An Indian woman in still alive two years after a mesothelioma diagnosis thanks to a remarkable mesothelioma tumor response to nivolumab.
Nivolumab is sold under the brand name Opdivo. It is a type of immunotherapy. Nivolumab is sometimes used for lung cancer that progresses after chemotherapy.
A hospital in Mumbai tried nivolumab on a pleural mesothelioma patient after several types of chemotherapy did not work. Doctors say the mesothelioma tumor response to nivolumab was so great that the patient no longer needed supplemental oxygen.
Opdivo in Mesothelioma Treatment
Opdivo is not FDA-approved for mesothelioma treatment. Only Alimta (pemetrexed) holds that designation. But pleural mesothelioma grows quickly and is hard to treat. Even the gold standard therapies often do not work or stop working after a while.
If that happens, doctors may try investigational medicines or drugs approved for other cancers. Opdivo is an immunotherapy drug. It blocks a protein inside cancer cells called PD-1. PD-1 helps mesothelioma cells evade immune system attack.
Past studies on mesothelioma tumor response to nivolumab have returned mixed results. At least one study suggested that the drug did not work well by itself.
Fortunately for the Indian mesothelioma patient in the new case study, her mesothelioma tumor response to nivolumab was “exceptional”.
Mesothelioma Recurs After Chemotherapy
The new case study appears in the most recent issue of the South Asian Journal of Cancer. It focuses on a 41-year-old woman with pleural mesothelioma. The woman did not smoke, did not have other health problems, and had no family history of cancer.
She came to her doctor with back pain. Imaging tests showed she had pleural mesothelioma that had spread to some of her bones.
Doctors tried four different chemotherapy combinations before her mesothelioma tumor response to nivolumab.
The patient had two cycles of chemotherapy with carboplatin and paclitaxel. When that did not work, she underwent three cycles of treatment with pemetrexed (Alimta), carboplatin and bevacizumab. Her mesothelioma tumor continued to grow.
Three cycles of topotecan and three cycles of vinorelbine did not make a difference either. The patient continued to deteriorate. She ended up in the hospital on continuous supplemental oxygen.
Taking a Chance on Mesothelioma Tumor Response to Nivolumab
In desperation, the woman’s family pushed her doctors to try immunotherapy. Because she was so sick, the hospital agreed to try it, even though the clinical data is limited.
Within weeks, doctors called her mesothelioma tumor response to nivolumab “exceptional”. A CT scan showed that the tumor was shrinking.
“Her performance status improved to ECOG performance status 1 and her requirements ofsupplemental oxygen therapy drastically reduced with subsequent cycles,” reports Dr. Vikas Talreja.
After three cycles of Opdivo, the woman no longer needed any supplemental oxygen. She also did not have any major side effects.
“At the time of this writing, she remains active and disease controlled more than 24 months after malignant disease was diagnosed,” her doctors report.
Other studies of mesothelioma tumor response to nivolumab are ongoing. At Baylor College of Medicine, scientists are combining it with a modified virus in people with recurrent mesothelioma.
Talreja, VT, et al, “An exceptional response to nivolumab in relapsed and refractory malignant mesothelioma”, July-Sept 2019, South Asian Journal of Cancer, http://journal.sajc.org/temp/SouthAsianJCancer83159-4023409_111034.pdf