Sarcomatoid malignant pleural mesothelioma treated with nivolumab: A case series

Our plain-English summary of Sarcomatoid malignant pleural mesothelioma treated with nivolumab: A case series, by K. Hashimoto, H. Ozasa, A. Yoshizawa, et al (Oncology Letters, 2022).

The study

• Authors: K. Hashimoto, H. Ozasa, A. Yoshizawa, H. Yoshida, T. Ogimoto, K. Hosoya, M. Yamazoe, H. Ajimizu, T. Funazo, H. Yoshida, Y. Sakamori, T. Hirai
• Journal: Oncology Letters
• Published: 2022;24(5):402
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Immune checkpoint therapy (ICT) with nivolumab has been widely used to treat malignant pleural mesothelioma (MPM) since clinical trials confirmed its efficacy. However, only a few clinical trials have been conducted for the treatment of sarcomatoid MPM, which is a rare histological type of MPM. Additionally, clinical reports of sarcomatoid MPM are scarce. Therefore, the benefits and risks of nivolumab treatment for sarcomatoid MPM remain unclear. The present report describes the treatment of 3 cases of sarcomatoid MPM (all 3 were men) with nivolumab monotherapy. In all three cases, nivolumab was effective despite variations in the duration of treatment, although side effects were observed in 2 patients. Programmed death ligand 1 (PD-L1) expression was positive in all 3 cases. In particular, the patient with the highest PD-L1 expression had the most rapid response of the 3 patients, and the effect lasted as long as those of the other 2, despite receiving the smallest number of doses of nivolumab. It has been reported that sarcomatoid MPM tends to respond poorly to chemotherapy and express higher levels of PD-L1 than epithelial MPM; thus, ICT may be necessary in these cases. This case series suggests that ICT with nivolumab is a promising treatment option for sarcomatoid MPM.

Copyright: © Hashimoto et al.

In plain English

This case series described three men with sarcomatoid malignant pleural mesothelioma who were treated with nivolumab, an immune checkpoint drug, at Kyoto University Hospital, Japan. Two of the three had a history of known asbestos exposure. The article did not describe the type of asbestos or the jobs involved. Each man first received carboplatin and pemetrexed chemotherapy, which was judged ineffective, and then nivolumab alone. In all three patients the tumor partly responded, with a mean time to response of 58 days. The disease progressed 223, 211 and 202 days after nivolumab began, although the men received different numbers of nivolumab cycles: 12, 9 and 2. The patient whose tumor had the highest PD-L1 level (more than 50%; the other two were 1 to 24%) responded fastest. Two of the three patients had side effects: one developed acute kidney injury and nephrotic syndrome, and the other developed liver dysfunction. The authors noted that three cases from one institution limits their findings. The authors concluded that nivolumab alone may be more effective in sarcomatoid than in epithelial mesothelioma and is a promising treatment option.

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 series (3 cases)
• Who was studied: 3 men with sarcomatoid malignant pleural mesothelioma (one desmoplastic, one sarcomatoid or desmoplastic, one sarcomatoid), aged 73, 66 and 82, treated at Kyoto University Hospital, Japan; dates of treatment not stated
• Exposure: Treatment studied: nivolumab monotherapy as second-line treatment after carboplatin and pemetrexed. Two of the 3 patients had a history of known asbestos exposure; for the third it was listed as uncertain. No fiber type or occupation was given.
• Main results:
  • All 3 patients had a tumor response (partial response) to nivolumab
  • Mean time to response to nivolumab across the 3 patients was 58 days
  • Time to disease progression after starting nivolumab was 223, 211 and 202 days for Cases 1, 2 and 3
  • The 3 patients received 12, 9 and 2 cycles of nivolumab, respectively
  • Case 3 had more than 50% PD-L1 positivity; Cases 1 and 2 had 1 to 24%
  • The patient with the highest PD-L1 expression (Case 3) had the most rapid response
  • 2 of the 3 patients had adverse effects: Case 2 developed acute kidney injury and nephrotic syndrome attributed to immune-related adverse events (2 months after nivolumab ended); Case 3 developed liver dysfunction before the third cycle, and nivolumab was stopped
  • In Case 1, no side effects attributable to nivolumab were seen
• The authors' conclusion: The authors concluded that PD-1 monotherapy may be more effective in treating sarcomatoid than epithelial MPM, and that nivolumab is a promising treatment option.
• Limitations the authors state:
  • Only three cases from a single institution, which the authors say potentially limits the validity of the findings

Topics

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

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• Effectiveness of Nivolumab on Sarcomatoid Malignant Pleural Mesothelioma With Eosinophilia and Eosinophilic Pleural Effusion — M. Yamazoe, H. Ozasa, et al. (2019)
• Safety of First-Line Nivolumab Plus Ipilimumab in Very Old (≥ 80 Years) Patients With Unresectable Malignant Pleural Mesothelioma: A Retrospective Single-Center Case Series — T. Shimamoto, Y. Morimoto, et al. (2024)
• Retreatment With Nivolumab and Ipilimumab in Pleural Mesothelioma Following Disease Progression After a Durable Response: Case Series — I. Smesseim, P. Baas, et al. (2025)
• 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)
• Remarkable response to nivolumab in sarcomatoid malignant pleural mesothelioma with high PD-L1 — K. Tsubouchi, S. Inoue, et al. (2020)

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