Long-Term Disease Control With Second-Line Nivolumab Monotherapy in Malignant Pleural Mesothelioma: A Case Report

Our plain-English summary of Long-Term Disease Control With Second-Line Nivolumab Monotherapy in Malignant Pleural Mesothelioma: A Case Report, by S. Otsuka, K. Hiraoka, N. Iwashiro (Curēus, 2026).

The study

• Authors: S. Otsuka, K. Hiraoka, N. Iwashiro
• Journal: Curēus
• Published: 2026;18(6):e110026
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Nivolumab is recommended as second-line therapy for malignant pleural mesothelioma (MPM); however, durable responses remain uncommon. In addition, combination immune checkpoint inhibitors are frequently limited by immune-related adverse events. A 72-year-old man with epithelioid MPM underwent extrapleural pneumonectomy followed by adjuvant chemotherapy with cisplatin and pemetrexed. After recurrence, additional platinum-based chemotherapy was administered, followed by disease progression. Nivolumab monotherapy was then initiated as second-line therapy, resulting in a sustained radiological response. The patient has maintained progression-free survival for 24 months without severe immune-related adverse events, allowing long-term treatment continuation. This case highlights that nivolumab monotherapy may achieve durable disease control with a favorable safety profile in selected patients with MPM.

Copyright © 2026, Otsuka et al.

In plain English

This was a case report about one patient. A 72-year-old man had worked in shipbuilding, ironworks and construction, which the authors said suggested prior asbestos exposure. He was diagnosed with epithelioid malignant pleural mesothelioma. He underwent right extrapleural pneumonectomy, followed by chemotherapy with cisplatin and pemetrexed. The cancer returned in lymph nodes in the middle of the chest 31 months after surgery. Six more courses of cisplatin plus pemetrexed shrank the tumor. Eleven months after that chemotherapy began, the disease grew again, with a new chest wall lesion. He then received the immunotherapy drug nivolumab alone, 240 mg every two weeks. Scans showed a partial response, with near-complete disappearance of the enlarged lymph nodes and the chest wall lesion. After 47 cycles, he had gone 24 months without the disease progressing and without severe immune-related side effects requiring a pause or stop. The authors concluded that nivolumab alone may give durable disease control in selected patients. They noted that PD-L1, tumor mutational burden and molecular testing were not available, and that standardized response evaluation was not fully performed.

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
• Who was studied: One 72-year-old man with epithelioid malignant pleural mesothelioma; the authors are from the Department of Surgery, NHO Hakodate Medical Center, Japan
• Exposure: Work in shipbuilding, ironworks and construction, which the authors said suggested prior asbestos exposure; no fiber type or dose given. The treatment studied was second-line nivolumab monotherapy, 240 mg every two weeks.
• Main results:
  • Pleural biopsy confirmed epithelioid malignant pleural mesothelioma
  • After right extrapleural pneumonectomy, the pathological stage was pT4N0M0 (stage IIIB), with no lymph node metastases
  • Recurrence in mediastinal lymph nodes was found 31 months after surgery; six more courses of cisplatin plus pemetrexed shrank the tumor
  • Disease progressed, with regrowth of mediastinal lymph nodes and a new chest wall lesion, 11 months after that chemotherapy started
  • On nivolumab, the patient had a radiological partial response with sustained near-complete resolution of the mediastinal lymph nodes and the chest wall lesion
  • After 47 cycles of nivolumab, the patient had progression-free survival of 24 months without severe immune-related adverse events requiring treatment interruption or discontinuation
• The authors' conclusion: The authors concluded that second-line nivolumab monotherapy may achieve durable disease control with a favorable safety profile in selected patients with malignant pleural mesothelioma, and that further studies are warranted.
• Limitations the authors state:
  • PD-L1 expression, tumor mutational burden and molecular profiling were not available
  • Standardized response evaluation was not fully performed
  • The biological mechanisms behind the response remain unclear

Topics

Medical terms in this study, explained in our Lexicon: Nivolumab (Opdivo), Pleural Mesothelioma, Second-Line Therapy, checkpoint inhibitors, Immune-Related Adverse Events, Epithelioid, Extrapleural Pneumonectomy (EPP), Chemotherapy.

Related studies

• NIPU: a randomised, open-label, phase II study evaluating nivolumab and ipilimumab combined with UV1 vaccination as second line treatment in patients with malignant mesothelioma — V.D. Haakensen, A.K. Nowak, et al. (2021)
• Response to Nivolumab followed by complete cytoreductive surgery with HIPEC resulted in long-term survival in a patient with sarcomatoid-predominant biphasic peritoneal mesothelioma. A case report — P.H. Sugarbaker (2023)
• Jejunal Metastasis from Malignant Pleural Mesothelioma during Long-Term Nivolumab Therapy: A Case Report and Literature Review — H. Minagi, H. Aoki, et al. (2026)
• Sarcomatoid diffuse pleural mesothelioma in an 80-year-Old woman with long-term response to nivolumab plus ipilimumab: A case report — Y. Yoshida, H. Mizugaki, et al. (2025)
• Decrease in Intracellular Perforin Levels and IFN-γ Production in Human CD8+ T Cell Line following Long-Term Exposure to Asbestos Fibers — N. Kumagai-Takei, Y. Nishimura, et al. (2018)
• Case report: complete response and long-term survival on third-line immunotherapy in patient with pleural mesothelioma — Ž. Jurić Čuljak, S. Tomić, et al. (2024)

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