Major pathological response obtained after neoadjuvant chemotherapy combined with dual immunotherapy for malignant pleural mesothelioma: a case report

Our plain-English summary of Major pathological response obtained after neoadjuvant chemotherapy combined with dual immunotherapy for malignant pleural mesothelioma: a case report, by Y. Zhang, G. Zhao, C. Xu, et al (Translational Lung Cancer Research, 2024).

The study

• Authors: Y. Zhang, G. Zhao, C. Xu, J. Gu, D. Ge
• Journal: Translational Lung Cancer Research
• Published: 2024;13(6):1420-1425
• 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 (MPM) is a rare thoracic malignancy with high morbidity and mortality. A combination of systemic therapy and surgery may be a promising modality for the treatment of MPM, but evidence-based medicine is still lacking.

Case Description: Here we report a case of MPM. The patient presented to hospital with cough and sputum. After ineffective symptomatic treatment, computed tomography (CT) examination suggested a malignant tumor of pleural origin. Positron emission tomography/computed tomography (PET/CT) examination suggested no lymph node metastasis or distant metastasis. The pathologic diagnosis of MPM was confirmed after CT-guided puncture biopsy. Next, she underwent 3 courses of neoadjuvant chemotherapy combined with dual immunotherapy (carboplatin and pemetrexed combined with anti-CTLA4 and anti-PD-1), resulting in significant tumor shrinkage. After obtaining the patient's consent and completing a preoperative evaluation, we modified the extrapleural pneumonectomy (EPP) and pleurectomy/decortication (P/D) by performing a lower lobe resection and partial pleurectomy of the left lung. Intraoperative rapid frozen pathology suggested that the margins of the tumor were negative and complete resection was achieved. The postoperative pathology report showed 10% residual viable tumor, so the major pathological response (MPR) was achieved after treatment.

Conclusions: MPM might respond well to neoadjuvant chemotherapy and dual immunotherapy, improving the probability of complete surgical resection and attaining an encouraging pathologic response.

2024 Translational Lung Cancer Research. All rights reserved.

In plain English

This case report described one 69-year-old woman with epithelial-type malignant pleural mesothelioma, reported by surgeons at Zhongshan Hospital, Fudan University, Shanghai. The article did not mention asbestos exposure. Scans showed a left-sided pleural tumor without lymph node or distant spread. Before surgery she received 3 courses of carboplatin and pemetrexed chemotherapy combined with the immunotherapy drugs nivolumab and ipilimumab. On CT, the tumor shrank from 79.6 × 49.9 × 35.5 mm to 40.0 × 38.5 × 16.4 mm. Surgeons removed the lower lobe of the left lung and part of the pleura. The margins were negative and the authors reported complete resection. The removed tissue showed 10% residual viable tumor, which met the criteria for a major pathological response. The only reported side effect was a transient mild loss of appetite. The authors concluded that, according to this single case, mesothelioma might respond well to this treatment. They also stated that one case cannot assess a therapy's safety or efficacy. They noted that tumor shrinkage was not measured by the standard RECIST criteria.

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 69-year-old woman with epithelial malignant mesothelioma of the left pleura, with no lymph node or distant metastasis on PET/CT, reported by authors at Zhongshan Hospital, Fudan University, Shanghai, China
• Exposure: The article does not report any asbestos exposure. What it studied was treatment: 3 courses of carboplatin 400 mg plus pemetrexed 720 mg every 3 weeks, combined with nivolumab 140 mg plus ipilimumab 50 mg every 6 weeks, followed by surgery
• Main results:
  • After 3 courses of treatment, the tumor on CT shrank from 79.6 mm × 49.9 mm × 35.5 mm to 40.0 mm × 38.5 mm × 16.4 mm
  • Surgery (left lower lobe resection with partial pleurectomy) had negative margins on intraoperative frozen pathology, and the authors reported complete resection
  • The postoperative pathology showed 10% residual viable tumor, which the authors classed as a major pathological response
  • In this patient's tumor tissue, PD-1-positive T cells fell from about 40% before treatment to about 10% after. CTLA4-positive T cells fell from about 20% to barely visible. CD8-positive T cells increased.
  • The patient had only a transient mild loss of appetite and no significant side effects during treatment
• The authors' conclusion: The authors concluded that, according to this single case, MPM might respond well to neoadjuvant chemotherapy and dual immunotherapy, improving the probability of complete surgical resection
• Limitations the authors state:
  • A single case cannot establish the safety or efficacy of a therapy; large multicenter studies are needed
  • It is debatable whether the therapy applies to both diffuse and localized pleural mesothelioma
  • RECIST criteria were not followed: enhanced CT was used before treatment and plain CT after
  • No PET/CT was done after treatment, for economic reasons

Topics

Medical terms in this study, explained in our Lexicon: Neoadjuvant Therapy, Immunotherapy, Pleural Mesothelioma, Systemic Therapy, Sputum, Metastasis, Biopsy, Carboplatin.

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