Management of recurrent pleural mesothelioma: Successful rechallenge with nintedanib in combination with chemotherapy

Our plain-English summary of Management of recurrent pleural mesothelioma: Successful rechallenge with nintedanib in combination with chemotherapy, by F. Grosso, A. Roveta, G. Gallizzi, et al (Clinical Case Reports, 2018).

The study

• Authors: F. Grosso, A. Roveta, G. Gallizzi, M. Belletti
• Journal: Clinical Case Reports
• Published: 2018;6(10):2000-2004
• Type of article: Case report
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma (MPM) is a rare neoplasm, generally caused by asbestos exposure. This case details how a patient treated with nintedanib during the LUME-Meso study was rechallenged with nintedanib. The findings highlight the benefit of nintedanib rechallenge and the potential use of continuous anti-angiogenic therapy in MPM treatment.

In plain English

This case report, by doctors in Alessandria, Italy, described one man with malignant pleural mesothelioma of the epithelioid subtype. He was 53 when breathlessness began in January 2014. He had never smoked, and the article says that as a factory worker he had been exposed to environmental asbestos. It does not name a fiber type. In the LUME-Meso trial he received nintedanib with pemetrexed and cisplatin, and his total tumor measurement fell from 116 mm to 41 mm by Week 24. The tumor grew again in December 2014. His next two treatments, trabectedin and then gemcitabine plus carboplatin, did not stop the disease from progressing. From May 2015 he received pemetrexed again, with nintedanib added from the second cycle, and his disease was stable for more than 5 months. It then progressed, and he died at the end of March 2016, 23 months after diagnosis. The authors concluded that nintedanib with chemotherapy was effective first-line treatment and gave sustained disease stabilization when restarted. They also said further research is needed. Boehringer Ingelheim funded medical writing assistance for the article.

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: case report (single patient)
• Who was studied: One man, aged 53 when symptoms began in January 2014, a non-smoker, with epithelioid subtype malignant pleural mesothelioma; reported from SS Antonio e Biagio General Hospital, Alessandria, and Santo Spirito Hospital, Casale Monferrato, Italy
• Exposure: Asbestos exposure as a factory worker, described by the article as environmental asbestos; no fiber type, product, or dose is given. The treatments studied were nintedanib plus pemetrexed/cisplatin first-line, and nintedanib plus pemetrexed on rechallenge.
• Main results:
  • During first-line nintedanib plus pemetrexed/cisplatin, the patient's total tumor measurement of target lesions fell from 116 mm at baseline to 64 mm, 50 mm, 40 mm and 41 mm at Weeks 6, 12, 18 and 24 (a very good partial response from June to October 2014).
  • In December 2014 the tumor progressed: the total tumor measurement rose 77.5% from its lowest point at Week 24, and treatment was stopped.
  • Second-line trabectedin (ATREUS study) and third-line gemcitabine plus carboplatin (three cycles) both showed progressive disease.
  • On fourth-line rechallenge from May 2015 (pemetrexed, with nintedanib added from the second cycle, given through individual compassionate use), the disease was stable for more than 5 months, with a 12.6% decrease in tumor measurement between July and September 2015, and the patient had symptom relief.
  • Side effects reported for this patient were Grade 3 venous thromboembolism in June 2014, considered unrelated to study treatment, and Grade 2 perimalleolar (ankle) edema during the rechallenge.
  • After carboplatin was added, the disease kept progressing. By December 2015 the total tumor measurement had increased to 219 mm. Fifth-line vinorelbine did not stop progression, and the patient died at the end of March 2016, 23 months after diagnosis.
• The authors' conclusion: The authors concluded that nintedanib in combination with chemotherapy was effective as first-line therapy, gave sustained disease stabilization on rechallenge 6 months after the first nintedanib course ended, and showed acceptable tolerability. They said the benefit of rechallenge may support continuous anti-angiogenic therapy in MPM.
• Limitations the authors state:
  • The authors state that there are no clinical data indicating benefits of continued therapy with nintedanib.
  • The authors state that further research is needed to evaluate the clinical impact of continuous anti-angiogenic therapy.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Chemotherapy, Neoplasm, Asbestos Exposure.

Related studies

• Nintedanib in combination with pemetrexed and cisplatin for chemotherapy-naive patients with advanced malignant pleural mesothelioma (LUME-Meso): a double-blind, randomised, placebo-controlled phase 3 trial — G.V. Scagliotti, R. Gaafar, et al. (2019)
• A Case of Well-Differentiated Papillary Mesothelioma of the Male Peritoneum: Successful Treatment by Systemic Chemotherapy — A. Bazine, M. Fetohi, et al. (2017)
• Successful salvage chemotherapy with gemcitabine and vinorelbine in a malignant pleural mesothelioma patient previously treated with pemetrexed — T. Agatsuma, T. Koizumi, et al. (2010)
• The long-term morbidity of pleuroperitoneal shunts in the management of recurrent malignant effusions — O. Genc, M. Petrou, et al. (2000)
• Iterative cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent or progressive diffuse malignant peritoneal mesothelioma: clinicopathologic characteristics and survival outcome — C. Ihemelandu, L. Bijelic, et al. (2015)
• Iterative cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent peritoneal metastases — T.C. Chua, L.E. Quinn, et al. (2013)

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