Evolving Landscape of Initial Treatments for Patients with Malignant Pleural Mesotheliomas: Clinical Trials to Clinical Practice

Our plain-English summary of Evolving Landscape of Initial Treatments for Patients with Malignant Pleural Mesotheliomas: Clinical Trials to Clinical Practice, by M. Offin, V.W. Rusch, A. Rimner, et al (The Oncologist, 2022).

The study

• Authors: M. Offin, V.W. Rusch, A. Rimner, P.S. Adusumilli, M.G. Zauderer
• Journal: The Oncologist
• Published: 2022;27(8):610-614
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma (MPM) is the most common form of mesothelioma and the type most often studied in prospective clinical trials.This review reports the trials that have shaped first-line treatment for patients with advanced/unresectable MPM and the real-world integration of first-line immune checkpoint inhibitors into clinical practice.

In plain English

This article was a commentary, not a new study. The authors reviewed clinical trials that have shaped first-line (initial) treatment for people with advanced or unresectable malignant pleural mesothelioma. Among the earlier trials it described, the EMPHACIS trial of cisplatin plus pemetrexed versus cisplatin alone reported median overall survival of 12.1 versus 9.3 months. For the CheckMate 743 trial, which compared nivolumab plus ipilimumab with platinum and pemetrexed chemotherapy, the authors reported overall survival of 18.1 versus 14.1 months (hazard ratio 0.74, 95% CI 0.60-0.91). In non-epithelioid mesothelioma the figures were 18.1 versus 8.8 months (HR 0.46, 95% CI 0.31-0.68). In epithelioid mesothelioma they were 18.7 versus 16.5 months (HR 0.86, 95% CI 0.69-1.08), which was not statistically significant. No benefit was reported for patients aged 75 and older. The authors noted that the trial's control arm did not include bevacizumab. The authors concluded that first-line nivolumab plus ipilimumab is preferable for non-epithelioid disease, especially under age 75. They added that its benefit in epithelioid disease and in patients 75 or older has not been established.

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: Commentary (narrative review) of clinical trials of first-line treatment for advanced/unresectable malignant pleural mesothelioma; no new patient data
• Who was studied: No population was studied directly. The reviewed trials enrolled patients with malignant pleural mesothelioma, including CheckMate 743, which randomized previously untreated patients with unresectable disease
• Exposure: No asbestos exposure was examined. The exposures were treatments: chemotherapy (cisplatin or carboplatin with pemetrexed), bevacizumab, targeted agents, and immune checkpoint inhibitors (nivolumab plus ipilimumab)
• Main results:
  • EMPHACIS trial (as reported by the authors): median overall survival was 12.1 months with cisplatin plus pemetrexed vs 9.3 months with cisplatin alone
  • MAPS trial (as reported by the authors): adding bevacizumab to cisplatin and pemetrexed gave overall survival of 18.8 vs 16.1 months
  • CheckMate 743 (as reported by the authors): overall survival was 18.1 months with nivolumab plus ipilimumab vs 14.1 months with chemotherapy (HR = 0.74, 95% CI 0.60-0.91)
  • CheckMate 743: grade 3-4 adverse events occurred in approximately 30% of patients in both arms
  • CheckMate 743, non-epithelioid mesothelioma: overall survival was 18.1 months with dual immunotherapy vs 8.8 months with chemotherapy (HR = 0.46, 95% CI 0.31-0.68)
  • CheckMate 743, epithelioid mesothelioma: there was no statistically significant survival advantage, 18.7 vs 16.5 months (HR = 0.86, 95% CI 0.69-1.08)
  • CheckMate 743, by PD-L1 expression: patients whose tumors had PD-L1 of 1% or more had improved overall survival with dual immunotherapy (HR = 0.69, 95% CI 0.55-0.87)
  • CheckMate 743: patients with PD-L1-negative disease showed no benefit (HR = 0.94, 95% CI 0.62-1.40)
  • CheckMate 743: for the 26% of patients aged 75 or older, the authors reported no benefit of dual immunotherapy
  • The authors' caveat: the CheckMate 743 control arm used a regimen they considered inferior to the triplet of platinum, pemetrexed and bevacizumab
• The authors' conclusion: The authors concluded that for non-epithelioid histology, especially under age 75, first-line nivolumab plus ipilimumab is preferable over platinum-based chemotherapy. They also concluded that in epithelioid mesothelioma and in patients 75 or older, its benefit over chemotherapy has not been established.

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Clinical Trial, Mesothelioma, Unresectable, checkpoint inhibitors.

Related studies

• Review on clinical trials of targeted treatments in malignant mesothelioma — J.N. Jakobsen, J.B. Sørensen (2011)
• Systemic treatment of malignant pleural mesothelioma: new agents in clinical trials raise hope of relevant improvements — D.C. Christoph, W.E. Eberhardt (2014)
• Radiologic Considerations and Standardization of Malignant Pleural Mesothelioma Imaging Within Clinical Trials: Consensus Statement from the NCI Thoracic Malignancy Steering Committee - International Association for the Study of Lung Cancer - Mesothelioma Applied Research Foundation Clinical Trials Planning Meeting — R.R. Gill, A.S. Tsao, et al. (2019)
• The Evolving Landscape of the Molecular Epidemiology of Malignant Pleural Mesothelioma — S. Lettieri, C. Bortolotto, et al. (2021)
• Recurrent Hydropneumothorax as an Initial Presentation of Malignant Pleural Mesothelioma: Diagnostic Challenges and the Evolving Role of Pleural Fluid Cytology — A. Goedseels, E. De Droogh, et al. (2026)
• Malignant pleural mesothelioma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up — P. Baas, D. Fennell, et al. (2015)

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