Tislelizumab combined with anlotinib in the second-line treatment of malignant pleural mesothelioma

Our plain-English summary of Tislelizumab combined with anlotinib in the second-line treatment of malignant pleural mesothelioma, by D. Zhang, J. Liang, Y. Lv, et al (Medicine, 2022).

The study

• Authors: D. Zhang, J. Liang, Y. Lv, X. Huang, W. Guo
• Journal: Medicine
• Published: 2022;101(52):e32459
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Rationale: Malignant pleural mesothelioma (MPM) is a malevolent tumor originated from pleura and often leads to poor prognosis. Chemotherapy of pemetrexed and cisplatin combined with antiangiogenic therapy of bevacizumab is recommended as the first-line regimen by guidelines. However, there are few sustainable second-line anti-tumor theraies that bring distinct survival benefit after the occurrence of drug resistance as the reported mPFS (median progression-free survival) scarcely exceeds 6 months. Immune checkpoint inhibitors are extensively investigated in pan-cancer, and dual immunotherapy has been listed in the first-line recommendation of MPM in several guidelines, while MPM patients benefit modestly from immune checkpoint inhibitors combination or monotherapy in second-line practice.

Patient Concerns And Diagnosis: We report a 59-year-old male patient who was diagnosed with unresectable MPM in April 2021.

Interventions: He received firstly pemetrexed combined with platinum and bevacizumab, which barely curbed disease progression; When the first line treatment failed, he was switched to tislelizumab combined with anlotinib.

Outcomes: Tislelizumab combined with anlotinib significantly relieved his clinical symptoms, and imaging examination further validated the improvement. Until present, the second-line treatment PFS is more than 10 months.

Lessons: The case firstly demonstrated the efficacy of tislelizumab combined with anlotinib in the second-line management of MPM. Thus, immunotherapy combined with small-molecule multi-target anti-angiogenic medication may be alternative for the second-line schemes of MPM.

Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

In plain English

This case report from Zhongshan City People's Hospital in China described one patient. He was a 59-year-old man who worked for a professional construction company and was diagnosed in April 2021 with malignant pleural mesothelioma of the epithelioid subtype, stage IIIB, judged unsuitable for surgery. The article did not say whether he had been exposed to asbestos. First-line treatment was pemetrexed, nedaplatin and bevacizumab for 6 courses, then pemetrexed plus bevacizumab for 2 cycles. During this time the tumors grew, faster from 6 months, his pain worsened, and he needed repeated red blood cell transfusions for anemia. His tumor tested negative for PD-L1. Second-line treatment combined tislelizumab, an immune checkpoint (PD-1) inhibitor, with anlotinib, a drug that blocks tumor blood vessel growth. After about 2 cycles his chest pain eased and his anemia improved without transfusions. After 4 cycles, CT showed that many pleural nodules and masses had shrunk. Remission was maintained over 10 months of treatment. The authors concluded this combination may be an alternative second-line treatment. A single case shows what happened to one patient, not how often a treatment works.

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 (one patient)
• Who was studied: One 59-year-old male employee of a professional construction company, treated at Zhongshan City People's Hospital, China. He was diagnosed with malignant pleural mesothelioma, epithelioid subtype, in April 2021, staged T4N0M0, stage IIIB, with no indication for surgery.
• Exposure: The article reports no asbestos exposure history for this patient; only his job (construction company employee) is given. What was studied is treatment: second-line tislelizumab (PD-1 inhibitor) 200 mg on day one plus anlotinib 10 mg daily for 2 weeks with 1 week off, in 21-day cycles.
• Main results:
  • First-line treatment was 860 mg pemetrexed disodium, 130 mg nedaplatin and 500 mg bevacizumab on day one of every 21 days for 6 courses, followed by pemetrexed plus bevacizumab for 2 cycles.
  • During first-line treatment the lesions progressed slowly, then faster at 6 months.
  • During first-line treatment the patient had repeated anemia requiring several red blood cell transfusions.
  • The patient's tumor was negative for PD-L1 expression.
  • After about 2 cycles of second-line treatment, the patient's anemia improved and blood transfusions were no longer needed.
  • After 4 cycles of second-line treatment, CT showed that many nodules and masses in the left pleura had shrunk.
  • Second-line treatment was continued for a total of 10 months, and the patient's remission was maintained.
• The authors' conclusion: The authors concluded that the case demonstrated the efficacy of tislelizumab with anlotinib as second-line treatment of malignant pleural mesothelioma, and that immunotherapy combined with small-molecule multi-target anti-angiogenic therapy may be an alternative second-line treatment.

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: Pleural Mesothelioma, Pleura, Prognosis, Chemotherapy, Pemetrexed (Alimta), Cisplatin, Bevacizumab, Progression-Free Survival.

Related studies

• NIPU: a randomised, open-label, phase II study evaluating nivolumab and ipilimumab combined with UV1 vaccination as second line treatment in patients with malignant mesothelioma — V.D. Haakensen, A.K. Nowak, et al. (2021)
• Gemcitabine and vinorelbine as second-line or beyond treatment in patients with malignant pleural mesothelioma pretreated with platinum plus pemetrexed chemotherapy — G. Toyokawa, M. Takenoyama, et al. (2014)
• Efficacy of second-line treatment and prognostic factors in patients with advanced malignant peritoneal mesothelioma: a retrospective study — R. Kitadai, T. Shimoi, et al. (2021)
• Integration of the PD-L1 inhibitor atezolizumab and WT1/DC vaccination into standard-of-care first-line treatment for patients with epithelioid malignant pleural mesothelioma-Protocol of the Immuno-MESODEC study — J. Van den Bossche, M. De Laere, et al. (2024)
• Gemcitabine with or without ramucirumab as second-line treatment for malignant pleural mesothelioma (RAMES): a randomised, double-blind, placebo-controlled, phase 2 trial — C. Pinto, P.A. Zucali, et al. (2021)
• Case Report: Tislelizumab combined with bevacizumab in the treatment of primary malignant pericardial mesothelioma — Z. Liu, Y. Yan, et al. (2026)

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