\[Advances in Immunotherapy for Malignant Pleural Mesothelioma\]

Our plain-English summary of [Advances in Immunotherapy for Malignant Pleural Mesothelioma], by Y. Chi, Y. Liu, J. Zhao (Zhongguo Fei Ai Za Zhi = Chinese Journal of Lung Cancer, 2022).

The study

• Authors: Y. Chi, Y. Liu, J. Zhao
• Journal: Zhongguo Fei Ai Za Zhi = Chinese Journal of Lung Cancer
• Published: 2022;25(4):259-265
• Language: Chinese
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Patients with malignant pleural mesothelioma (MPM) usually present with poor prognosis and short survival period, and there has been a lack of effective treatment options for a long time. Chemotherapy has limited improvement in the clinical outcome of advanced patients (the median survival is less than one year), and it is difficult to find suitable targets for targeted therapy. Recent in-depth research on immunotherapy has changed the treatment pattern of MPM. Especially, the dual immunotherapy regimen significantly improved the survival outcome of patients across subgroups and prolonged the survival time of MPM patients. Therefore, it has been approved for unresectable MPM as first-line treatment for patients. The exploration of other mono or combo immunotherapy regimens in the first and second-line settings of MPM is also underway. How to identify the best beneficial population of each regimen through predictive biomarkers is also a hot spot for researchers. This article will focus on the most up-to-date progress of MPM epidemiology, histological characteristics, pathogenesis, treatment patterns and the advances of immunotherapy in the disease. .

In plain English

This article was a review, written in Chinese, of immunotherapy for malignant pleural mesothelioma. It did not study patients itself; it summarized published clinical trials. As background, it stated that asbestos exposure is the main risk factor for this cancer, with about 80% of patients having a history of asbestos contact. The review described the CheckMate 743 trial of 605 untreated patients with unresectable disease. Median overall survival was 18.1 months with nivolumab plus ipilimumab versus 14.1 months with platinum-pemetrexed chemotherapy (HR=0.74; P=0.002), and 3-year survival was 23% versus 15%. Grade 3-4 treatment-related side effects occurred in 31% versus 32% of patients. In the CONFIRM trial of previously treated patients, median overall survival was 9.2 months with nivolumab versus 6.6 months with placebo. In the PROMISE-meso trial, pembrolizumab did not improve progression-free survival compared with chemotherapy. The authors concluded that the 2020 approval of nivolumab plus ipilimumab greatly changed the clinical treatment of this disease and gave patients more options. They cautioned that some subgroup results, including those by PD-L1 level, need careful interpretation.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Narrative review of published clinical trials of immunotherapy in malignant pleural mesothelioma
• Who was studied: No study population of its own. The review summarized clinical trials in patients with malignant pleural mesothelioma. Its central trial, CheckMate 743, was a randomized, open-label phase III study of 605 untreated patients with histologically confirmed unresectable disease.
• Exposure: Asbestos exposure was not studied. The review was about immunotherapy drugs, including nivolumab, ipilimumab, pembrolizumab, durvalumab, avelumab and tremelimumab. In its background section it stated that asbestos exposure is the main risk factor for malignant pleural mesothelioma and that about 80% of patients have a history of asbestos contact. No fiber types were named.
• Main results:
  • CheckMate 743 (as reported in the review): median overall survival was 18.1 months in the nivolumab plus ipilimumab group versus 14.1 months in the chemotherapy group (HR=0.74).
  • CheckMate 743 at 3-year follow-up: 3-year survival was 23% in the dual immunotherapy group and 15% in the chemotherapy group (HR=0.73, 95% CI 0.61-0.87).
  • CheckMate 743: the benefit over chemotherapy appeared greater in non-epithelioid patients (HR=0.48) than in epithelioid patients (HR=0.85).
  • CheckMate 743 safety: grade 3-4 treatment-related adverse events occurred in 31% of the dual immunotherapy group versus 32% of the chemotherapy group. 3 patients (1%) in the dual immunotherapy group had treatment-related deaths.
  • CONFIRM trial in previously treated patients: median overall survival was 9.2 months with nivolumab versus 6.6 months with placebo (HR=0.72, P=0.018).
  • PROMISE-meso trial in previously treated patients: median progression-free survival was 2.5 months with pembrolizumab versus 3.4 months with chemotherapy (HR=1.06, P=0.76).
  • CheckMate 743 exploratory biomarker analysis: in the dual immunotherapy group, median overall survival was 21.7 months for patients with a high 4-gene inflammatory signature score versus 16.8 months for a low score (HR=0.57). This association was not seen in the chemotherapy group.
• The authors' conclusion: The authors concluded that the 2020 approval of nivolumab plus ipilimumab for first-line treatment greatly changed the clinical treatment of malignant pleural mesothelioma and gave patients more treatment options.
• Limitations the authors state:
  • The authors cautioned that the CheckMate 743 results by PD-L1 level need careful interpretation, because PD-L1 expression was not a stratification factor in that trial.
  • The authors noted that the MERIT and NivoMes trials gave conflicting PD-L1 findings, and that both were too small to draw conclusions.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Immunotherapy, Pleural Mesothelioma, Prognosis, Chemotherapy, Median Overall Survival, Targeted Therapy, Unresectable, Second-Line Therapy.

Related studies

• Advances in Immunotherapy of Malignant Pleural Mesothelioma — D. Liao, Y. Yu, et al. (2021)
• Advances in Immunotherapy for Malignant Pleural Mesothelioma: From Emerging Strategies to Translational Insights — R. López-Castro, Á. Fuentes-Martín, et al. (2024)
• Recent Advances in Mesothelioma Treatment: Immunotherapy, Advanced Cell Therapy, and Other Innovative Therapeutic Modalities — R. Suraya, T. Nagano, et al. (2025)
• Immunotherapy advances in pleural mesothelioma — A.L. Zhang, M.L. Hsu (2026)
• Recent advances in the treatment of malignant pleural mesothelioma — S.S. Ramalingam, C.P. Belani (2008)
• Advances in treatment of mesothelioma — C. Maggioni, G. Barletta, et al. (2016)

Browse more research in Zhongguo Fei Ai Za Zhi = Chinese Journal of Lung Cancer, or return to medical research.