Zimberelimab plus chemotherapy as the first-line treatment of malignant peritoneal mesothelioma: A case report and review of literature

Our plain-English summary of Zimberelimab plus chemotherapy as the first-line treatment of malignant peritoneal mesothelioma: A case report and review of literature, by X.D. Peng, Z.Y. You, L.X. He, et al (World Journal of Clinical Cases, 2023).

The study

• Authors: X.D. Peng, Z.Y. You, L.X. He, Q. Deng
• Journal: World Journal of Clinical Cases
• Published: 2023;11(22):5296-5302
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Malignant peritoneal mesothelioma (MPeM) is a rare cancer with a poor prognosis at advanced stage, and the standard first-line treatment for inoperable patients is chemotherapy. Although combining programmed cell death 1 (PD-1) inhibitors with chemotherapy is generally considered safe and effective in several malignant solid tumors, there are few reports regarding initial immunochemotherapy in advanced MPeM.

Case Summary: Here, to our knowledge, we present the first case of a patient with epithelioid subtype MPeM, who was treatment-naïve and benefited from initial PD-1 inhibitor plus standard chemotherapy with a prolonged progression-free survival (PFS) and good tolerance. A 49-year-old man was admitted to our hospital for a persistent burning sensation in the abdomen. Computed tomography revealed a solid mass in the lower abdomen, which was subsequently diagnosed histologically as epithelioid subtype MPeM by core needle biopsy. The patient received eight cycles of pemetrexed 800 mg (day 1), cisplatin 60/50 mg (day 1-2), and zimberelimab (PD-1 inhibitor) 240 mg (day 1) every 3 wk. He achieved significant reduction of peritoneal tumors with remarkable improvement in symptoms. The best tumor response was partial remission with a final PFS of 7 mo. No immune-related adverse event occurred during the combination treatment.

Conclusion: The outcome of the present case demonstrates the promising anti-tumor activity of immunochemotherapy to treat inoperable MPeM in the future.

©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.

In plain English

This article reported a single patient and discussed earlier published studies. A 49-year-old man was referred to a hospital in Nanchang, China, in December 2021 with an abdominal mass and a 10 kg weight loss. A core needle biopsy showed stage III malignant peritoneal mesothelioma (cancer of the abdominal lining), epithelioid subtype, too advanced for surgery. The article does not mention asbestos. From January 2022 he received pemetrexed and cisplatin chemotherapy plus zimberelimab, an immunotherapy drug (a PD-1 inhibitor), every 3 weeks. Cisplatin was reduced from the fifth cycle after a rise in serum creatinine, a kidney blood test. By April 2022 the largest tumor had shrunk from 8.9 cm × 5.2 cm to 4.1 cm × 4.0 cm, rated a partial response. Scans in July 2022 showed growth and a new mass. In September 2022 his disease was judged progressive, giving a progression-free survival of 7 months. He had no significant immune-related side effect and was later lost to follow-up. The authors concluded that the combination achieved anti-tumor activity in this case. They noted that PD-L1 expression was not tested and called for a prospective clinical trial.

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) with a discussion of previously published studies
• Who was studied: One 49-year-old man referred to The First Affiliated Hospital of Nanchang University, China, in December 2021. He had a history of untreated hepatitis B. He was diagnosed by core needle biopsy with stage III (cT3N0M1) malignant peritoneal mesothelioma, epithelioid subtype.
• Exposure: No asbestos or occupational exposure is reported. The exposure studied was a treatment: pemetrexed 800 mg (day 1), cisplatin 60 mg (days 1 to 2) and zimberelimab 240 mg (day 1) every 3 weeks. Cisplatin was reduced to 50 mg from the fifth cycle onward.
• Main results:
  • In this patient, after five treatment cycles (April 2022), the largest lesion shrank from 8.9 cm × 5.2 cm to 4.1 cm × 4.0 cm. This was evaluated as a partial response.
  • In this patient, the tumor marker CA125 fell from 64.1 U/mL to 15.1 U/mL over the same period.
  • In July 2022 the target lesion grew to 4.4 cm × 4.0 cm and a new solid mass appeared in the pelvis (vesicorectal fossa).
  • At the last follow-up in September 2022 the patient had progressive disease, with a progression-free survival of 7 months.
  • Serum creatinine rose moderately to 116.6 μmol/L (normal range in men 53 to 106 μmol/L), which the authors attributed to the chemotherapy drugs.
  • The patient had no significant immune-related adverse event.
• The authors' conclusion: The authors concluded that, in this case of inoperable peritoneal mesothelioma, initial PD-1 inhibitor plus chemotherapy achieved anti-tumor activity and could be considered for personalized therapy. They recommended a well-designed prospective clinical trial.
• Limitations the authors state:
  • PD-L1 expression in the tumor was not tested, because current guidelines do not routinely recommend it.

Topics

Medical terms in this study, explained in our Lexicon: Chemotherapy, Peritoneal Mesothelioma, Prognosis, Epithelioid, Progression-Free Survival, Needle Biopsy, Pemetrexed (Alimta), Cisplatin.

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