The two decades since the approval of cisplatin and pemetrexed for pleural mesothelioma1 have seen little progress in development of new and more efficacious therapies. Recently, ipilimumab plus nivolumab has emerged as a treatment strategy conferring improved overall and progression-free survival relative to chemotherapy in this patient population, especially for those with non-epithelioid histology.2 Although a meaningful subset of patients with pleural mesothelioma will have deep and sustained responses with immune checkpoint inhibitors,3 primary resistance and transient disease control are common, highlighting the need for alteration of the treatment catalogue.