Cisplatin plus pemetrexed therapy and subsequent immune checkpoint inhibitor administration for malignant peritoneal mesothelioma without pleural lesions: Case report

Our plain-English summary of Cisplatin plus pemetrexed therapy and subsequent immune checkpoint inhibitor administration for malignant peritoneal mesothelioma without pleural lesions: Case report, by H. Ikushima, T. Sakatani, S. Ohara, et al (Medicine, 2020).

The study

• Authors: H. Ikushima, T. Sakatani, S. Ohara, H. Takeshima, H. Horiuchi, T. Morikawa, K. Usui
• Journal: Medicine
• Published: 2020;99(22):e19956
• Type of article: Case report
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Rationale: Malignant peritoneal mesothelioma is a rare tumor with a poor prognosis and has no recommended therapy after first-line pemetrexed and platinum-based chemotherapy. Moreover, effects of immune checkpoint inhibitors on peritoneal mesothelioma remains to be elucidated. We herein report the case of a 75-year-old man with peritoneal mesothelioma treated with cisplatin plus pemetrexed and subsequent nivolumab.

Patient Concerns: A 75-year-old man was referred to our hospital due to lower abdominal pain.

Diagnosis: Positron emission tomography-computed tomography (CT) showed the accumulation of fluorodeoxyglucose in an intraperitoneal mass. A histological examination of a laparoscopic biopsy specimen revealed malignant peritoneal mesothelioma.

Interventions: After 4 cycles of cisplatin plus pemetrexed and 13 subsequent cycles of pemetrexed maintenance therapy showed beneficial responses until CT revealed liver metastasis. Nivolumab was then administered as the second-line therapy.

Outcomes: After 3 cycles of biweekly nivolumab administration, he developed severe abdominal distention. CT revealed an intraperitoneal mass growing much more rapidly than ever, indicating hyperprogressive disease after nivolumab treatment. He ultimately died 51 days after the initial nivolumab administration.

Lessons: To our knowledge, this is the first report of hyperprogressive disease in a case of peritoneal mesothelioma after nivolumab treatment. While immune checkpoint inhibitors may be promising therapeutic strategies for treating malignant peritoneal mesothelioma, careful monitoring must be practiced with their application.

In plain English

This case report described one patient: a 75-year-old male ex-smoker with a history of asbestos exposure, seen at the authors' hospital in Tokyo, Japan, for lower abdominal pain. The article did not say what type of asbestos it was or how the exposure occurred. Scans showed a 50-mm abdominal mass involving the ascending colon and multiple nodules on the abdominal lining. No pleural thickening, plaques or calcification were seen. A biopsy confirmed malignant peritoneal mesothelioma, epithelioid type. Four cycles of cisplatin plus pemetrexed shrank the tumor, and pemetrexed maintenance therapy kept a favorable response for about 12 months. After 13 maintenance cycles, liver metastasis appeared. The patient was then given nivolumab, an immune checkpoint inhibitor, as second-line therapy. After 3 cycles, the abdominal lesions and liver metastasis grew much faster than before, which the authors called hyperprogressive disease. The patient died 51 days after the first nivolumab dose. The authors believed this was the first such report in peritoneal mesothelioma. They concluded that these drugs may be promising but need careful monitoring, including follow-up imaging. One case shows what happened to one person, not how often it happens.

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 of a single patient
• Who was studied: one 75-year-old male ex-smoker with a history of asbestos exposure who presented with lower abdominal pain, treated at NTT Medical Center Tokyo, Japan
• Exposure: a history of asbestos exposure; the article gives no fiber type, job, product or dose. No pleural thickening, plaques or calcification were found on chest imaging. The treatments described were cisplatin 75mg/m2 plus pemetrexed 500mg/m2, pemetrexed maintenance, then nivolumab 240mg/body
• Main results:
  • CT showed a 50-mm mass involving the ascending colon, with multiple peritoneal dissemination nodules and ascites
  • Biopsy diagnosis was malignant peritoneal mesothelioma, epithelioid type
  • After 4 cycles of cisplatin plus pemetrexed, the right lower abdominal mass shrank, the peritoneal thickening improved and the ascites cleared
  • Pemetrexed maintenance therapy showed a favorable response for about 12 months, until CT showed liver metastasis after 13 cycles
  • After 3 cycles of biweekly nivolumab, the patient developed severe abdominal distention, and the intraperitoneal lesions and liver metastasis grew much more rapidly than before, which the authors described as hyperprogressive disease
  • The patient died 51 days after the first nivolumab dose
• The authors' conclusion: The authors stated that, to their knowledge, this was the first report of hyperprogressive disease in peritoneal mesothelioma after nivolumab. They concluded that immune checkpoint inhibitors may be promising for malignant peritoneal mesothelioma but that careful monitoring, including follow-up imaging, must be practiced when they are used.

Topics

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

Medical terms in this study, explained in our Lexicon: Cisplatin, Pemetrexed (Alimta), checkpoint inhibitors, Peritoneal Mesothelioma, Prognosis, Chemotherapy, Nivolumab (Opdivo), Biopsy.

Related studies

• Anticancer effect of bromelain with and without cisplatin or 5-FU on malignant peritoneal mesothelioma cells — K. Pillai, A. Ehteda, et al. (2014)
• First-line chemotherapy with pemetrexed plus cisplatin for malignant peritoneal mesothelioma — E. Fujimoto, T. Kijima, et al. (2017)
• Celiac Disease After Administration of Immune Checkpoint Inhibitors: A Case Report — J. Leblanc, S. Hoibian, et al. (2021)
• Trimodality strategy for treating malignant pleural mesothelioma: results of a feasibility study of induction pemetrexed plus cisplatin followed by extrapleural pneumonectomy and postoperative hemithoracic radiation (Japan Mesothelioma Interest Group 0601 Trial) — S. Hasegawa, M. Okada, et al. (2016)
• Systemic chemotherapy with pemetrexed and cisplatin for malignant peritoneal mesothelioma: a single institution experience — G. Lainakis, F. Zagouri, et al. (2011)
• Complete pathological response to neoadjuvant pemetrexed/cisplatin in combination with regional hyperthermia in a patient with sarcomatoid peritoneal mesothelioma — S. Kruger, M.K. Angele, et al. (2014)

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