An exceptional response to nivolumab in relapsed and refractory malignant mesothelioma

Our plain-English summary of An exceptional response to nivolumab in relapsed and refractory malignant mesothelioma, by V.T. Talreja, V. Noronha, A. Joshi, et al (South Asian Journal of Cancer, 2019).

The study

• Authors: V.T. Talreja, V. Noronha, A. Joshi, V. Patil, A. Mahajan, K. Prabhash
• Journal: South Asian Journal of Cancer
• Published: 2019;8(3):159
• Read it: PubMed · Publisher · Free full text

In plain English

This letter to the editor, from Tata Memorial Hospital in Mumbai, India, described one patient: a 41-year-old woman with malignant pleural mesothelioma that had spread to bone. The article did not mention asbestos exposure. Her disease progressed through four lines of chemotherapy. Afterwards she had a 7.2 cm pleural-based lesion, new brain metastasis, a new mediastinal lymph node and pleural effusion, and she needed continuous oxygen. She was then given nivolumab, an immune checkpoint inhibitor, at 240 mg (3 mg/kg) every 14 days on compassionate grounds. By the end of the third cycle she no longer needed oxygen. A CT scan at 12 weeks showed a partial response, with the pleural mass reduced to 3.5 cm. She completed 24 cycles with a sustained response. Side effects were grade 2 hypothyroidism treated with levothyroxine and a low-grade rise in serum lipase that needed no treatment. At the time of writing she remained active, with disease controlled more than 24 months after diagnosis. The authors called this an exceptional and sustained response and said further studies may clarify the role of this treatment. A single case shows what happened to one patient, not how often such responses occur.

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: Case report (letter to the editor) describing one patient
• Who was studied: One 41-year-old female patient with malignant pleural mesothelioma with metastasis to bone (right iliac bone, sacroiliac joint, and ischial bone), treated at the Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
• Exposure: No asbestos or other fiber exposure is reported. The treatment described was single-agent nivolumab 240 mg (3 mg/kg) every 14 days, given after four lines of chemotherapy: carboplatin and paclitaxel; pemetrexed–carboplatin and bevacizumab; topotecan; and vinorelbine.
• Main results:
  • Four lines of chemotherapy failed. In this patient the disease progressed with each subsequent treatment.
  • After the fourth line of chemotherapy the patient had a 7.2 cm pleural-based lesion, new brain metastasis, a new mediastinal node and pleural effusion.
  • On nivolumab, the patient's performance status improved to ECOG 1. By the end of the third cycle she did not require supplemental oxygen.
  • A CT scan at 12 weeks showed a partial response, with the pleural mass reduced to 3.5 cm. The Figure 1 caption gives the mass as 6.4 cm × 3.5 cm before nivolumab and 3.5 cm × 2.0 cm currently.
  • The patient completed 24 cycles of nivolumab with sustained response.
  • Side effect: grade 2 hypothyroidism requiring 50 µg levothyroxine supplementation.
  • Side effect: a low-grade elevation of serum lipase. No hepatitis or pancreatitis was found, and no intervention was needed.
  • At the time of writing, the patient remained active with disease controlled more than 24 months after diagnosis.
• The authors' conclusion: The authors concluded that this patient, whose disease progressed rapidly after standard chemotherapy, had an exceptional and sustained response to single-agent nivolumab. They said further studies may provide insight into the role of this treatment in managing malignant pleural mesothelioma.

Topics

Medical terms in this study, explained in our Lexicon: Nivolumab (Opdivo), Mesothelioma.

Related studies

• Nivolumab Immunotherapy in Malignant Mesothelioma: A Case Report Highlighting a New Opportunity for Exceptional Outcomes — R.G. Jones, F. Karthik, et al. (2018)
• Pembrolizumab in paediatric patients with advanced melanoma or a PD-L1-positive, advanced, relapsed, or refractory solid tumour or lymphoma (KEYNOTE-051): interim analysis of an open-label, single-arm, phase 1-2 trial — B. Geoerger, H.J. Kang, et al. (2020)
• Phase I study of gemcitabine, docetaxel and imatinib in refractory and relapsed solid tumors — B. Saraiya, R. Chugh, et al. (2012)
• Nivolumab or nivolumab plus ipilimumab in patients with relapsed malignant pleural mesothelioma (IFCT-1501 MAPS2): a multicentre, open-label, randomised, non-comparative, phase 2 trial — A. Scherpereel, J. Mazieres, et al. (2019)
• Nivolumab versus placebo in patients with relapsed malignant mesothelioma (CONFIRM): a multicentre, double-blind, randomised, phase 3 trial — D.A. Fennell, S. Ewings, et al. (2021)
• CONFIRM: a double-blind, placebo-controlled phase III clinical trial investigating the effect of nivolumab in patients with relapsed mesothelioma: study protocol for a randomised controlled trial — D.A. Fennell, E. Kirkpatrick, et al. (2018)

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