Current status and progress in immunotherapy for malignant pleural mesothelioma

Our plain-English summary of Current status and progress in immunotherapy for malignant pleural mesothelioma, by B. Sun, Y. Dong, J. Xu, et al (Chronic Diseases and Translational Medicine, 2022).

The study

• Authors: B. Sun, Y. Dong, J. Xu, Z. Wang
• Journal: Chronic Diseases and Translational Medicine
• Published: 2022;8(2):91-99
• Type of article: Review
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma (MPM) is a rare and aggressive malignant disease. Currently, the platinum doublet of pemetrexed and cisplatin is the standard first-line treatment for unresectable MPM. However, recent promising results of immunotherapy have markedly changed the landscape of MPM treatment. Further, the ongoing innovative therapeutic strategies are expected to expand the range of treatment options; however, several questions remain unanswered. First, establishing predictive biomarkers with high potency is urgently needed to optimize the patient selection process. Second, further exploration of the combination algorithm is expected to unveil more effective and safe regimens. Moreover, other dilemmas, such as the resistance mechanism of immunotherapy and the role of immunotherapy in perioperative settings, still warrant further exploration.

© 2022 The Authors. Chronic Diseases and Translational Medicine published by John Wiley & Sons Ltd on behalf of Chinese Medical Association.

In plain English

This article was a narrative review, not a new study. The authors collected and discussed clinical trials of immunotherapy drugs (immune checkpoint inhibitors) for malignant pleural mesothelioma. They did not describe how the studies were chosen. Asbestos was mentioned only as the widely regarded cause of the disease, and no asbestos exposure was studied. Among the trials reviewed, CheckMate-743 (605 previously untreated patients) reported median overall survival of 18.1 months with nivolumab plus ipilimumab versus 14.1 months with platinum-pemetrexed chemotherapy. CONFIRM (332 previously treated patients) reported median overall survival of 9.2 months with nivolumab versus 6.6 months with placebo. In PROMISE-Meso, pembrolizumab did not improve survival over single-agent chemotherapy. DETERMINE found no differences between tremelimumab and placebo in survival, progression-free survival, response rate or disease control, though treatment-emergent adverse events were relatively higher with tremelimumab. The authors judged that PD-L1 testing had failed to be a strong predictor of who benefits. They concluded that immunotherapy had markedly changed mesothelioma treatment, but that reliable predictive biomarkers and better drug combinations were still needed. Some trial figures in the table differ from the text.

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: Narrative review of clinical trials of immunotherapy for malignant pleural mesothelioma; no search or selection method is described
• Who was studied: Published and ongoing clinical trials of immune checkpoint inhibitors in patients with malignant pleural mesothelioma (unresectable and resectable disease), as reported by other research groups
• Exposure: No asbestos exposure was studied. The review concerned immunotherapy drugs (PD-1, PD-L1, CTLA-4, TIM-3 and LAG-3 inhibitors). Asbestos is mentioned in the introduction only as the widely regarded cause of malignant pleural mesothelioma.
• Main results:
  • Reviewed trial CheckMate-743 (605 previously untreated patients, randomized): median overall survival was 18.1 months with nivolumab plus ipilimumab versus 14.1 months with platinum-pemetrexed chemotherapy
  • Reviewed trial CONFIRM (332 previously treated patients, nivolumab versus placebo): median progression-free survival was 3.0 versus 1.8 months (hazard ratio 0.62, p less than 0.001) and median overall survival was 9.2 versus 6.6 months (hazard ratio 0.72, p = 0.02)
  • Reviewed trial PROMISE-Meso (114 previously treated patients): pembrolizumab did not improve median overall survival over single-agent chemotherapy (10.7 versus 11.7 months)
  • Reviewed trial DETERMINE (571 patients, tremelimumab versus placebo): no differences between the groups in overall survival, progression-free survival, response rate or disease control rate
  • Reviewed trial DETERMINE: treatment-emergent adverse events were relatively higher in the tremelimumab group than in the placebo group
  • Across the studies reviewed, the authors judged that PD-L1 expression had not worked well as a predictor of benefit from immunotherapy in malignant pleural mesothelioma
• The authors' conclusion: The authors concluded that immunotherapy had markedly changed the treatment of malignant pleural mesothelioma, that predictive biomarkers are urgently needed to select patients, and that combination approaches are expected to give more effective and safe regimens

Topics

Medical terms in this study, explained in our Lexicon: Immunotherapy, Pleural Mesothelioma, Pemetrexed (Alimta), Cisplatin, Unresectable, Biomarker.

Related studies

• Immunotherapy for malignant pleural mesothelioma. Current status and future prospects — R.M. Wong, I. Ianculescu, et al. (2014)
• Immunotherapy with immune checkpoint inhibitors and predictive biomarkers in malignant mesothelioma: Work still in progress — M. Perrino, F. De Vincenzo, et al. (2023)
• Clinical Trials with Oncolytic Measles Virus: Current Status and Future Prospects — P. Msaouel, M. Opyrchal, et al. (2018)
• Malignant mesothelioma. Current status and future prospects — J. Aisner, P.H. Wiernik (1978)
• Raltitrexed: current clinical status and future directions — E. Van Cutsem, D. Cunningham, et al. (2002)
• Current status of screening for malignant pleural mesothelioma — H.I. Pass, M. Carbone (2009)

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