Salvage Pleurectomy/Decortication After Immunotherapy for Sarcomatoid Malignant Pleural Mesothelioma

Our plain-English summary of Salvage Pleurectomy/Decortication After Immunotherapy for Sarcomatoid Malignant Pleural Mesothelioma, by K. Kajiyama, A. Taira, M. Takenaka, et al (Annals of Thoracic Surgery Short Reports, 2023).

The study

• Authors: K. Kajiyama, A. Taira, M. Takenaka, K. Kuroda, M. Kusano, A. Nawata, F. Tanaka
• Journal: Annals of Thoracic Surgery Short Reports
• Published: 2023;1(1):121-123
• Type of article: Case report
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Sarcomatoid malignant pleural mesothelioma (MPM) is a highly aggressive malignant tumor. Surgery may not be recommended, and chemotherapy is less effective. More recently, immunotherapy has become a new standard treatment of care for advanced MPM across all histologic subtypes. This reports describes a case of salvage lung-sparing surgery (pleurectomy with decortication) after immunotherapy with nivolumab in combination with ipilimumab for sarcomatoid MPM. The surgical specimen showed that a major pathologic response was achieved with immunotherapy. The present case indicates not only the feasibility of pleurectomy with decortication after immunotherapy but also pathologic evidence of the efficacy of immunotherapy, which provides insight into the treatment of advanced MPM.

© 2022 The Author(s).

In plain English

This article was a case report about one patient. A 69-year-old Japanese man with right-sided chest pain was diagnosed by biopsy with sarcomatoid malignant pleural mesothelioma. Scans showed the cancer involved the chest wall in several places, and it was judged unresectable, clinical stage IIIB (T4 N0 M0). The patient received a 3-month course of immunotherapy: nivolumab every 2 weeks and ipilimumab every 6 weeks. On scans the tumor measurements decreased by 50% from baseline. The surgeons then performed extended pleurectomy with decortication, a lung-sparing operation that also removed parts of the pericardium, diaphragm and chest wall, with macroscopic complete resection. Under the microscope, less than 1% of tumor cells in the removed tissue were viable. Recovery was uneventful, and the patient was alive without recurrence 5 months after surgery. The authors concluded that the case may indicate this surgery is safe and feasible after immunotherapy. They said the results suggest immunotherapy before surgery for resectable mesothelioma should be examined in future clinical trials; this patient's disease had been judged unresectable. The article did not report any asbestos exposure history.

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 Japanese man with sarcomatoid malignant pleural mesothelioma, unresectable clinical stage IIIB (T4 N0 M0), treated at the University of Occupational and Environmental Health, Japan (Kitakyushu)
• Exposure: No asbestos or other exposure history was reported. The treatment described was a 3-month course of nivolumab (3 mg/kg every 2 weeks) and ipilimumab (1 mg/kg every 6 weeks), followed by salvage pleurectomy with decortication.
• Main results:
  • After immunotherapy, scans showed a 50% decrease in summed tumor measurement from baseline in this patient.
  • Extended pleurectomy with decortication achieved macroscopic complete resection.
  • Less than 1% of tumor cells in the resected specimen were viable, which the authors called a major pathologic response.
  • Recovery after surgery was uneventful, and the patient was alive without recurrence 5 months after surgery.
• The authors' conclusion: The authors concluded that the case may indicate pleurectomy with decortication is safe and feasible after immunotherapy, and that immunotherapy may produce a dramatic pathologic response in MPM. They said neoadjuvant immunotherapy before surgery for resectable MPM is a promising strategy that should be examined in future clinical trials.

Topics

Medical terms in this study, explained in our Lexicon: Pleurectomy/Decortication (P/D), Immunotherapy, Sarcomatoid, Pleural Mesothelioma, Chemotherapy, Histological Subtype, Nivolumab (Opdivo), Ipilimumab (Yervoy).

Related studies

• Salvage pleurectomy/decortication following immunotherapy for malignant pleural mesothelioma — M. Takenaka, K. Kuroda, et al. (2024)
• Non-incisional pleurectomy/decortication for malignant pleural mesothelioma — F. Tanaka, M. Takenaka, et al. (2021)
• Feasibility of multimodality treatment, including pleurectomy decortication, in carefully selected patients with sarcomatoid mesothelioma — M. Lapidot, E. Mazzola, et al. (2026)
• Non-incisional pleurectomy-decortication for malignant pleural mesothelioma — F. Tanaka, N. Imanishi, et al. (2018)
• Surgical indications for pleurectomy/decortication in pleural mesothelioma based on the newly revised 9th edition of the tumour-node-metastasis classification — M. Kanayama, M. Takenaka, et al. (2024)
• Extended pleurectomy decortication for thymoma with pleural dissemination — N. Imanishi, Y. Nabe, et al. (2019)

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