Study design

A retrospective, single-center, case series

Introduction

Malignant pleural mesothelioma (MPM) is a rare and aggressive neoplasm with poor prognosis. The combined cisplatin/pemetrexed regimen is the only regimen currently approved by the FDA. Immunotherapy with checkpoint inhibitors and other therapeutics are quickly becoming the preferred second-line therapy following incorporation into clinical practice guidelines in 2018 as a salvage therapy.

Purpose

of the study: To describe the use of PD-1/PD-L1 targeted therapy to manage MPM.

Methods

Retrospective chart review of patients with MPM treated at a single institution with pembrolizumab or nivolumab was performed. Clinical and pathologic information were extracted and clinical response rate and other outcomes were assessed.

Results

Twelve patients received pembrolizumab, and two patients received nivolumab. Patients were 43% male (6 out of 14), 64% non-Hispanic white (9 out of 14), and 93% epithelioid histological subtype (13 out of 14). Prior to immunotherapy, 36% had received surgical resection (5 out of 14), 36% had received radiotherapy (5 out of 14), and 93% received platinum-pemetrexed based chemotherapy (13 out of 14). Objective response rate was 21% (0 CR and 3 PRs), and disease control rate was 43% (3 PRs and 3 SDs). Time to progression ranged from <1 month to 19 months.

Conclusion

Based on this small series, real-world PD-1/PD-L1 targeted therapy appears to be a promising treatment for patients with MPM who have disease progression on systemic chemotherapy, consistent with small single arm clinical trials. Further investigation with multicenter, prospective longitudinal cohorts and/or randomized clinical trials may help identify which patients have the largest magnitude of benefit.

中文翻译：

---

恶性胸膜间皮瘤的 PD-1/PD-L1 检查点抑制剂免疫疗法：病例系列和文献综述。

学习规划

回顾性、单中心、病例系列

介绍

恶性胸膜间皮瘤（MPM）是一种罕见的侵袭性肿瘤，预后不良。顺铂/培美曲塞联合方案是目前 FDA 批准的唯一方案。检查点抑制剂和其他疗法的免疫疗法在 2018 年作为补救疗法纳入临床实践指南后，正迅速成为首选的二线疗法。

目的

研究内容：描述使用 PD-1/PD-L1 靶向治疗来管理 MPM。

方法

对在单一机构接受帕博利珠单抗或纳武单抗治疗的 MPM 患者进行回顾性图表审查。提取临床和病理信息并评估临床反应率和其他结果。

结果

12 名患者接受了 pembrolizumab，2 名患者接受了 nivolumab。患者为 43% 的男性（14 名中的 6 名）、64% 的非西班牙裔白人（14 名中的 9 名）和 93% 的上皮样组织学亚型（14 名中的 13 名）。在免疫治疗之前，36% 的人接受了手术切除（14 人中的 5 人），36% 接受了放疗（14 人中的 5 人），93% 接受了基于铂类培美曲塞的化疗（14 人中的 13 人）。客观缓解率为 21%（0 CR 和 3 PR），疾病控制率为 43%（3 PR 和 3 SD）。进展时间从 <1 个月到 19 个月不等。

结论

基于这个小系列，真实世界的 PD-1/PD-L1 靶向治疗似乎是一种有希望的治疗方法，用于全身化疗后疾病进展的 MPM 患者，与小型单臂临床试验一致。多中心、前瞻性纵向队列和/或随机临床试验的进一步调查可能有助于确定哪些患者具有最大的获益。