both are alive and well 10–13 years from diagnosis.

Conclusion These case presentations highlight a subgroup of rare MPeM that behave indolently that is compatible with long-term survival. This series identifies the use of targeted therapies with PI3K-mTOR-based inhibitors as a novel approach, warranting further clinical assessment. Development of prognostic biomarkers is essential to aid identify tumour aggressiveness, help stratify patients and facilitate treatment decisions.

  • Peritoneal mesothelioma
  • PI3K
  • mTOR
  • Apitolisib
  • Therapy

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  • Competing interests None declared.

  • Patient consent Written informed consent was obtained from the patients for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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