Case Report: Tislelizumab combined with bevacizumab in the treatment of primary malignant pericardial mesothelioma

Our plain-English summary of Case Report: Tislelizumab combined with bevacizumab in the treatment of primary malignant pericardial mesothelioma, by Z. Liu, Y. Yan, C. Jiang (Frontiers in Oncology, 2026).

The study

• Authors: Z. Liu, Y. Yan, C. Jiang
• Journal: Frontiers in Oncology
• Published: 2026;16:1848097
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Primary malignant pericardial mesothelioma (PMPM) is an exceedingly rare and highly malignant tumor that originates in the serosal layer of the pericardium. Currently, there are no specific guidelines for diagnosis and treatment in China and international countries for this disease, so treatment experiences from previous clinical cases are very important in the management of this disease.

Case Summary: A case involving grade IV bone marrow suppression following pemetrexed in combination with platinum-based chemotherapy has been documented. Subsequently, the patient underwent treatment with tislelizumab and bevacizumab (an immune checkpoint inhibitor combined with a vascular endothelial growth factor inhibitor). After 29.4 months of this treatment, the patient experienced significant relief from symptoms of chest tightness and breathlessness, while the primary tumor lesion remained stable. Imaging assessments indicated stable disease (SD). Throughout the treatment course, no severe adverse reactions resulting in mortality were observed, with only grade II bone marrow suppression and intermittent dry, scaly, and peeling skin on the feet reported. Symptoms improved following symptomatic and supportive interventions.

Conclusion: This case report provides suggestive information for the application of tislelizumab combined with bevacizumab in the treatment of pericardial mesothelioma patients, especially those who are unable to tolerate the adverse effects associated with pemetrexed and platinum-based chemotherapy. The limitation is that only one patient is included, the number of cases is small, and there may be uniqueness of individual cases. Consequently, it remains uncertain whether this combination therapy is applicable to all patients with pericardial mesothelioma, nor can we ascertain whether other immune checkpoint inhibitor (ICIs) and vascular endothelial growth factor inhibitors (VEGF inhibitors) exhibit similar efficacy in this context.

Copyright © 2026 Liu, Yan and Jiang.

In plain English

This case report described one 50-year-old woman in China with primary malignant pericardial mesothelioma. A pericardial biopsy in August 2022 was consistent with epithelioid malignant mesothelioma, and the patient denied any history of asbestos exposure or chest radiotherapy. One cycle of tislelizumab with pemetrexed and nedaplatin chemotherapy was followed by grade IV bone marrow suppression. From September 2022 to February 2025 the patient received 29 cycles of tislelizumab, an immune checkpoint inhibitor, plus bevacizumab, a VEGF inhibitor. The patient also had radiotherapy to the pericardium in March 2024, which the authors described as achieving insignificant tumor remission. Chest tightness and shortness of breath became less frequent. Reported side effects were grade 2 drops in white cells, neutrophils and hemoglobin, grade 1 low platelets, and dry, peeling skin on the feet. The disease progressed 894 days (29.4 months) after the combination began. After a switch to dual immunotherapy with anlotinib, the patient developed total heart failure and died 1007 days (33.6 months) after diagnosis. The authors concluded that the case offers suggestive information for this combination, but that one case cannot show it prolonged survival.

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 (one patient)
• Who was studied: One 50-year-old woman in China, pathologically diagnosed with epithelioid malignant mesothelioma of the pericardium on August 26, 2022
• Exposure: No asbestos exposure was reported: the patient denied asbestos exposure or chest radiotherapy. The exposure studied was treatment with tislelizumab 200 mg plus bevacizumab 7.5 mg/kg (450 mg), given every three weeks.
• Main results:
  • After one cycle of tislelizumab, pemetrexed and nedaplatin (September 4, 2022), the patient developed grade IV bone marrow suppression.
  • The patient received tislelizumab plus bevacizumab for 29 cycles, from September 29, 2022 to February 26, 2025.
  • During the combination treatment, the patient had fewer episodes of chest tightness, shortness of breath and abdominal distension than before treatment.
  • Side effects during the combination were grade 2 reductions in white blood cells, neutrophils and hemoglobin, grade 1 thrombocytopenia, and intermittent dryness, scaling and peeling of the feet.
  • Radiotherapy to the pericardium (30 Gy in 10 sessions, starting March 18, 2024) achieved insignificant tumor remission, according to the authors.
  • Progression-free survival on tislelizumab plus bevacizumab was 894 days (29.4 months), with progressive disease found on March 11, 2025.
  • After switching to dual immunotherapy plus anlotinib, the patient was diagnosed with total heart failure in April 2025 and died on May 29, 2025. Overall survival from pathologic diagnosis was 1007 days (33.6 months).
• The authors' conclusion: The authors concluded that the case provides suggestive information for using tislelizumab with bevacizumab in pericardial mesothelioma, especially in patients who cannot tolerate the side effects of pemetrexed and platinum-based chemotherapy.
• Limitations the authors state:
  • Only one patient was included, and the case may be unique.
  • A causal link between the patient's prolonged survival and the tislelizumab plus bevacizumab treatment could not be established. The patient also received other treatments.
  • It was not clear whether immune-related pericarditis occurred during the later dual immunotherapy.

Topics

Medical terms in this study, explained in our Lexicon: Bevacizumab, Pericardial Mesothelioma, Pericardium, Pemetrexed (Alimta), Chemotherapy, checkpoint inhibitors, VEGF inhibitors.

Related studies

• Tislelizumab combined with anlotinib in the second-line treatment of malignant pleural mesothelioma — D. Zhang, J. Liang, et al. (2022)
• Case Report: Early diagnosis and bevacizumab-based chemotherapy for primary pericardial mesothelioma: a case with occupational asbestos exposure history — D. Wang, Y.H. Wang, et al. (2023)
• Cost-effectiveness analysis of bevacizumab combined with lomustine in the treatment of progressive glioblastoma using a Markov model simulation analysis — Z. Chen, F. Tian, et al. (2024)
• Case Report: A case of primary pericardial mesothelioma treated with multimodal combined therapy — J. Gong, X. Wu, et al. (2024)
• Treatment and Outcomes of Primary Pericardial Mesothelioma: A Contemporary Review of 103 Published Cases — E. McGehee, D.E. Gerber, et al. (2019)
• Chemosensitivity of three patient-derived primary cultures of canine pericardial mesothelioma by single-agent and combination treatment — R. Nabeta, A. Kanaya, et al. (2023)

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