Opdivo for Mesothelioma Recurrence is Safe and Effective, Study Finds

A new Japanese study appears to show that Opdivo for mesothelioma recurrence after surgery is safe and effective. 

Opdivo (nivolumab) is an immunotherapy drug similar to Keytruda (pembrolizumab). It blocks a protein called PD-L1. PD-L1 helps mesothelioma cells avoid detection by the immune system. 

In the latest study, 35 patients received Opdivo for mesothelioma recurrence. More than three quarters of them experienced either stable or decreased disease.

Understanding How Nivolumab Works

Nivolumab is most often used to treat non-small cell lung cancer. It makes tumors more vulnerable to immune system attack. Pleural mesothelioma has many of the same characteristics as lung cancer. This is one reason researchers are hopeful about Opdivo for mesothelioma recurrence. 

The primary treatment for mesothelioma is chemotherapy with Alimta. The healthiest patients may also have surgery. But if mesothelioma comes back after treatment, these patients have no good topions. The FDA has not approved a second-line mesothelioma treatment. 

Earlier this year, a Japanese study called MERIT found that Opdivo for mesothelioma recurrence helped patients live longer. The newest study appears to back up those findings. 

Testing Opdivo for Mesothelioma Recurrence

The latest study included 35 pleural mesothelioma patients whose cancer came back after surgery. The patients received 240 mg of nivolumab every two weeks. Doctors stopped the treatment only if the cancer recurred or the patient developed serious side effects. 

To gauge the value of Opdivo for mesothelioma recurrence, researchers evaluated the response rate, how long they lived, and the type and severity of any side effects. They followed the patients’ progress for six months. 

Of the 35 patients receiving Opdivo for mesothelioma recurrence, 25 (77.1%) had at least a partial response. In one case, the patient’s mesothelioma tumor disappeared. Six other patients’ tumors shrank in size. The remaining 18 responders had stable disease. 

Just over 11 percent  of patients had Grade 3 complications (on a 5-point scale). None of them had Grade 4 or 5 complications. 

The research team, led by Dr. Akifumi Nakamura, concludes, “Nivolumab treatment in patients with post-operative recurrence of MPM seems safe and [shows] clinical efficacy.”

The median overall survival for study participants was 13.1 months. Treated patients lived an average of 4.4 months without mesothelioma progression. 

Ongoing Immunotherapy Studies

Previous studies show Opdivo for mesothelioma recurrence works best in patients with the highest PD-L1 levels. The same appears to be true for Keytruda. 

More than 300 previously-treated mesothelioma patients are in a UK trial called CONFIRM. CONFIRM is the first double-blind placebo-controlled phase III trial of Opdivo for mesothelioma recurrence after chemotherapy. If the results are good, Opdivo may eventually become the standard-of-care for recurrent mesothelioma.

Source:

Nakamura, A, “Initial evaluation of nivolumab in patients with post-operative recurrence of malignant pleural mesothelioma”, May 28, 2020, Japanese Journal of Clinical Oncology, https://academic.oup.com/jjco/advance-article-abstract/doi/10.1093/jjco/hyaa069/5848077?redirectedFrom=fulltext