Epithelioid pleural mesothelioma successfully treated with perioperative immunotherapy: a case report

Our plain-English summary of Epithelioid pleural mesothelioma successfully treated with perioperative immunotherapy: a case report, by G. Yamazaki, A. Fujiwara-Kuroda, J. Muto, et al (General Thoracic and Cardiovascular Surgery Cases, 2024).

The study

• Authors: G. Yamazaki, A. Fujiwara-Kuroda, J. Muto, H. Ujiie, M. Aragaki, M. Furuta, S. Ohno, K.C. Hatanaka, Y. Hatanaka, Y. Matsuno, T. Kato
• Journal: General Thoracic and Cardiovascular Surgery Cases
• Published: 2024;3(1):31
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Pleural mesothelioma, characterized by a dismal prognosis even with multimodal therapy, has seen emerging interest in immune checkpoint inhibitors (ICIs) due to their demonstrated efficacy. Here, we present a case of epithelioid-type pleural mesothelioma with chest wall invasion treated with definitive ICI therapy, resulting in a remarkable pretreatment effect.

Case Presentation: A 46-year-old man was diagnosed with an abnormal chest shadow on a medical check, and a computed tomography scan showed pleural thickening at the dorsal right upper chest wall. One of the nodules was suspected to have invaded the chest wall. A needle biopsy revealed epithelioid-type pleural mesothelioma. After five cycles of nivolumab plus ipilimumab, he underwent right pleurectomy/decortication (P/D). Pathological examination revealed a significant treatment effect, showing numerous lymphocytes infiltrating the tumor nodule and viable tumor cells localized at approximately 6 mm.

Conclusion: Although further accumulation of cases is required to evaluate the effectiveness and case selection, P/D after immunotherapy is a useful curative treatment option for advanced pleural mesothelioma.

© 2024. The Author(s).

In plain English

This case report described one 46-year-old man with epithelioid-type pleural mesothelioma. He had been environmentally exposed to asbestos for 4 years at a railway yard, where asbestos was in the walls and ceilings. The fiber type was not stated. He also had a 20 pack-year smoking history. One tumor nodule, up to 34 mm across, was suspected of invading the chest wall. After five cycles of the immunotherapy drugs nivolumab plus ipilimumab, the tumor shrank markedly and a PET scan showed no abnormal uptake. About 4 months after diagnosis he had a right pleurectomy/decortication, surgery that removes the pleura. Pathology found one remaining tumor nodule of about 6 mm and many lymphocytes (immune cells) in the tumor. He had no drug side effects and no recurrence 14 months after surgery. The authors concluded that this surgery after immunotherapy is a useful curative option for advanced pleural mesothelioma. They noted that more cases are needed to judge its effectiveness and which patients it suits.

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 man with epithelioid-type pleural mesothelioma, found after an abnormal chest shadow at a medical check. He was treated at the authors' facility (Hokkaido University Hospital, Japan, per author affiliations).
• Exposure: Environmental asbestos exposure for 4 years, between ages 22 and 25, while working at a railway yard where asbestos was present in the walls and ceilings. Fiber type was not stated.
• Main results:
  • The patient had a smoking history of 20 pack-years.
  • Before treatment, one nodule suspected of invading the chest wall had a maximum diameter of 34 mm. It was staged clinically as T4N0M0 (stage IIIB).
  • The patient received nivolumab 360 mg per body every 3 weeks plus ipilimumab 1 mg/kg every 6 weeks. After five cycles the tumor dramatically shrank and FDG-PET showed no abnormal uptake, so it was judged resectable.
  • The patient underwent right pleurectomy/decortication approximately 4 months after the initial diagnosis.
  • Pathology found viable tumor cells only in a nodule of approximately 6 mm in the right upper dorsal pleura (ypT1). Other fibrous thickening was presumed to be post-treatment scarring, and the resected margins had no residual tumor cells.
  • After immunotherapy, CD3, CD4 and CD8 staining showed numerous lymphocytes infiltrating the tumor nodule.
  • PD-L1 and MECA-79 staining were negative in both the pretreatment biopsy and the resected specimens.
  • The patient tolerated the immunotherapy without side effects, and surgery had no perioperative complications.
  • Immunotherapy was restarted 9 weeks after surgery. The patient was followed up without recurrence 14 months after surgery.
• The authors' conclusion: The authors concluded that the case provides pathological evidence of immunotherapy's efficacy. They also concluded that pleurectomy/decortication after immunotherapy is a useful curative treatment option for advanced pleural mesothelioma.
• Limitations the authors state:
  • The authors stated that more cases must be accumulated to evaluate the effectiveness of this approach and how to select patients.
  • The authors noted that the use of immunotherapy after surgery remains controversial.

Topics

Medical terms in this study, explained in our Lexicon: Epithelioid, Pleural Mesothelioma, Immunotherapy, Prognosis, Multimodal Therapy, checkpoint inhibitors, Pleural Thickening, Needle Biopsy.

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