Nivolumab for malignant peritoneal mesothelioma

Our plain-English summary of Nivolumab for malignant peritoneal mesothelioma, by T. Tanaka, Y. Miyamoto, A. Sakai, et al (BMJ Case Reports, 2020).

The study

• Authors: T. Tanaka, Y. Miyamoto, A. Sakai, N. Fujimoto
• Journal: BMJ Case Reports
• Published: 2020;13(11)
• Type of article: Case report
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant peritoneal mesothelioma (MPeM) is a highly malignant neoplasm of the peritoneum, which carries a poor prognosis. A 70-year-old man, who was employed in the shipbuilding industry and exposed to asbestos for 50 years, was found to have a low-density lesion in the peritoneum around the liver and spleen, associated with multiple mediastinal and parasternal lymphadenopathy. Laparoscopic exploration was performed, and biopsy specimen analysis led to a diagnosis of MPeM. Initial systemic chemotherapy comprising cisplatin and pemetrexed yielded a modest cytoreductive effect. However, 4 months later, the patient presented with abdominal distension and anorexia. CT images revealed massive ascites, bowel obstruction and an enlarged intra-abdominal tumour, which was considered progression of the MPeM. The patient was treated with nivolumab. Bowel obstruction was improved after the first administration, and his sense of abdomen distension completely disappeared after the third administration. This case supports the utility of immunotherapy in MPeM.

© BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.

In plain English

This case report describes one 70-year-old man with epithelioid malignant peritoneal mesothelioma (cancer of the abdominal lining). He had worked in shipbuilding and was exposed to asbestos, but the article gives conflicting durations: 50 years in its summary, 22 years between ages 16 and 38 in the case description, and ages 17 to 20 in his own account. The fiber type was not stated. Six cycles of cisplatin and pemetrexed chemotherapy had a modest shrinking effect, but four months later he had bowel obstruction, massive abdominal fluid and an enlarged tumour. He was then given the immunotherapy drug nivolumab. The obstruction improved after the first dose, his sense of abdominal distension completely disappeared after the third, and CT after the fourth showed marked tumour reduction. The only side effect reported was a grade 1 skin eruption. After 24 courses without regrowth, treatment stopped for financial reasons. At the time of the report he had been progression free for 10 months without cancer treatment. The authors concluded the response suggests immunotherapy may be useful in this disease and called for a well-designed clinical study.

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 (one patient)
• Who was studied: One 70-year-old man who had worked in the shipbuilding industry, diagnosed by laparoscopic biopsy with malignant peritoneal mesothelioma (MPeM), epithelioid subtype
• Exposure: Occupational asbestos exposure in the shipbuilding industry; fiber type not stated. The case description gives 22 years of exposure between ages 16 and 38. The article's summary says 50 years, and the patient's own account says ages 17 to 20.
• Main results:
  • Six cycles of first-line cisplatin and pemetrexed chemotherapy produced a modest cytoreductive (tumour-shrinking) effect
  • Four months later, CT showed massive ascites, bowel obstruction and an enlarged intra-abdominal tumour, considered progression of the MPeM
  • After the first nivolumab administration, the bowel obstruction improved
  • The patient's sense of abdominal distension completely disappeared after the third nivolumab administration
  • After the fourth administration, CT showed remarkable reduction of the abdominal tumour
  • The only adverse event reported with nivolumab was a grade 1 skin eruption
  • The patient received 24 courses of nivolumab without disease regrowth
  • Nivolumab was suspended for financial reasons. At the time of the report the patient had been progression free for 10 months after discontinuation, without any cancer treatment.
• The authors' conclusion: The authors concluded that the drastic and durable clinical response to nivolumab in this case suggests the utility of immunotherapy in MPeM
• Limitations the authors state:
  • The authors stated that a well-designed clinical study is needed to examine whether nivolumab should be considered a new treatment option for MPeM

Topics

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

Medical terms in this study, explained in our Lexicon: Nivolumab (Opdivo), Peritoneal Mesothelioma, Neoplasm, Peritoneum, Prognosis, Lymphadenopathy, Biopsy, Chemotherapy.

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• Nivolumab or nivolumab plus ipilimumab in patients with relapsed malignant pleural mesothelioma (IFCT-1501 MAPS2): a multicentre, open-label, randomised, non-comparative, phase 2 trial — A. Scherpereel, J. Mazieres, et al. (2019)
• Programmed Death 1 Blockade With Nivolumab in Patients With Recurrent Malignant Pleural Mesothelioma — J. Quispel-Janssen, V. van der Noort, et al. (2018)
• Ipilimumab/Nivolumab-related Opsoclonus-Myoclonus-Ataxia Syndrome Variant in a Patient with Malignant Pleural Mesothelioma — B. Maller, E. Peguero, et al. (2018)
• Effectiveness of Nivolumab on Sarcomatoid Malignant Pleural Mesothelioma With Eosinophilia and Eosinophilic Pleural Effusion — M. Yamazoe, H. Ozasa, et al. (2019)
• A Phase II Trial of Nivolumab With Chemotherapy Followed by Maintenance Nivolumab in Patients With Pleural Mesothelioma After Surgery: The NICITA Study Protocol — R. Shah, L.V. Klotz, et al. (2021)

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