Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immunotherapy for the treatment of lung cancer and mesothelioma

Our plain-English summary of Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immunotherapy for the treatment of lung cancer and mesothelioma, by R. Govindan, C. Aggarwal, S.J. Antonia, et al (Journal for Immunotherapy of Cancer, 2022).

The study

• Authors: R. Govindan, C. Aggarwal, S.J. Antonia, M. Davies, S.M. Dubinett, A. Ferris, P.M. Forde, E.B. Garon, S.B. Goldberg, R. Hassan, M.D. Hellmann, F.R. Hirsch, M.L. Johnson, S. Malik, D. Morgensztern, J.W. Neal, J.D. Patel, D.L. Rimm, S. Sagorsky, L.H. Schwartz, B. Sepesi, R.S. Herbst
• Journal: Journal for Immunotherapy of Cancer
• Published: 2022;10(5)
• Type of article: Guideline
• Cited by: 36 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Immunotherapy has transformed lung cancer care in recent years. In addition to providing durable responses and prolonged survival outcomes for a subset of patients with heavily pretreated non-small cell lung cancer (NSCLC), immune checkpoint inhibitors (ICIs)- either as monotherapy or in combination with other ICIs or chemotherapy-have demonstrated benefits in first-line therapy for advanced disease, the neoadjuvant and adjuvant settings, as well as in additional thoracic malignancies such as small-cell lung cancer (SCLC) and mesothelioma. Challenging questions remain, however, on topics including therapy selection, appropriate biomarker-based identification of patients who may derive benefit, the use of immunotherapy in special populations such as people with autoimmune disorders, and toxicity management. Patient and caregiver education and support for quality of life (QOL) is also important to attain maximal benefit with immunotherapy. To provide guidance to the oncology community on these and other important concerns, the Society for Immunotherapy of Cancer (SITC) convened a multidisciplinary panel of experts to develop a clinical practice guideline (CPG). This CPG represents an update to SITC's 2018 publication on immunotherapy for the treatment of NSCLC, and is expanded to include recommendations on SCLC and mesothelioma. The Expert Panel drew on the published literature as well as their clinical experience to develop recommendations for healthcare professionals on these important aspects of immunotherapeutic treatment for lung cancer and mesothelioma, including diagnostic testing, treatment planning, immune-related adverse events, and patient QOL considerations. The evidence- and consensus-based recommendations in this CPG are intended to give guidance to cancer care providers using immunotherapy to treat patients with lung cancer or mesothelioma.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

In plain English

This article is a clinical practice guideline, not a new study. The Society for Immunotherapy of Cancer convened a panel of experts. The panel drew on published research and clinical experience, and voted on recommendations for immunotherapy in lung cancer and mesothelioma. Most of it covers non-small cell and small cell lung cancer, and it does not discuss asbestos. For pleural mesothelioma, the panel summarized trials run by others. In the CheckMate 743 trial of 605 patients with unresectable malignant pleural mesothelioma, median overall survival was 18.1 months (95% CI 16.8 to 21.5) with nivolumab plus ipilimumab versus 14.1 months (95% CI 12.5 to 16.2) with chemotherapy. For patients with non-epithelioid mesothelioma it was 18.1 months (95% CI 12.2 to 22.8) versus 8.8 months (95% CI 7.4 to 10.2). The panel strongly recommended nivolumab plus ipilimumab for non-epithelioid mesothelioma and said it may be considered for the epithelioid subtype. It also advised considering germline BAP1 genetic testing for some patients. The authors stated that no molecular marker of prognosis or treatment response in mesothelioma had been validated for clinical use. The version provided was updated in May 2025.

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: Clinical practice guideline (expert panel consensus based on published literature and clinical experience, with formal voting); not an original study
• Who was studied: The guideline was written by an expert panel and addresses patients in the US setting with non-small cell lung cancer, small cell lung cancer and mesothelioma (mainly pleural mesothelioma) who are being considered for immunotherapy
• Exposure: No asbestos or fiber exposure is studied or mentioned. The guideline concerns cancer treatment with immunotherapy drugs: immune checkpoint inhibitors such as nivolumab, ipilimumab and pembrolizumab, and, for small cell lung cancer, tarlatamab.
• Main results:
  • The guideline cites a background figure from other sources: about 3,000 new mesothelioma cases are diagnosed in the US each year.
  • The guideline reports results from the CheckMate 743 trial (605 patients with unresectable malignant pleural mesothelioma); these are not this article's own data. Median overall survival was significantly higher with nivolumab plus ipilimumab than with chemotherapy: 18.1 months (95% CI 16.8 to 21.5) versus 14.1 months (95% CI 12.5 to 16.2), HR 0.74 (95% CI 0.61 to 0.89).
  • In CheckMate 743, patients with non-epithelioid mesothelioma had a median overall survival of 18.1 months (95% CI 12.2 to 22.8) with ipilimumab and nivolumab versus 8.8 months (95% CI 7.4 to 10.2) with chemotherapy. For epithelioid mesothelioma, survival was similar in the two groups: 18.7 versus 16.5 months.
  • The guideline reports results from the KEYNOTE-483 trial in patients with unresectable, advanced or metastatic malignant pleural mesothelioma. Patients given pembrolizumab with pemetrexed and platinum chemotherapy (n=222) had a median overall survival of 17.3 months, versus 16.1 months for those given chemotherapy alone (n=218), HR 0.79 (95% CI 0.64 to 0.98).
  • Panel recommendation: nivolumab plus ipilimumab is strongly recommended for non-epithelioid subtype mesothelioma. For the epithelioid subtype it may be considered, with treatment decisions made individually.
  • Panel recommendation: germline genetic testing for BAP1 mutation should be considered for patients with mesothelioma. This applies especially to those with a family history of mesothelioma or other BAP1-associated cancers, or those aged under 60.
• The authors' conclusion: The authors concluded that immunotherapy indications for lung cancer and mesothelioma are likely to keep expanding, and that future prospective trials to identify and validate biomarkers of response will be key. The guideline will be updated as the field develops.
• Limitations the authors state:
  • For mesothelioma, no molecular biomarkers of prognosis or treatment response have been validated for clinical use; such markers remain limited to research.
  • Some recommendations rest on expert consensus alone, without a graded level of evidence.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Immunotherapy, Lung Cancer, Mesothelioma, Non-Small Cell Lung Cancer, checkpoint inhibitors, Chemotherapy, First-line Therapy, Biomarker.

Related studies

• Treatment of Malignant Pleural Mesothelioma: American Society of Clinical Oncology Clinical Practice Guideline Summary — H.L. Kindler, N. Ismaila, et al. (2018)
• Malignant pleural mesothelioma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up — P. Baas, D. Fennell, et al. (2015)
• Peritoneal mesothelioma: PSOGI/EURACAN clinical practice guidelines for diagnosis, treatment and follow-up — S. Kusamura, V. Kepenekian, et al. (2021)
• Malignant pleural mesothelioma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up — R.A. Stahel, W. Weder, et al. (2010)
• Factors influencing exercise performance in thoracic cancer — R. England, M. Maddocks, et al. (2012)
• Role of Immunotherapy in Small Cell Lung Cancer, Thymic Epithelial Tumors, and Mesothelioma — C.L. Hann, A. Scherpereel, et al. (2019)

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