Immunotherapy combined with antiangiogenic agents in patients with advanced malignant pleural mesothelioma: A case report

Our plain-English summary of Immunotherapy combined with antiangiogenic agents in patients with advanced malignant pleural mesothelioma: A case report, by T.T. Xuan, G.Y. Li, S.B. Meng, et al (World Journal of Clinical Cases, 2022).

The study

• Authors: T.T. Xuan, G.Y. Li, S.B. Meng, Z.M. Wang, L.L. Qu
• Journal: World Journal of Clinical Cases
• Published: 2022;10(23):8284-8290
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Malignant pleural mesothelioma has limited therapeutic options and a poor outcome. Antiangiogenic agents might increase the efficacy of immunotherapy as second-line treatment of advanced-stage malignancies.

Case Summary: A patient with stage IIIB pleural mesothelioma received second-line treatment with a combination of pembrolizumab, bevacizumab and chemotherapy following standard chemotherapy under the guidance of second-generation sequencing. He achieved a partial response after four cycles of treatment with progression-free survival of 5 mo. Pembrolizumab was suspended due to grade 2 immunerelated pneumonia, which was resolved by oral glucocorticoids. However, disease progression was observed after immunotherapy rechallenge and anlotinib therapy. The patient had disease progression, multiorgan dysfuntion and died suddenly in October 2019.

Conclusion: The combination of immune checkpoint inhibitor, anti-angiogenic agents and chemotherapy showed effective response for advanced pleural mesothelioma, but with adverse reactions.

©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.

In plain English

This case report from Qilu Hospital (Qingdao), China, describes a 51-year-old Asian man with stage IIIB malignant pleural mesothelioma (epithelial type), admitted with fever in November 2018. The report describes no asbestos exposure; it states only that his past medical history, including asbestosis, was not significant. One cycle of carboplatin plus pemetrexed was followed by progression with lung metastasis. From January to April 2019 he received four cycles of pembrolizumab, bevacizumab and liposome taxol. His tumors shrank (a partial response), and the disease did not progress for 5 months. He developed moderate (grade 2) immune-related pneumonia, which improved with glucocorticoids after pembrolizumab was stopped. In July 2019 the cancer had spread to the liver. Pembrolizumab was restarted with anlotinib, but the pneumonia returned after one cycle, and the disease progressed again in August 2019. He died in October 2019. The authors concluded that the combination produced a partial response but no lasting benefit when pembrolizumab was restarted. They added that restarting immune checkpoint inhibitors should be carefully considered after immune-related pneumonia in patients with advanced pleural mesothelioma treated with pembrolizumab.

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 51-year-old Asian man with malignant pleural mesothelioma (epithelial type), clinical stage cT4N0M0, stage IIIB, admitted with fever to Qilu Hospital (Qingdao), China, in November 2018
• Exposure: No asbestos exposure is described. The past medical history is stated as not significant, including asbestosis. The report concerns drug treatment, not asbestos exposure.
• Main results:
  • After one cycle of first-line carboplatin plus pemetrexed, the patient's disease progressed, with a larger right pleural lesion and lung metastasis
  • Second-line treatment was four cycles of pembrolizumab (200 mg every 3 weeks), bevacizumab (600 mg every 3 weeks) and liposome taxol (175 mg/m2, day 1), given January to April 2019
  • The pleural lesions and lung metastases shrank, rated as a partial response by RECIST1.1 criteria
  • Progression-free survival after the second-line combination was 5 months
  • The patient developed moderate (grade 2) immune-related pneumonia. Pembrolizumab was suspended and glucocorticoid given. The pneumonia resolved to grade 1 or lower, and glucocorticoid was stopped after 2 months.
  • Disease progressed with liver metastasis in July 2019
  • When pembrolizumab was restarted together with anlotinib as third-line therapy, grade 2 immune-related pneumonia recurred after one cycle
  • Disease progressed again in August 2019 with increased liver metastases. One cycle of capecitabine and temozolomide failed to control it.
  • The patient died suddenly in October 2019 after persistent severe pneumonia, anemia, hypoproteinemia and electrolyte disturbance
  • Blood next-generation sequencing showed a TP53 splicing exon 4 alteration (6.44%), microsatellite stability and moderate tumor mutational burden (2.70 Mut/Mb). A later test showed low tumor mutational burden (less than 1 Mut/Mb).
• The authors' conclusion: The authors concluded that this patient had a partial response with pembrolizumab, bevacizumab and chemotherapy but did not achieve a durable clinical benefit on rechallenge. They also stated that immune checkpoint inhibitor rechallenge should be carefully considered when immune-related pneumonia has occurred previously in patients with advanced MPM treated with pembrolizumab.

Topics

Medical terms in this study, explained in our Lexicon: Immunotherapy, Pleural Mesothelioma, Pembrolizumab (Keytruda), Bevacizumab, Chemotherapy, Progression-Free Survival, Disease Progression, checkpoint inhibitors.

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