Unprecedented long-term survival in a patient with malignant pleural mesothelioma treated with subsequent systemic chemo- and immunotherapeutic regimens

Our plain-English summary of Unprecedented long-term survival in a patient with malignant pleural mesothelioma treated with subsequent systemic chemo- and immunotherapeutic regimens, by L. Cerbone, S. Delfanti, A.M. De Angelis, et al (Thoracic Cancer, 2023).

The study

• Authors: L. Cerbone, S. Delfanti, A.M. De Angelis, S. Crivellari, F. Boccuzzi, A. Cimorelli, M. Bertolotti, L. Righi, P. Bertino, F. Grosso
• Journal: Thoracic Cancer
• Published: 2023;14(5):524-527
• Type of article: Case report
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Pleural mesothelioma is a rare disease with a dismal prognosis and few therapeutic options. Until recently the median overall survival for a pleural mesothelioma patient was up to 2 years, with few exceptional cases of patients achieving a longer survival. Here, we report the clinical case of a patient whose survival spanned over 10 years. The patient underwent several systemic treatments, including three different chemotherapy lines (cisplatin-pemetrexed, vinorelbine and platinum rechallenge) and two immunotherapy regimens using immune checkpoint inhibitors (anti CTLA-4 tremelimumab and anti PD-1 nivolumab). At the time this report was written, the patient was off-treatment, asymptomatic and with a stable radiological disease. Our case demonstrates that a prolonged survival with a preserved quality of life may be reached in selected patients through the exploitation of the available treatments in an expertise setting.

© 2023 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd.

In plain English

This case report described one man in Italy with malignant pleural mesothelioma, a cancer of the lining of the chest and lungs. The authors reported that he survived more than 10 years. In 2012, at age 59 and after years of recurrent pleuritis (inflammation of the chest lining), he was diagnosed with epithelioid diffuse pleural mesothelioma of the adenomatoid variant, graded low. He was a non-smoking general practitioner with no known history of asbestos exposure, and his disease could not be removed by surgery. He received these treatments in turn:

• cisplatin plus pemetrexed, with a partial response
• tremelimumab in a clinical trial, with fast shrinkage of the lesions, stopped after a severe hemorrhagic colitis
• vinorelbine, with stable disease
• carboplatin plus pemetrexed, after which the disease stayed stable for 16 months
• 27 courses of nivolumab between January 2020 and April 2021, with substantial reduction of the pleural lesion

Scans in March 2022 confirmed stable disease, and he was without symptoms and in good condition. The authors concluded that prolonged survival with preserved quality of life may be reached in selected patients by using the available treatments in an expert setting. As a report on one patient, it does not show how often such survival occurs.

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 59-year-old man in Italy, a non-smoking general practitioner, diagnosed in 2012 with epithelioid diffuse pleural mesothelioma (adenomatoid variant) after recurrent pleuritis from 2004 to 2012; managed at three Italian referral centers
• Exposure: No known history of asbestos exposure was reported for this patient; the report concerns the sequence of chemotherapy and immunotherapy treatments he received
• Main results:
  • Tissue examination showed epithelioid diffuse pleural mesothelioma, the adenomatoid variant, graded low; the disease could not be removed surgically
  • First-line cisplatin plus pemetrexed was stopped after the fifth course because of a deep venous thrombosis but produced a partial response
  • In a clinical trial, four monthly cycles of tremelimumab 10 mg/kg gave fast shrinkage of the lesions; treatment was stopped after a grade 4 hemorrhagic colitis at the fourth cycle
  • Six courses of vinorelbine gave stable disease as the best response
  • A rechallenge with six courses of carboplatin plus pemetrexed achieved disease stabilization lasting 16 months
  • Nivolumab for 27 courses between January 2020 and April 2021 was followed by substantial volumetric reduction of the pleural lesion and then stable disease
  • At CT and PET scans in March 2022 the disease was stable; the patient was asymptomatic, in good clinical condition, performance status ECOG 0, with survival exceeding 10 years
• The authors' conclusion: The authors concluded that a prolonged survival with preserved quality of life may be reached in selected patients by using the available treatments in an expert setting, and stated that, to their knowledge, no similar cases had been reported
• Limitations the authors state:
  • Because the case was diagnosed in 2012, no additional tissue markers were available, and weak antigenicity of the tissue prevented further staining
  • The authors noted that the tumor's histology can be counted among favorable prognostic factors

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, Prognosis, Median Overall Survival, Chemotherapy, Cisplatin, Pemetrexed (Alimta), Vinorelbine, Immunotherapy.

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