Pathological complete response in a patient with pleural mesothelioma treated with immunotherapy: a case report

Our plain-English summary of Pathological complete response in a patient with pleural mesothelioma treated with immunotherapy: a case report, by E. Faccioli, F. Grosso, A. Dell'Amore, et al (Frontiers in Oncology, 2024).

The study

• Authors: E. Faccioli, F. Grosso, A. Dell'Amore, S. Delfanti, G. Zambello, L. Cerbone, G. Canu, A. De Angelis, V. Sambataro, F. Pezzuto, P. Barbieri, G. Pasello, F. Calabrese, F. Rea
• Journal: Frontiers in Oncology
• Published: 2024;14:1378530
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

The role of immunotherapy in the multimodal treatment for pleural mesothelioma (PM) is still under investigation, particularly in the preoperative setting. Pathological complete response (pCR) has been previously described after chemotherapy and immunotherapy; however, there is no prior experience reported with immunotherapy alone before surgery. We report the case of a 58-year-old male with biphasic PM treated with immunotherapy, resulting in a major clinical partial response. Following a multidisciplinary evaluation between thoracic surgeons, medical oncologists, pathologists, radiologists and radiation oncologists, the patient underwent surgery with radical intent through a right extended pleurectomy/decortication (eP/D). Histopathological examination of the specimen confirmed a pathological Complete Response (pCR). This case supports the feasibility and potential efficacy of combining preoperative immunotherapy with surgery in the management of advanced PM.

Copyright © 2024 Faccioli, Grosso, Dell’Amore, Delfanti, Zambello, Cerbone, Canu, De Angelis, Sambataro, Pezzuto, Barbieri, Pasello, Calabrese and Rea.

In plain English

This article is a case report from hospitals in Padova and Alessandria, Italy. It describes one 58-year-old man with pleural mesothelioma who was a former smoker with a history of environmental asbestos exposure. The article does not name a fiber type. Biopsies showed biphasic mesothelioma with a minor (less than 5%) spindle-cell component. Because of this and a high disease burden (139 mm by mRECIST measurement), his disease was judged unresectable. He received five courses of the immunotherapy drugs nivolumab (360 mg) and ipilimumab (80 mg). The only reported adverse events were mild diarrhea, related to treatment, and episodes of atrial fibrillation, which the authors considered likely related to the disease's closeness to the pericardium. Tumor measurements fell to 15 mm after the second course and 14 mm after the fourth. He then had a right extended pleurectomy/decortication with removal of mediastinal lymph nodes. Staining of the removed tissue for tumor cells was negative, and a pathological complete response was reported. He left hospital after eleven days. Six months after surgery he showed no signs of recurrence. The authors concluded this was the first such case after nivolumab and ipilimumab and called for further studies.

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 58-year-old male former smoker (30 pack/year) with a history of environmental asbestos exposure and right pleural mesothelioma, reported by authors from hospitals in Padova and Alessandria, Italy
• Exposure: Treatment studied: up-front immunotherapy with nivolumab 360 mg plus ipilimumab 80 mg for five courses, followed by surgery. The asbestos history is described only as environmental; no fiber type is given.
• Main results:
  • The final diagnosis was biphasic mesothelioma with a minor (less than 5%) spindle-cell component, and the disease was deemed unresectable (mRECIST at diagnosis 139 mm).
  • The tumor shrank to mRECIST 15 mm after the second course of immunotherapy and to 14 mm after the fourth course.
  • The only reported adverse events during treatment were mild diarrhea related to treatment and episodes of atrial fibrillation, which the authors considered likely related to the disease's proximity to the pericardium.
  • The patient underwent a right extended pleurectomy/decortication with mediastinal lymph node dissection.
  • Cytokeratin immunostaining (MNF116) of the specimen was negative, and a pathological complete response was reported.
  • The patient was discharged after eleven days. At six months after surgery he was alive with no signs of recurrence or metastasis.
• The authors' conclusion: The authors concluded that this is the first reported case of a pathological complete response in a pleural mesothelioma patient previously treated with nivolumab and ipilimumab. They said it highlights potential benefits of immunotherapy before surgery and that further studies are mandatory.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Immunotherapy, Chemotherapy, Biphasic Mesothelioma, Pleurectomy/Decortication (P/D).

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