Author of

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  P22 - Mesothelioma, Thymoma and Other Thoracic Malignancies - Case Reports (ID 136)

  • Event: WCLC 2020
  • Type: Posters
  • Track: Mesothelioma, Thymoma and Other Thoracic Malignancies
  • Presentations: 1
  • Moderators:
  • Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall

  • 35250

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    P22.07 - Nivolumab Immunotherapy as a Promising Therapy in Relapsed Malignant Pleural Mesothelioma (ID 3053)

    00:00 - 00:00  |  Presenting Author(s): Sara Costa-Martins
    • Abstract
    • Presentation
    • Slides

    Introduction
    

    There is no recommended therapy for malignant pleural mesothelioma (MPM) that has progressed after first-line pemetrexed and platinum-based chemotherapy. Disease control has been less than 30% in all previous studies of second-line drugs.

    More recently, preliminary results from clinical trials have suggested a potential role of anti-programmed cell death 1 (PD-1) monoclonal antibody in future therapeutic options, but so far, there are still no approved second-line therapies for this aggressive tumour.

    Methods
    

    Herein, we present a patient with MPM who experienced rapid disease progression after standard therapy but who had an exceptional and sustained response to immune checkpoint inhibition with single agent nivolumab.

    Results
    

    A 62-year-old man, active smoker with a past history of prolonged occupational exposure to asbestos, has an incidental identification of unilateral exudative pleural effusion associated with massive thickening of the costodiaphragmatic pleura. The conducted study confirmed the diagnosis of an unresectable malignant epithelioid pleural mesothelioma. The patient was initially submitted to pleural decortication by uniportal VATS and first-line chemotherapy with pemetrexed and carboplatin, which was suspended after six treatment cycles due to disease progression with worsening of the performance status (ECOG 2) and development of left posterolateral thoracic mass, painful on palpation and needing antalgic radiation therapy. Imaging studies also reported dimensional lesion increase and invasion of the chest wall.

    In this context, immunotherapy anti-programmed cell death 1 (PD-1) monoclonal antibody was administered as an off-label rescue strategy, with single agent intravenous nivolumab 3mg/Kg, every two weeks. Initial outpatient reassessments were performed on a 14 day schedule. It was possible to witness a progressive improvement in symptoms and weight recovery; after seven weeks the chest-computed tomography showed complete remission of the neoplastic lesion.

    The patient has been maintained on 3 mg/kg nivolumab infusions every two weeks, with an excellent sustained therapeutic response and significant improvement in quality of life, without unacceptable pharmacological toxicity, maintaining the benefits that came from immunotherapy throughout subsequent evaluations and well more than 24 months after malignant disease was diagnosed.

    Conclusion
    

    This clinical case reveals the progressive character of malignant mesothelioma despite current standard therapeutic options and emphasizes the promising role of nivolumab in the treatment of recurrent malignant epithelioid pleural mesothelioma, where therapeutic alternatives have remained elusive in recent years.

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