A just-released study conducted in the Netherlands provides a mixed assessment of the use of nivolumab-ipilimumab immunotherapy in patients with malignant pleural mesothelioma. While researchers found that the real-world efficacy of the combination was comparable to what was reported in a phase 3 study, they also reported that toxicities – particularly among elderly patients – forced some to discontinue the protocol.
Netherlands Mesothelioma Researchers Investigate Real-World Impact of Immunotherapy
In a report published in the journal Lung Cancer this week, researchers from the Erasmus Medical Center Cancer Institute, University Medical Center in Rotterdam, the Netherlands, and the Netherlands Cancer Institute in Amsterdam, the Netherlands noted that median survival of mesothelioma patients with no treatment ranges between six and nine months, that the addition of platinum and pemetrexed adds another three months, and adding bevacizumab added another three months.
They describe the results of a phase 3 trial in which mesothelioma patients were provided a combination of nivolumab and ipilimumab instead of the chemotherapy combination. The use of the immunotherapy drugs raised overall survival from 14.1 months to 18.1 months, but 30% percent of those in the trial suffered grade 3 (26%) or 4 (4%) adverse events, and 23% of participants discontinued at least one treatment component. These findings led to both the Food and Drug Administration and European Medicines Agency approving the combination as a first-line treatment for patients with unresectable mesothelioma.
Report Follows Real-World Mesothelioma Patients
The researchers reported on 184 mesothelioma patients treated at their cancer centers between January 2021 and August 2022, following this approval of the combination. Participants’ tumors were evaluated using CT scans every 12 weeks and adverse events were assessed continuously throughout the treatment with a primary goal of investigating safety in terms of adverse events and a secondary goal of describing the drugs’ impact.
Their findings echoed that of the phase 3 Checkmate-743 mesothelioma trial in terms of treatment-related adverse events and the number of patients who dropped out of treatment, with no new safety issues reported. Progression-free survival was somewhat lower than that found in the trial, which they believe is due to the difference between patients in clinical trials and real-world patients, who had higher factors known to be negatively associated with outcomes. The researchers concluded that clinicians should prescribe the nivolumab-ipilimumab combination with caution.
If you or someone you love has been diagnosed with malignant mesothelioma, research like this provides invaluable information to guide your treatment decisions. For access to additional resources, contact the Patient Advocates at Mesothelioma.net today at 1-800-692-8608.
