A groundbreaking mesothelioma study conducted by researchers at Johns Hopkins Kimmel Cancer Center reports that using combination immunotherapy before and after surgery is feasible and safe for patients with operable tumors. More importantly, this first clinical trial to test perioperative immune checkpoint blockade in the rare asbestos-related cancer yielded promising survival results.
Combination Immunotherapy Delivers 28.6-Month Median Survival for Mesothelioma
The phase 2 mesothelioma trial, published September 8 in Nature Medicine, tested using immunotherapy in a new way: preoperative nivolumab administered alone or combined with ipilimumab, followed by surgery and postoperative nivolumab. Over 80% of patients with the deadly form of cancer successfully underwent surgery within the preplanned window after receiving neoadjuvant immunotherapy. Side effects from the treatment were shown to be manageable, showing the protocol’s safety.
Mesothelioma patients treated with the combination regimen (nivolumab and ipilimumab) lived a median of 28.6 months, with nearly 36% still alive and recurrence-free at follow-up. This dramatically exceeds the 18-month average survival for mesothelioma. According to senior author Dr. Valsamo “Elsa” Anagnostou, the Alex Grass Professor of Oncology and co-director of the upper aerodigestive cancers program at Johns Hopkins, “This is the first published clinical trial to show that perioperative combination immune checkpoint blockade is not only feasible but potentially beneficial in resectable mesothelioma.”
Mesothelioma Study Used Innovative Liquid Biopsy
There have been very few treatment improvements for mesothelioma. While immunotherapy has been added to care for patients whose tumors are deemed inoperable, its value in managing operable mesothelioma had been unknown until this study. The researchers made use of an innovative whole-genome sequencing liquid biopsy that identified the presence of circulating tumor DNA. This was the first time this method has been used in operable mesothelioma. “Imaging doesn’t always capture what’s happening with mesothelioma, especially during treatment,” Dr. Anagnostou explained. “By using an ultra-sensitive genome-wide ctDNA sequencing method, we were able to detect microscopic signs of cancer that imaging missed and predict which patients were most likely to benefit from treatment or experience relapse.”
Mesothelioma patients with undetectable ctDNA levels after neoadjuvant immunotherapy and before surgery, or who showed 95% or greater ctDNA drops during treatment, experienced significantly longer event-free and overall survival, while those with persistent ctDNA suffered early disease progression, even when imaging results appeared stable. “This adds a new level of precision to treatment decision-making,” said Dr. Julie Brahmer, co-director of the upper aerodigestive cancers program. “It helps distinguish patients who may need additional therapy from those who do not.”
This innovative immunotherapy approach offers real hope for patients diagnosed with unresectable pleural mesothelioma. For more information on resources available to you, contact the Patient Advocates at Mesothelioma.net today at 1-800-692-8608.
