New and old treatments for malignant mesothelioma: not just immunotherapy

Our plain-English summary of New and old treatments for malignant mesothelioma: not just immunotherapy, by A.K. Nowak (The Lancet. Respiratory Medicine, 2021).

The study

• Author: A.K. Nowak
• Journal: The Lancet. Respiratory Medicine
• Published: 2021;9(6):547-549
• Type of article: Comment
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This was a short commentary, not an original study. The author, at the National Centre for Asbestos Related Diseases in Western Australia, discussed two mesothelioma drug trials published in the same journal issue. No asbestos exposure was studied. The author reported that the randomised phase 2 NVALT19 trial found a positive result for progression-free survival with switch-maintenance gemcitabine plus supportive care compared with supportive care alone (hazard ratio 0.48, 95% CI 0.33 to 0.71; p=0.0002), but no effect on overall survival. In the MiST1 trial of the drug rucaparib, disease control at 12 weeks was reached in 15 (58%) of 26 patients, and partial responses in three (12%). The author suggested a 12% response rate might have little value for patients. The author also described the 2020 FDA approval of ipilimumab plus nivolumab, with median overall survival of 18.1 months compared with 14.1 months on platinum and pemetrexed chemotherapy. The author concluded that NVALT19 offered a gemcitabine option without sufficient evidence for FDA approval. The author also concluded that MiST1 provided proof of concept for molecular stratification.

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 (Lancet Respiratory Medicine 'Comment') on two trials published in the same issue; not an original study
• Who was studied: No study population of its own; the comment discussed trials in patients with malignant mesothelioma (NVALT19 and MiST1; in MiST1, 26 of 36 screened patients were eligible for rucaparib)
• Exposure: No asbestos exposure was studied; the comment concerned treatments: switch-maintenance gemcitabine (NVALT19), the PARP inhibitor rucaparib for tumours with BAP1 inactivation or BRCA1 deficiency (MiST1), and ipilimumab plus nivolumab
• Main results:
  • As reported by the author, in the NVALT19 trial gemcitabine plus supportive care versus supportive care alone gave a progression-free survival hazard ratio of 0.48 (95% CI 0.33 to 0.71; p=0.0002)
  • As reported by the author, the NVALT19 trial found no effect on overall survival
  • As reported by the author, in the MiST1 trial disease control was reached at 12 weeks in 15 (58%) of 26 patients and at 24 weeks in six patients (23%), with partial responses in three patients (12%)
  • As described by the author, ipilimumab plus nivolumab gave a median overall survival of 18.1 months compared with 14.1 months with combination chemotherapy (platinum and pemetrexed)
  • The author stated that for patients with epithelioid mesothelioma, combination immunotherapy has not meaningfully improved overall survival
• The authors' conclusion: The author concluded that NVALT19 provides an option of switch-maintenance gemcitabine without sufficient evidence for FDA approval. The author also concluded that MiST1 provided proof of concept for molecular stratification in a mesothelioma trial, though better targets may be needed.
• Limitations the authors state:
  • The author noted that the NVALT19 trial being discussed was not placebo controlled, but judged that any effect on the progression-free survival assessment was probably reduced by a masked independent radiological reviewer

Topics

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

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

Related studies

• What's the place of immunotherapy in malignant mesothelioma treatments? — M. Grégoire (2010)
• Immunotherapy for Treatment of Pleural Mesothelioma: Current and Emerging Therapeutic Strategies — L. Chiec, D.S. Bruno (2024)
• Multimodality treatment of malignant pleural mesothelioma with or without immunotherapy: does it change anything? — M. Lucchi, A. Picchi, et al. (2010)
• SEOM clinical guidelines for the treatment of malignant pleural mesothelioma (2020) — E. Nadal, J. Bosch-Barrera, et al. (2021)
• Network analysis of immunotherapy-induced regressing tumours identifies novel synergistic drug combinations — W.J. Lesterhuis, C. Rinaldi, et al. (2015)
• Fractionated low-dose radiotherapy primes the tumor microenvironment for immunotherapy in a murine mesothelioma model — R.A. D'Alonzo, S. Keam, et al. (2025)

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