Malignant mesothelioma is a rare and deadly form of cancer most frequently diagnosed decades after its victims are exposed to asbestos. The long latency means that the median age at diagnosis is 76 years old. Though immunotherapy treatment of nivolumab plus ipilimumab has provided superior survival outcomes as a first-line treatment for the disease, Japanese researchers recently reported that it may not be the best answer for extremely elderly patients.
Effective Mesothelioma Treatment May Not Be Safe for Patients Over 80 Years Old
The quest for an effective treatment for malignant pleural mesothelioma has gotten a significant boost with the introduction of immunotherapy drugs, with the CheckMate 743 trial showing that first-line nivolumab plus ipilimumab provided superior overall survival compared to the traditional chemotherapy treatment of cisplatin plus pemetrexed.
Realizing that the efficacy and safety of this protocol had not been fully tested for mesothelioma patients over the age of 80, researchers from the Department of Pulmonary Medicine at Kyoto Kuramuguchi Medical Center in Kyoto, Japan report on three cases of very old patients treated with the combination of drugs. They found that all three suffered adverse events severe enough to force them to discontinue the treatment, and overall survival for the three was 2.5, 3.5, and 4.0 months.
Three Elderly Mesothelioma Patients Treated with Nivolumab Plus Ipilimumab Suffered Adverse Events
The three mesothelioma patients profiled in the Kyoto study all discontinued the combination therapy due to adverse events, with two stopping due to pneumonitis and the third due to grade 5 aspiration. Their median progression-free survival and overall survival were significantly shorter than what was reported in the CheckMate 743 study, which only looked at patients aged 80 or younger.
The researchers conclude that because only 30% of patients are eligible for trials, and those who are ineligible who then receive the treatment have poorer overall survival, it is important to use caution when considering nivolumab plus ipilimumab for the treatment of very old patients with malignant pleural mesothelioma, and urges the scientific community to conduct large-scale clinical studies to evaluate its use in those over the age of 80.
If you or someone you love has been diagnosed with malignant mesothelioma, the Patient Advocates at Mesothelioma.net can help. Contact us today at 1-800-692-8608.
