Clinical Response of Primary Malignant Pericardial Mesothelioma with Peritoneal Dissemination to Nivolumab

Our plain-English summary of Clinical Response of Primary Malignant Pericardial Mesothelioma with Peritoneal Dissemination to Nivolumab, by S. Fujiwara, Y. Kano, Y. Maejima, et al (Internal Medicine, 2024).

The study

• Authors: S. Fujiwara, Y. Kano, Y. Maejima, T. Fujioka, K. Tamura, S. Kirimura, S. Miyake, R. Okamoto
• Journal: Internal Medicine
• Published: 2024;63(4):513-519
• Type of article: Case report
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pericardial mesothelioma (MPM) is extremely rare, and peritoneal dissemination has not yet been reported. There is no consensus regarding appropriate pharmacological treatment for MPM, including immune checkpoint inhibitors (ICIs). We herein report a 36-year-old man with MPM diagnosed by peritoneal dissemination and treated with an ICI. Cytology of the ascites revealed malignant peritonitis, and a re-evaluation of a pericardial biopsy performed at the previous hospital led to a diagnosis of MPM. The patient was treated with nivolumab and showed a clinical response despite several complications, such as renal dysfunction and performance status deterioration. This case report provides suggestive information for the diagnosis and ICI therapy of a rare type of mesothelioma.

In plain English

This case report described a 36-year-old man in Japan, a watch salesman with no history of asbestos exposure, with malignant pericardial mesothelioma (cancer of the lining around the heart) that had spread to the abdominal lining. After a year of treatment for pericarditis, cytology of his abdominal fluid showed malignant peritonitis. Re-examination of an earlier pericardial biopsy, including a test showing homozygous deletion of p16, supported the diagnosis. Because of severe heart failure, poor performance status and kidney dysfunction, he received the immunotherapy drug nivolumab. After the first dose there was a clinically partial response, with improved performance status, creatinine level and cardiothoracic ratio. His condition then worsened, and he died on day 71. Autopsy findings indicated primary pericardial mesothelioma of the biphasic type, and heart failure was considered the immediate cause of death. The authors reported no evidence of asbestos exposure. The authors said worsening heart failure made it impossible to assess whether treatment worked. They reported this as, to their knowledge, the first such case with peritoneal dissemination and concluded that immune checkpoint inhibitors are expected to be effective.

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 (with a literature search of published cases)
• Who was studied: One 36-year-old man treated at the authors' hospital (Tokyo Medical and Dental University, Japan), who had presented with shortness of breath and lower-leg swelling; dates of care not given
• Exposure: No asbestos exposure: the patient worked as a watch salesman and had no history of asbestos exposure. The treatment studied was the immune checkpoint inhibitor nivolumab.
• Main results:
  • In the patient, cytology of the ascites (abdominal fluid) was diagnosed as malignant peritonitis even though no tumor was seen on imaging
  • In the patient, tumor cells in pericardial tissue from the previous hospital were positive for calretinin, and FISH testing detected homozygous deletion of p16, supporting the diagnosis
  • The patient was given nivolumab instead of standard platinum and pemetrexed chemotherapy because of class IV heart failure, performance status of 3 and renal dysfunction (creatinine 2.4 mg/dL)
  • After the first nivolumab dose, the patient had a clinically partial response, with improvements in performance status, creatinine level and cardiothoracic ratio
  • On day 45 the patient's performance status dropped to the equivalent of 4, and he died on day 71
  • At autopsy of the patient, tumor infiltration of the heart muscle indicated primary pericardial mesothelioma, classified as biphasic type
  • Based on the autopsy, heart failure was considered the immediate cause of death
  • The authors reported no evidence of asbestos exposure or autoimmune diseases in the patient; the article does not describe how asbestos exposure was assessed
  • The authors' literature search found 24 published cases of malignant pericardial mesothelioma treated with drugs, mostly first-line pemetrexed plus platinum without immune checkpoint inhibitors
• The authors' conclusion: The authors concluded that, to their knowledge, this was the first case report of malignant pericardial mesothelioma with peritoneal dissemination. They stated that immune checkpoint inhibitors are expected to be effective and that more cases are needed to establish treatment.
• Limitations the authors state:
  • After three weeks of treatment the heart failure worsened, so it became impossible to assess whether the therapy was effective
  • The patient's poor performance status at the start of treatment may have led to the treatment effect being underestimated; patients in better condition are needed for a true evaluation

Topics

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

Medical terms in this study, explained in our Lexicon: Pericardial Mesothelioma, Nivolumab (Opdivo), checkpoint inhibitors, Cytology, Ascites, Pericardial, Biopsy, Performance Status.

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• Clinical picture, response to therapy, and survival of women with diffuse malignant peritoneal mesothelioma — G.H. Eltabbakh, M.S. Piver, et al. (1999)
• Primary Malignant Pericardial Mesothelioma: A Clinical Case Series Illustrating the Necessity of a Multidisciplinary Approach — A.N. Rosenbaum, M.C. Bois, et al. (2019)
• Primary pericardial malignant mesothelioma and response to radiation therapy — K.A. Reardon, M.A. Reardon, et al. (2010)

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