Immuno-oncology in malignant pleural mesothelioma

Our plain-English summary of Immuno-oncology in malignant pleural mesothelioma, by P. Baas, M. Disselhorst (The Lancet. Respiratory Medicine, 2018).

The study

• Authors: P. Baas, M. Disselhorst
• Journal: The Lancet. Respiratory Medicine
• Published: 2018;6(6):408-410
• Type of article: Comment
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This article was a short commentary, not an original study. The authors discussed a separate single-arm phase 2 trial by Calabrò and colleagues, published in the same journal. That trial gave tremelimumab and durvalumab together to 40 patients with pleural or peritoneal mesothelioma. As the commentary reported, 10 of those 40 patients (25%) had a confirmed immune-related partial response lasting a median of 16.1 months (IQR 11.5 to 20.5), 26 (65%) had immune-related disease control, and median overall survival was 16.6 months (95% CI 13.1 to 20.1). PD-L1 levels in tumour biopsies were not significantly associated with outcomes, but that trial was not powered to detect differences of less than 40%. The 13 retreated patients had a non-significantly longer median survival than the 27 not retreated (17.8 vs 11.2 months). The commentators noted that the sample was too small for firm conclusions from these exploratory analyses. The authors concluded that research should focus on biomarkers other than PD-L1 and on identifying which patients benefit from immuno-oncology therapy.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Commentary on another research group's single-arm phase 2 trial (Calabrò and colleagues); this article reports no new data of its own
• Who was studied: The discussed trial (Calabrò and colleagues) included 40 patients with pleural or peritoneal mesothelioma; 32 (80%) had the epithelioid subtype and 29 (73%) had stage IV disease
• Exposure: No asbestos exposure is discussed. The treatment studied in the discussed trial was the anti-CTLA-4 antibody tremelimumab combined with the anti-PD-L1 antibody durvalumab
• Main results:
  • In Calabrò and colleagues' trial, 10 (25%) of 40 patients had a confirmed immune-related partial response, with a median duration of 16.1 months (IQR 11.5 to 20.5)
  • In that trial, 26 (65%) patients had immune-related disease control, and median overall survival was 16.6 months (95% CI 13.1 to 20.1)
  • In that trial, median overall survival was non-significantly longer in the 13 retreated patients than in the 27 not retreated (17.8 months vs 11.2 months; p=0.19)
  • In that trial, baseline PD-L1 expression (tested in biopsies from 38 patients at six cutoffs) was not significantly associated with response, disease control, progression-free survival or 1-year overall survival
• The authors' conclusion: The commentary authors concluded that researchers should focus on biomarkers other than PD-L1, and that patient characteristics and biomarkers need to be studied prospectively to identify the patients who benefit from immuno-oncology therapy
• Limitations the authors state:
  • The commentators stated that the discussed trial's sample was too small to draw firm conclusions from its exploratory analyses (first line vs second line treatment; retreatment)
  • The commentators stated that the discussed trial was not powered to detect differences of less than 40% at each PD-L1 cutoff

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma.

Related studies

• Treat it or Leave it: Immuno-Oncology in Mesothelioma Observed by the Eyes of Argus — C.J. de Gooijer, P. Baas (2018)
• Assessing Tumor-Infiltrating Lymphocytes in Solid Tumors: A Practical Review for Pathologists and Proposal for a Standardized Method from the International Immuno-Oncology Biomarkers Working Group: Part 2: TILs in Melanoma, Gastrointestinal Tract Carcinomas, Non-Small Cell Lung Carcinoma and Mesothelioma, Endometrial and Ovarian Carcinomas, Squamous Cell Carcinoma of the Head and Neck, Genitourinary Carcinomas, and Primary Brain Tumors — S. Hendry, R. Salgado, et al. (2017)
• Scientific Advances in Thoracic Oncology 2016 — R.A. Soo, E.C.A. Stone, et al. (2017)
• First-ever Abscopal Effect after Palliative Radiotherapy and Immuno-gene Therapy for Malignant Pleural Mesothelioma — A.R. Barsky, K.A. Cengel, et al. (2019)
• An integrative histopathologic clustering model based on immuno-matrix elements to predict the risk of death in malignant mesothelioma — M.L. Balancin, W.R. Teodoro, et al. (2020)
• Distinguishing malignant mesothelioma from pulmonary adenocarcinoma: an immuno-histochemical approach using a panel of monoclonal antibodies — S.E. Tuttle, J.G. Lucas, et al. (1990)

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