Dual Immunotherapy for Pericardial Mesothelioma That Developed After a Decade-Long Idiopathic Pericarditis: A Case Report

Our plain-English summary of Dual Immunotherapy for Pericardial Mesothelioma That Developed After a Decade-Long Idiopathic Pericarditis: A Case Report, by B.G. Mirete, P.R. Paya, M.M. Marin, et al (Respirology Case Reports, 2025).

The study

• Authors: B.G. Mirete, P.R. Paya, M.M. Marin, A.F. Arias, M.B. Rivilla, A.D.L. Sanchez, P.M. Blasco, A. Rodriguez-Lescure, J.D. Benítez Fuentes
• Journal: Respirology Case Reports
• Published: 2025;13(5):e70190
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pericardial mesothelioma (MPeM) is exceptionally rare, and its association with long-standing idiopathic pericarditis remains unreported. We present a 46-year-old woman with a decade-long history of recurrent idiopathic pericarditis who developed multiple pericardial nodules, mediastinal lymphadenopathy, and metastatic liver and bone lesions. A core needle biopsy confirmed biphasic MPeM. Due to her pericardial condition, she initially received platinum-based chemotherapy instead of immunotherapy, but the disease progressed. She then underwent dual immune checkpoint inhibition (ICI) and achieved a significant clinical and radiological response. This case raises the possibility of chronic inflammation contributing to pericardial malignancy and underscores the potential role of dual ICI in this rare and challenging disease.

© 2025 The Author(s). Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.

In plain English

This case report described one woman, aged 46, treated at a hospital in Elche, Spain, who had no asbestos or tobacco exposure. She had had recurrent idiopathic pericarditis (repeated inflammation of the sac around the heart, of unknown cause) since 2011. In March 2024 a routine scan showed new pericardial nodules and lesions in the liver and the L5 vertebra. A liver biopsy confirmed biphasic malignant pericardial mesothelioma. Because of concern that immunotherapy might worsen her pericarditis, she first received carboplatin and pemetrexed chemotherapy. The disease stabilised after three cycles but progressed after six. She then received two immunotherapy drugs, nivolumab and ipilimumab. After three cycles, scans showed a complete metabolic response in the liver and bone lesions and a partial response in most chest and lung nodules. The response in the pericardium could not be assessed. The authors reported that this treatment did not worsen her pericarditis. They said they could not determine when the cancer began. The authors concluded that dual immunotherapy was a possible treatment strategy worth further exploration.

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 46-year-old obese Caucasian woman with recurrent idiopathic pericarditis since 2011, treated at Hospital General Universitario de Elche, Spain; mesothelioma found in March 2024
• Exposure: The patient had no asbestos or tobacco exposure; the background condition of interest was a decade-long history of recurrent idiopathic pericarditis
• Main results:
  • In March 2024 a PET-CT scan showed new pericardial nodules, mediastinal adenopathy, bilateral pulmonary nodules, and metastatic lesions in the liver (segment IVa) and the L5 vertebra
  • A liver core needle biopsy confirmed biphasic malignant pericardial mesothelioma, with PD-L1 expression of 30%
  • First-line treatment was carboplatin and pemetrexed chemotherapy, chosen because of concern that immunotherapy might worsen the pericarditis
  • The disease stabilised after three cycles of chemotherapy, but progressed after six cycles, with new bone and liver lesions
  • After three cycles of nivolumab plus ipilimumab, PET-CT showed a complete metabolic response in the liver and bone lesions
  • After three cycles of nivolumab plus ipilimumab, PET-CT showed a partial response in most mediastinal and pulmonary nodules
  • The response in the pericardium could not be assessed because of hypermetabolic nodules that were already present
  • In this patient, dual immunotherapy did not worsen the idiopathic pericarditis
• The authors' conclusion: The authors concluded that using dual immunotherapy in a patient with pre-existing autoimmune pericarditis, without worsening of that condition and with a response of the cancer, suggests a potential treatment strategy worth further exploration. They also raised the possibility that long-standing pericardial inflammation and treatment-related immunosuppression might play a role in causing the cancer.
• Limitations the authors state:
  • The authors stated that it is not possible to determine exactly when the malignant transformation began
  • The authors stated that direct evidence for dual immunotherapy in pericardial mesothelioma is lacking

Topics

Medical terms in this study, explained in our Lexicon: Immunotherapy, Pericardial Mesothelioma, Idiopathic, Standing, Pericardial, Lymphadenopathy, Needle Biopsy, Biphasic Mesothelioma.

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