Remarkable response to nivolumab in sarcomatoid malignant pleural mesothelioma with high PD-L1

Our plain-English summary of Remarkable response to nivolumab in sarcomatoid malignant pleural mesothelioma with high PD-L1, by K. Tsubouchi, S. Inoue, R. Ibusuki, et al (Respirology Case Reports, 2020).

The study

• Authors: K. Tsubouchi, S. Inoue, R. Ibusuki, T. Iwasaki, T. Harada
• Journal: Respirology Case Reports
• Published: 2020;8(3):e00536
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

We report herein a case of sarcomatoid malignant pleural mesothelioma (MPM) with high PD-L1 expression who was refractory to standard chemotherapy but had a remarkable and sustained response to nivolumab. A 78-year-old man presented with right chest pain. Computed tomography (CT) showed a solid mass extending to the right pleura. Histopathological examination revealed the proliferation of spindle to pleomorphic ovoid shaped tumour cells, which are positive for calretinin and podoplanin. The patient was diagnosed with sarcomatoid MPM. Despite treatment with carboplatin and pemetrexed, the primary lesion rapidly progressed and new multiple pleural metastases were observed. Although his performance status decreased with advancing of symptoms and adverse events, nivolumab was administered. After the nivolumab treatment, CT showed a significant reduction in pleural tumours with a marked improvement in symptoms. In the primary specimens, TPS of PD-L1 was 80%. The patient has continued this treatment with sustained and remarkable effectiveness with good quality of life (QOL).

© 2020 The Authors. Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.

In plain English

This case report described one patient, a 78-year-old man at a hospital in Fukuoka, Japan, who came in with right chest pain. A CT scan showed a solid mass along the right pleura. A needle biopsy led to a diagnosis of sarcomatoid malignant pleural mesothelioma, a subtype the authors described as hardly responding to chemotherapy. The article does not describe the patient's asbestos exposure. After two cycles of standard chemotherapy (carboplatin and pemetrexed), the main tumour grew quickly, new pleural tumours appeared, and the patient's physical condition declined. The patient was then given nivolumab, an immune checkpoint inhibitor drug. After four cycles, CT showed a significant reduction in the pleural tumours, and symptoms improved markedly. Testing of the original biopsy gave a PD-L1 tumour proportion score of 80%. One year after diagnosis, the patient was still on this treatment with improved quality of life. The authors concluded that this case suggests such drugs may be expected to work in sarcomatoid mesothelioma with high PD-L1. A single case does not show how often this happens.

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 78-year-old man with right chest pain, treated at the Japan Community Health Care Organization Kyushu Hospital, Fukuoka, Japan; dates of care not given
• Exposure: The patient's asbestos exposure is not described. The article concerns treatment: carboplatin and pemetrexed chemotherapy, followed by nivolumab 240 mg given intravenously every two weeks
• Main results:
  • Biopsy tumour cells were positive for calretinin and podoplanin, and the patient was diagnosed with sarcomatoid malignant pleural mesothelioma
  • After two cycles of carboplatin and pemetrexed, the primary lesion rapidly progressed and new multiple pleural metastases were seen
  • The patient's performance status decreased, with increasing chest pain and chemotherapy side effects
  • After four cycles of nivolumab given alone, chest CT showed a significant reduction in pleural tumours, with marked improvement in symptoms
  • The PD-L1 tumour proportion score in the primary specimens was 80% using the 22C3 assay
  • The patient continued treatment, with improved quality of life one year after the initial diagnosis
• The authors' conclusion: The authors concluded that this case suggests immune checkpoint inhibitors would be expected to have a marked therapeutic effect in patients with sarcomatoid malignant pleural mesothelioma and high PD-L1 expression. They added that treatment strategies for advanced mesothelioma may be distinguished by histological subtype, as in lung cancer.

Topics

Medical terms in this study, explained in our Lexicon: Nivolumab (Opdivo), Sarcomatoid, Pleural Mesothelioma, PD-L1, Chemotherapy, Pleura, Pleomorphic, Calretinin.

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