A real-world study of Dutch patients suggests that nivolumab for mesothelioma can dramatically extend survival in the right patients.
Nivolumab is sold under the brand name Opdivo. It is a type of immunotherapy. It works by making cancer cells more vulnerable to attack. The FDA approved nivolumab to treat non-small cell lung cancer and some other cancers.
It is still in the testing phase for malignant mesothelioma. The new report suggests that careful patient selection is the key to making nivolumab for mesothelioma work.
Why Nivolumab for Mesothelioma?
Malignant mesothelioma is an aggressive cancer caused by past exposure to asbestos. Like other types of cancer, it has ways of protecting itself from immune system attack. A protein called PD-L1 is one of those ways.
Nivolumab for mesothelioma works by blocking PD-L1. Research suggests that 3 out of 4 mesothelioma tumors overexpress PD-L1. It is the same protein blocked by the immunotherapy drug Keytruda.
Randomized Phase III of nivolumab for mesothelioma are ongoing. The goal of the new study was to provide “real world” data on the treatment.
Improving Mesothelioma Survival
Chemotherapy is the primary treatment for pleural mesothelioma. But even with this treatment, most patients do not survive more than about a year after diagnosis.
The new study used data from 107 pre-treated Dutch mesothelioma patients. These patients received Opdivo through an expanded access program. Doctors used X-rays to measure their response to the drug and compare it with their survival.
Nivolumab for mesothelioma was not a miracle cure. The average time it took for mesothelioma tumors to start growing again after treatment was just over 2 months. Median overall survival for the whole group was 6.7 months.
The good news is that mesothelioma patients who did respond to Opdivo responded in a big way. “Exceptional survival rates were observed in patients who had a radiological response,” reports study author Luca Cantini.
Patients who overexpressed PD-L1 and/or had lower albumin levels had the best response to nivolumab for mesothelioma. The authors say taking these two measurements could help doctors predict whether Opdivo will work.
“PD-L1 expression and albumin were associated with greater response rate and may represent useful biomarkers for nivolumab treatment in malignant pleural mesothelioma,” the report concludes.
Nivolumab is the subject of several current mesothelioma studies. Some studies pair it with chemotherapy or with another immunotherapy drug. A Japanese study released earlier this year showed it was safe and effective as a second or third-line treatment for relapsed mesothelioma.
The chemotherapy drug Alimta is the only drug with FDA approval for the treatment of malignant mesothelioma.
Cantini, L, et al, “Nivolumab in pre-treated malignant pleural mesothelioma: real-world data from the Dutch expanded access program”, August 2020, Translational Lung Cancer Research, http://tlcr.amegroups.com/article/view/41557/html
AOE, K, “A phase II study of nivolumab: a multicenter, open-label, single arm study in malignant pleural mesothelioma (MERIT)”, Epub, January 7, 2020, Annals of Oncology