Complete Pathological Response After Neoadjuvant Chemo-Immunotherapy in Malignant Pleural Mesothelioma

Our plain-English summary of Complete Pathological Response After Neoadjuvant Chemo-Immunotherapy in Malignant Pleural Mesothelioma, by F.T. Tostes, M. Zugman, V.R. Paes, et al (Frontiers in Oncology, 2022).

The study

• Authors: F.T. Tostes, M. Zugman, V.R. Paes, G. Schvartsman
• Journal: Frontiers in Oncology
• Published: 2022;12:836751
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

In plain English

This article was a case report about one patient treated in São Paulo, Brazil. She was a 73-year-old non-smoker diagnosed with epithelioid malignant pleural mesothelioma. The article said she had worked for 5 years at a dry-cleaning facility, with occupational exposure to perchloroethylene, twenty years earlier. It did not mention asbestos. Her disease was judged borderline resectable. Her mediastinal lymph nodes were not biopsied before treatment. Before surgery she received four cycles of cisplatin, pemetrexed and pembrolizumab, an immunotherapy drug used off-label here. Her tumor cells showed 80% PD-L1 expression. Her only significant side effect was tinnitus. A scan after 2 cycles showed a mixed response. After 4 cycles a scan showed a complete metabolic response in the pleural implants and near-complete improvement in the lymph nodes. She then had pleural decortication and lymph node removal. Review of 105 slides found no remaining cancer in any site. She had no evidence of disease 14 months after surgery. The authors described this as the first such case report and concluded that prospective clinical trials of this approach are warranted.

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 (single patient)
• Who was studied: one 73-year-old female non-smoker with epithelioid malignant pleural mesothelioma, treated at Hospital Israelita Albert Einstein, São Paulo, Brazil; clinical stage cT1cN2M0; considered borderline resectable
• Exposure: The article reports occupational exposure to perchloroethylene during 5 years at a dry-cleaning facility twenty years earlier; asbestos exposure is not mentioned. The treatment studied was cisplatin (75 mg/m2), pemetrexed (500 mg/m2) and off-label pembrolizumab (2 mg/kg) every three weeks for 4 cycles before surgery.
• Main results:
  • PD-L1 expression in the patient's tumor cells was 80% (22C3 antibody).
  • Treatment caused no significant adverse events except tinnitus.
  • After 2 cycles PET-CT showed a mixed response: pleural implants improved, but the mediastinal lymph nodes grew and took up more tracer.
  • After 4 cycles a scan showed a complete metabolic response in the pleural implants and near-complete improvement in the lymph nodes.
  • After pleural decortication and mediastinal lymph node dissection, review of 105 slides showed complete pathological response in all sites (ypT0ypN0).
  • Adjuvant radiotherapy was not given. The patient had no evidence of disease 14 months after surgery and 18 months from the start of systemic therapy.
• The authors' conclusion: The authors stated that, to their knowledge, this is the first case report of immune checkpoint inhibitor use before surgery for malignant pleural mesothelioma with a pathological complete response. They concluded that prospective clinical trials of this strategy are warranted for patients with resectable tumors.

Topics

Medical terms in this study, explained in our Lexicon: Immunotherapy, Pleural Mesothelioma.

Related studies

• 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)
• Major pathological response obtained after neoadjuvant chemotherapy combined with dual immunotherapy for malignant pleural mesothelioma: a case report — Y. Zhang, G. Zhao, et al. (2024)
• Pathological complete response in a patient with pleural mesothelioma treated with immunotherapy: a case report — E. Faccioli, F. Grosso, et al. (2024)
• Pathological complete response in malignant pleural mesothelioma patients following induction chemotherapy: Predictive factors and outcomes — B. Lau, S. Kumar, et al. (2017)
• Complete pathological response after ceritinib for anaplastic lymphoma kinase-rearranged epithelioid peritoneal mesothelioma — S. Sakata, H. Rees, et al. (2021)
• A pathological complete response in malignant pleural mesothelioma after combination chemotherapy with Carboplatin and pemetrexed — S.C. Kao, B. McCaughan, et al. (2010)

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