There has been a vast increase in our understanding of the pathology of mesothelioma in the past 5 years, which is hoped to revolutionize the treatment of the disease, whose incidence is rising globally. Speaking from the British Thoracic Oncology Group (BTOG) Annual Conference 2018, held in Dublin, Ireland, Dean Fennell, PhD, FRCP, of University Hospitals of Leicester NHS Trust, Leicester, UK, discusses the genes involved in the development of mesothelioma and the studies investigating treatments to target them. Prof. Fennel emphasizes the role of BAP1 and BRCA1 in homologous recombination; the common CDKN2A (p16) deletion; and novel immunotherapy combinations targeting AXL, PD-1, PD-L1 and VEGF.