Nivolumab Immunotherapy in Malignant Mesothelioma: A Case Report Highlighting a New Opportunity for Exceptional Outcomes

Our plain-English summary of Nivolumab Immunotherapy in Malignant Mesothelioma: A Case Report Highlighting a New Opportunity for Exceptional Outcomes, by R.G. Jones, F. Karthik, A. Dugar, et al (The American Journal of Case Reports, 2018).

The study

• Authors: R.G. Jones, F. Karthik, A. Dugar, K. Kanagarajan, K. Desai, M. Bhandari
• Journal: The American Journal of Case Reports
• Published: 2018;19:783-789
• Type of article: Case report
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

BACKGROUND Malignant pleural mesothelioma (MPM) is a highly lethal cancer with a median survival of ~12 months even with aggressive intervention. Frontline therapy relies on systemic cisplatin and pemetrexed chemotherapy and has a response rate of ~35-41%; currently, there are no US Food and Drug Administration approved second-line therapies for MPM. Herein, we present a patient with MPM who experienced rapid disease progression after standard therapy but who had an exceptional and sustained response to immune checkpoint inhibition with single agent nivolumab. CASE REPORT A 68-year-old male with a history of work-related asbestos exposure was diagnosed with MPM. He was treated with primary resection followed by systemic chemotherapy with cisplatin and pemetrexed. When chemotherapy failed, he was switched to immunotherapy with nivolumab and achieved an exceptional response. CONCLUSIONS We report the first case of a patient with MPM who experienced rapid disease progression after standard therapy but had an exceptional and sustained response to immune checkpoint inhibition with single agent nivolumab. As outcomes with traditional chemotherapy regimens remain disappointing, there is a substantial need for new approaches to MPM; our case highlights a new therapeutic opportunity even in the face of aggressive disease. Indeed, a new era of investigation utilizing immunotherapy for mesothelioma is beginning, with much anticipation.

In plain English

This article is a case report about one patient: a 68-year-old man with malignant pleural mesothelioma of the epithelioid type. He had work-related asbestos exposure 30 years before he first became ill. The article does not name the fiber type or the job. In November 2014, scans and biopsies of the left chest found the mesothelioma. He had surgery to remove the left lung, followed by chemotherapy with cisplatin and pemetrexed. About 10 months after surgery the cancer had returned on the left side, and fluid and a new nodule had appeared on the right side. He needed constant oxygen. Based on tests of his tumor, he was switched to the immunotherapy drug nivolumab through a compassionate access program. Within 8 weeks he no longer needed oxygen. Scans showed no visible disease at 6 months and 9 months. He developed mild hypothyroidism (an underactive thyroid). The article gives his survival as more than 24 months in one place and more than 36 months in another. The authors concluded that nivolumab may have promise in this disease but that further study is needed.

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 68-year-old man, first seen in November 2014, diagnosed with poorly differentiated epithelioid malignant pleural mesothelioma. He had prostate cancer removed 9 years earlier. The affiliations are hospitals in Cincinnati, Ohio, and Gainesville, Florida.
• Exposure: Work-related asbestos exposure 30 years before he first became ill. The article does not state the fiber type, products or job.
• Main results:
  • Diagnosis on pleural biopsy was poorly differentiated epithelioid type malignant mesothelioma.
  • After surgery and chemotherapy with cisplatin and pemetrexed, he developed capillary leak syndrome 10 months after surgery. The disease returned in the left chest and spread to the right chest.
  • When the disease came back he needed continuous oxygen, and his Karnofsky performance status (a 0 to 100 scale of how well a patient can carry out daily activities) was 50%.
  • His tumor profile showed 1% tumor cell staining for PD-1 receptor (2+ intensity), 10% PDL-1 staining on tumor-infiltrating T-cells, and 13 mutations per megabase. On this basis he was given nivolumab 3 mg/kg every 2 weeks.
  • Within 8 weeks of starting nivolumab he no longer needed oxygen. By 4 months he had returned to work, with a Karnofsky performance status of 90%.
  • A CT scan after 6 months of nivolumab showed complete resolution of the recurrent disease in the left chest.
  • A PET scan after 9 months of nivolumab showed no hypermetabolic activity, which the authors describe as suggestive of complete remission.
  • Side effects were mild hypothyroidism, which required low-dose levothyroxine, and a low-grade rise in serum lipase. No hepatitis or pancreatitis was found.
  • The case report section says he remained well more than 24 months after diagnosis. The discussion says more than 36 months.
• The authors' conclusion: The authors concluded that, based on this patient's response and pre-clinical studies, nivolumab may have promise as a future therapy for malignant pleural mesothelioma, although further study is needed.

Topics

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

Medical terms in this study, explained in our Lexicon: Nivolumab (Opdivo), Immunotherapy, Malignant Mesothelioma, Pleural Mesothelioma, Median Survival, Cisplatin, Pemetrexed (Alimta), Chemotherapy.

Related studies

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• Outcome prediction based on [18F]FDG PET/CT in patients with pleural mesothelioma treated with ipilimumab and nivolumab +/- UV1 telomerase vaccine — S. Thunold, E. Hernes, et al. (2025)
• Tremelimumab for the treatment of malignant mesothelioma — A. Guazzelli, M. Hussain, et al. (2015)
• Anti-CTLA-4 therapy for malignant mesothelioma — A. Guazzelli, E. Bakker, et al. (2017)
• Mesothelin Immunotherapy for Cancer: Ready for Prime Time? — R. Hassan, A. Thomas, et al. (2016)
• Current readings: Window-of-opportunity trials for thoracic malignancies — A.S. Tsao (2014)

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