Drug Reation May Predict Mesothelioma Immunotherapy Results

Patients who have more serious reactions to the drug nivolumab tend to have better mesothelioma immunotherapy results than those who have little or no reaction. 

That is the finding of a new study from Japan’s Tokushima University. 

Researchers studied the cases of 11 patients treated with nivolumab between 2009 and 2021. They found that the patients who got the sickest from the drug had the best mesothelioma immunotherapy results. 

The study’s authors say it’s even more reason to find ways to manage immunotherapy side effects. If patients can work through their worst reactions, more of them might survive mesothelioma. 

Nivolumab in Mesothelioma Treatment

Nivolumab is an immune checkpoint inhibitor sold under the brand name Opdivo. It is a type of immunotherapy. It works by making cancer cells more vulnerable to attack. Nivolumab blocks a protective protein called PD-L1. Research suggests that 3 out of 4 mesothelioma tumors express extra PD-L1. 

Mesothelioma immunotherapy results with nivolumab have been mixed. Some people do not have much of a response. But the people who do respond, tend to respond in a big way. A 2020 Dutch study of nivolumab produced “exceptional survival rates” among the most responsive mesothelioma patients.

Last year, the FDA approved a combination of nivolumab and the drug Yervoy as an alternative treatment for pleural mesothelioma. Before that, Alimta (pemetrexed) was the only drug approved to treat mesothelioma. 

Unfortunately, positive mesothelioma immunotherapy results often come with negative side effects. 

The Cost of Positive Mesothelioma Immunotherapy Results

The patients who have the strongest response to nivolumab tend to be those with the highest PD-L1 levels. A 2020 Japanese study found a 40 percent response rate among mesothelioma patients with elevated PD-L1. Only 8 percent of the patients with normal PD-L1 had positive mesothelioma immunotherapy results with nivolumab. 

But those good response rates may come at a price. The new Japanese study found that 72 percent of treated patients had side effects on nivolumab. More than half of patients (54%) had serious side effects. 

Side effects of Opdivo can range from fatigue and muscle pain to nausea, vomiting, low white blood cell counts, pneumonia, and irregular heartbeat. 

In the new nivolumab study, the six patients who had the most serious reactions also had the best outcomes. People in this group had a median progression-free survival of 13.6 months. That compares to just 3.8 months among the least reactive patients. 

This is the first study to show a link between immune-related adverse events [irAEs] and mesothelioma immunotherapy results. The research team concludes, “Because the presence of irAEs may be associated with a favorable clinical outcome, early detection and appropriate management of irAEs will increase the therapeutic benefits to patients.”

Source:

Yoneda, H, et al, “Correlation between immune-related adverse events and therapeutic effects of nivolumab in patients with malignant pleural mesothelioma”, November 15, 2021, BMC Pulmonary Medicine, Open Access, https://bmcpulmmed.biomedcentral.com/articles/10.1186/s12890-021-01746-6