Primary pericardial mesothelioma: a case report of a patient treated with an immune checkpoint inhibitor as the second-line treatment

Our plain-English summary of Primary pericardial mesothelioma: a case report of a patient treated with an immune checkpoint inhibitor as the second-line treatment, by O. Arponen, V. Salo, A. Lönnberg, et al (Acta Oncologica, 2021).

The study

• Authors: O. Arponen, V. Salo, A. Lönnberg, L. Vaalavirta, H. Koivu, P. Nyandoto
• Journal: Acta Oncologica
• Published: 2021;60(5):687-691
• Type of article: Case report, Letter
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

This letter reported the case of a woman in her mid-twenties with primary pericardial mesothelioma who was treated at a hospital in Lahti, Finland. She had no history of regular smoking or exposure to asbestos. In the mid-2010s she developed fever, cough and chest pain. Tests showed an enlarged heart, pleural effusion, pericardial fluid and a mass in the upper mediastinum. Bone marrow and thoracoscopic biopsies showed only reactive changes. When she was readmitted about 17 months later, imaging showed nodular pericardial tissue. An open pericardial biopsy confirmed epithelioid mesothelioma almost one and a half years after her symptoms began. At surgery the tumour had infiltrated the heart muscle, so only the anterior pericardium could be removed, and a lymph node metastasis was later found. The tumour was PD-L1 negative. First-line cisplatin, pemetrexed and bevacizumab produced a partial response and then stable disease. Second-line pembrolizumab, alone and later combined with other drugs, was followed by long periods of stable disease, with muscle and joint pains and eczema as side effects. The disease later progressed despite several combinations, including atezolizumab-based regimens. She died over six years after first admission and over 4.5 years after diagnosis, compared with a previously reported mean survival of 8.5 ± 13.4 months. The authors concluded that some patients with advanced primary pericardial mesothelioma may benefit from immune checkpoint inhibitors after platinum and pemetrexed chemotherapy.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This letter describes a woman in her mid-twenties, treated in Finland, with primary pericardial mesothelioma, a cancer of the sac around the heart. She had no reported asbestos exposure or regular smoking. Early tissue samples showed only reactive changes, and confirming epithelioid mesothelioma took almost one and a half years from symptom onset. At surgery the tumor had grown into the heart muscle, and only the front of the pericardium could be removed. She first received cisplatin, pemetrexed and bevacizumab, and the disease responded. As second-line treatment she received pembrolizumab, an immune checkpoint inhibitor, although her tumor was PD-L1 negative. Muscle and joint pains and eczema were attributed to it. The discussion reports a partial response after six cycles of pembrolizumab alone, but the treatment table records stable disease then. After a 5.5-month pause, the disease stayed stable on pembrolizumab with chemotherapy and then alone. It later progressed despite several combinations. She died over six years after first admission. The authors concluded that some patients with advanced disease may benefit from immune checkpoint inhibitors. They noted that her youth and good health likely partly explain her long survival.

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 (letter to the editor) of a single patient
• Who was studied: One woman in her mid-twenties with primary pericardial mesothelioma, treated at Päijät-Häme Central Hospital, Lahti, Finland; symptoms began in the mid-2010s
• Exposure: No asbestos exposure was reported, and she had no history of regular smoking. The report concerns treatment: cisplatin, pemetrexed and bevacizumab first, then pembrolizumab (an immune checkpoint inhibitor) alone and in combinations, later atezolizumab combinations
• Main results:
  • A specialist pathologist confirmed epithelioid mesothelioma on day 559 after earlier samples gave inconclusive or reactive findings; the authors state it took almost one and a half years from symptom onset to confirm the diagnosis
  • At open cardiac surgery the tumor had infiltrated the heart muscle and only the anterior pericardium could be removed; lymph node metastasis was later found
  • The disease responded to first-line cisplatin, pemetrexed and bevacizumab; cisplatin was stopped after eight cycles and the tumor remained stable on pemetrexed and bevacizumab
  • The patient's tumor was PD-L1 negative (less than 1% of cells staining positive)
  • The discussion reports that a partial response was noted after six cycles of single-agent pembrolizumab, followed by a 5.5-month treatment pause; the treatment table instead records measurable disease as stable after these cycles
  • After the pause, pembrolizumab with cisplatin and pemetrexed for three cycles, followed by pembrolizumab alone for 10 cycles, was accompanied by stable disease
  • During pembrolizumab treatment the patient had muscle and joint pains and eczema attributed to the immune checkpoint inhibitor; these remained manageable
  • The disease subsequently progressed rapidly despite multiple regimes of pembrolizumab combined with other agents
  • The patient lived over 6 years after first admission and over 4.5 years after the conclusive pathological diagnosis
• The authors' conclusion: The authors concluded that their case suggests some patients with advanced primary pericardial mesothelioma may benefit from immune checkpoint inhibitors after platinum and pemetrexed based chemotherapy
• Limitations the authors state:
  • The authors state that the patient's long survival is likely partly attributable to her young age and good physical health at diagnosis

Topics

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

Medical terms in this study, explained in our Lexicon: Pericardial Mesothelioma, checkpoint inhibitors, Pleural Effusion, Pericardial, Mediastinum, Biopsy, Epithelioid, Mesothelioma.

Related studies

• Comparative effectiveness of second-line immune checkpoint inhibitor therapy versus chemotherapy for malignant pleural mesothelioma — R.Y. Kim, Y. Li, et al. (2021)
• Recurrent Tumor Suppressor Alterations in Primary Pericardial Mesothelioma — I.M. Schaefer, A. Mariño-Enríquez, et al. (2023)
• Immune checkpoint inhibitor associated reactivation of primary membranous nephropathy responsive to rituximab — J.S. Lin, D.Y. Wang, et al. (2020)
• Pre-treatment high-sensitivity troponin T for the short-term prediction of cardiac outcomes in patients on immune checkpoint inhibitors — S. Petricciuolo, M.G. Delle Donne, et al. (2021)
• Treatment and Outcomes of Primary Pericardial Mesothelioma: A Contemporary Review of 103 Published Cases — E. McGehee, D.E. Gerber, et al. (2019)
• Surgical treatment of a primary malignant pericardial mesothelioma: case report — G. Apicella, A. Boulemden, et al. (2022)

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