Advances in Immunotherapy of Malignant Pleural Mesothelioma

Our plain-English summary of Advances in Immunotherapy of Malignant Pleural Mesothelioma, by D. Liao, Y. Yu, Q. Mei, et al (OncoTargets and Therapy, 2021).

The study

• Authors: D. Liao, Y. Yu, Q. Mei, Z. Wang, X. Li, Y. Jia, F. Kong
• Journal: OncoTargets and Therapy
• Published: 2021;14:4477-4484
• Type of article: Review
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma (MPM) represents the uncommon cancer originating from pleural mesothelial cells, which is associated with dismal prognostic outcome. According to CheckMate-743 results, nivolumab plus ipilimumab has been approved to treat the unresectable MPM in treatment-naive patients as a first-line therapy by the FDA in October 2020. Immunotherapy is expected to be the best choice for MPM treatment. In the following article, the past treatment plan and the progress of immunotherapy for MPM will be reviewed.

© 2021 Liao et al.

In plain English

This article was a review of treatment for malignant pleural mesothelioma (MPM), focusing on immunotherapy, meaning drugs that help the immune system attack cancer. The authors are from a hospital in Tianjin, China. They collected no new patient data and did not describe how they chose the studies they discussed. They summarized earlier treatments, such as pemetrexed plus cisplatin chemotherapy, and results reported by other trials of immune checkpoint inhibitors. They reported that in the CheckMate 743 trial, previously untreated patients whose cancer could not be removed by surgery had a median overall survival of 18.1 months on nivolumab plus ipilimumab, against 14.1 months on chemotherapy. Two-year survival was 41% against 27%. They also described smaller trials of nivolumab, durvalumab and pembrolizumab, and research on possible biomarkers such as PD-L1 and BAP1. The authors concluded that nivolumab plus ipilimumab should be regarded as the new standard first-line treatment for these patients, and that immune checkpoint inhibitors are a new research direction. The review did not study asbestos exposure.

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 treatment studies, with no stated search method
• Who was studied: No population of its own. The review discussed published trials in patients with malignant pleural mesothelioma, mainly trials of immunotherapy.
• Exposure: Not an asbestos exposure study. Asbestos was mentioned only as background. The review covered treatments: chemotherapy (pemetrexed with cisplatin or carboplatin, bevacizumab, vinorelbine, gemcitabine) and immune checkpoint inhibitors (nivolumab, ipilimumab, durvalumab, pembrolizumab).
• Main results:
  • In the CheckMate 743 trial as reported by the review, median overall survival was 18.1 months with nivolumab plus ipilimumab and 14.1 months with chemotherapy (HR=0.74; 96.6% CI 0.60 to 0.91; P=0.002).
  • In CheckMate 743, 1-year and 2-year survival were 68% and 41% in the nivolumab plus ipilimumab group, and 58% and 27% in the chemotherapy group.
  • An earlier phase III chemotherapy trial (Vogelzang and others), as reported: median overall survival was 12.1 months with cisplatin plus pemetrexed and 9.3 months with cisplatin alone.
  • In the DREAM phase II trial of durvalumab with platinum-based chemotherapy, 31 of 54 patients (57%; 95% CI 44 to 70) were alive and progression-free at 6 months.
  • In the IFCT-1501 MAPS2 phase II trial in relapsed MPM, median overall survival was 11.9 months (95% CI 6.7 to 17.7) with nivolumab alone (n=63) and 15.9 months (95% CI 10.7 months to not reached) with nivolumab plus ipilimumab (n=62). One-year survival was 49% and 58% respectively. The review described this trial as non-comparative.
  • In the CONFIRM phase III trial in recurrent malignant mesothelioma (95% pleural), median survival was 9.2 months with nivolumab and 6.6 months with placebo (HR 0.72; 95% CI 0.55 to 0.94; P=0.02). One-year survival was 39.5% and 26.9% respectively.
  • In the NivoMes phase II study of 38 patients with relapsed MPM treated with nivolumab, the 3-month disease control rate was 50% and the objective response rate was 24%.
  • In the MERIT study of nivolumab in 34 previously treated patients, median overall survival was 17.3 months and median progression-free survival was 5.9 months. Two-year and 3-year survival rates were 35.3% and 23.5%.
  • Studies cited by the review linked PD-L1-positive MPM to poorer prognosis than PD-L1-negative MPM: median survival 4.8 to 5.0 months versus 14.5 to 16.3 months.
• The authors' conclusion: The authors concluded that nivolumab plus ipilimumab should be regarded as the new standard treatment for previously untreated, unresectable MPM regardless of histological subtype. They also concluded that immune checkpoint inhibitors are a new research direction, and that gene testing and targeted therapy may become options in the future.

Topics

Medical terms in this study, explained in our Lexicon: Immunotherapy, Pleural Mesothelioma, Mesothelial Cells, Nivolumab (Opdivo), Ipilimumab (Yervoy), Unresectable, First-line Therapy.

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