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Immune Checkpoint Inhibitor Safe Both Before and After Mesothelioma Surgery

immune checkpoint inhibitorA report presented to an international gathering of lung cancer doctors shows an immune checkpoint inhibitor can make pre-surgery chemotherapy more effective for pleural mesothelioma patients. 

The report was presented at the International Association for the Study of Lung Cancer 2021 World Conference on Lung Cancer. The week-long virtual conference ended yesterday. 

Dr. Anne Tsao of the University of Texas MD Anderson Cancer Center presented her study results. They show that mesothelioma patients may benefit from an immune checkpoint inhibitor as part of neoadjuvant chemotherapy. The same drug may also be helpful as a maintenance therapy after surgery.

How Does an Immune Checkpoint Inhibitor Work?

Immune checkpoint inhibitors are a form of immunotherapy. Immunotherapy treatments work by manipulating the immune system to help fight a patient’s cancer. 

Pleural mesothelioma is a virulent cancer with a poor prognosis. It starts on the pleural membrane that surrounds the lungs. One of the reasons mesothelioma tumors can grow out of control is their ability to trick the immune system. 

Malignant mesothelioma cells produce a protein called PD-1 that helps deflect cancer-killing cells. An immune checkpoint inhibitor blocks that protein so it cannot deliver it’s protective message. 

This allows the immune system to help fight the cancer. It also means that other treatments like chemotherapy and radiotherapy may be more damaging to the cancer cells. 

Immune checkpoint inhibitors like Keytruda (pembrolizumab), Opdivo (nivolumab),  and Tencentriq (atezolizumab) are changing the outlook for people with mesothelioma and other types of lung cancer. 

Tencentriq and Chemotherapy Before Surgery

Dr. Tsao’s study enrolled pleural mesothelioma surgery candidates between November 2017 and May 2020. Twenty-four patients were planned for P/D (pleurectomy with decortication) surgery. Four patients were scheduled to have EPP (extrapleural pneumonectomy).

Patients received at least two cycles of standard mesothelioma chemotherapy along with the immune checkpoint inhibitor Tencentriq. If their mesothelioma did not progress on this protocol they went on to have surgery. 

Eighteen patients ended up having mesothelioma surgery. Fifteen of them then started taking Tencentriq as a maintenance drug to keep cancer at bay. 

Only a handful of the patients who got the immune checkpoint inhibitor prior to surgery had serious side effects. Most side effects were mild. For the patients on maintenance Tencentriq, none had a serious complication. 

It is too early to know if the treatment improved overall survival. But the median progression-free survival was 18.6 months. That is already better than the average for pleural mesothelioma patients which is less than a year.

“This trial highlights the challenging nature of neoadjuvant therapy trials in this patient population,” Dr. Tsao told the assembly. “We need to conduct more research with window-of-opportunity studies to identify biomarkers predictive of benefits to these different treatments we give our patients.”

Other studies are underway to try to find predictive biomarkers for immune checkpoint inhibitor treatment of mesothelioma patients. 


OA13: Topics of Pleural Mesothelioma, Presented by Anne Tsao, MD, International Association for the Study of Lung Cancer 2021 World Conference on Lung Cancer presentation, September 8 – 14, 2021, https://www.iaslc.org/WCLC21-News?utm_source=wclc2021.iaslc.org%20&utm_medium=event-site&utm_campaign=IASLC-2021-Landing-Pag%20e-carousel-slide&utm_content=button


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