The increasing incidence of malignant pleural mesothelioma (MPM), better knowledge of its pathogenesis with a strong implication of asbestos fibers, and some promising therapeutic results have led to a new interest in the management of patients with this disease. The diagnosis of MPM is easier because of new immunohistochemical markers that recognize the mesothelial cells with good specificity and sensitivity on pleural biopsy samples ideally obtained by thoracoscopy. Moreover, this endoscopic procedure allows the physician to make the diagnosis of MPM at an early stage, which is the key of the therapeutic management of this disease. If radiotherapy is necessary in preventing the malignant seeding after pleural procedures in patients, the lack of comparative studies did not show the superiority of a given treatment against another. A new international staging of the disease, however, allows physicians to discriminate several groups of patients for such comparative studies--in particular, for testing the efficacy of intrapleural therapy, e.g., cytokines--for early-stage MPM and multimodal management, i.e., extrapleural pneumonectomy, radiotherapy, and chemotherapy for more advanced diseases, has led to prolonged survival in carefully selected patients. To reach this target, all patients must be enrolled in protocols. The usual pessimism for the management of patients with malignant pleural mesothelioma is over.