Programmed Death 1 Blockade With Nivolumab in Patients With Recurrent Malignant Pleural Mesothelioma

Our plain-English summary of Programmed Death 1 Blockade With Nivolumab in Patients With Recurrent Malignant Pleural Mesothelioma, by D.A. Fennell (Journal of Thoracic Oncology, 2018).

The study

• Author: D.A. Fennell
• Journal: Journal of Thoracic Oncology
• Published: 2018;13(10):1436-1437
• Type of article: Editorial, Comment
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

This editorial commented on a phase II study by Quispel-Janssen et al., published in the same issue, of the anti-PD-1 drug nivolumab in patients with relapsed malignant pleural mesothelioma. The author noted that no positive randomized trials had been reported in this setting, including one of tremelimumab. He compared the study with the earlier KEYNOTE-028 trial of pembrolizumab in PD-L1-positive patients, which reported a 20% response rate, a 12-month duration of response and a 76% disease control rate. The nivolumab study enrolled patients regardless of PD-L1 status. It reported an overall response rate of 24%, confirmed pseudoprogression in three patients, and responses lasting on average 7 months. More than half of patients were refractory to treatment. Of the 27% of patients with PD-L1 expression above 1%, no correlation with outcome was seen, and fewer than half of responders were PD-L1-positive. A rise in the neutrophil:lymphocyte ratio in the first 6 weeks was associated with poor outcome. The author discussed other possible predictors, including tumor mutation burden, HLA genotype and gut microbiome. He also reviewed ongoing and reported trials, including CONFIRM, PROMISE-meso, NIBIT-MESO-1 (28% response rate, 63% disease control), MAPS2, CheckMate 743 and DREAM. He concluded that the outlook for immunotherapy in mesothelioma remained good. He added that randomized trials were needed to clarify the role of PD-L1 testing.

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 is an editorial, not an original study, and it does not discuss asbestos exposure. The author commented on a phase II trial by Quispel-Janssen et al., published in the same journal, that tested nivolumab in patients with relapsed mesothelioma. Nivolumab is a drug that blocks the PD-1 immune checkpoint. According to the editorial, that trial included patients whatever their tumor PD-L1 status. It reported an overall response rate of 24%, with responses lasting on average 7 months, and more than half of patients did not respond to treatment. Tumors in 27% of patients expressed PD-L1 above 1%, and this was not correlated with outcome. Fewer than half of the patients who responded were PD-L1-positive. A rise in the neutrophil-to-lymphocyte ratio in the first 6 weeks was associated with poor outcome. The author compared these figures with the earlier KEYNOTE-028 study of pembrolizumab in PD-L1-positive patients, which reported a 20% response rate. The author concluded that the forecast for immunotherapy in mesothelioma remained good.

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: Editorial commenting on another group's phase II clinical trial; no original data
• Who was studied: No study population of its own. The editorial discusses a phase II trial of nivolumab in patients with relapsed mesothelioma reported by Quispel-Janssen et al.
• Exposure: Treatment with nivolumab (anti-PD-1 immunotherapy), given to patients regardless of PD-L1 status. Asbestos exposure is not discussed.
• Main results:
  • As reported by the editorial: Quispel-Janssen et al. found an overall response rate of 24% with nivolumab.
  • As reported by the editorial: in the nivolumab trial, responses lasted on average 7 months.
  • As reported by the editorial: more than half of the patients treated with nivolumab were refractory to treatment (did not respond).
  • As reported by the editorial: 27% of patients expressed PD-L1 at greater than 1%. This showed no correlation with outcome, and less than half of responders were PD-L1-positive.
  • As reported by the editorial: in the nivolumab trial, an increase in neutrophil:lymphocyte ratio in the first 6 weeks was associated with poor outcome.
  • For comparison, the editorial cites the earlier KEYNOTE-028 study of pembrolizumab in PD-L1-positive relapsed mesothelioma, which reported a 20% response rate.
• The authors' conclusion: The author concluded that the forecast for immunotherapy in mesothelioma remains good.

Topics

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

Medical terms in this study, explained in our Lexicon: Nivolumab (Opdivo), Pleural Mesothelioma, Tremelimumab, Pembrolizumab (Keytruda), PD-L1, CheckMate 743, Immunotherapy, Mesothelioma.

Related studies

• Programmed Death 1 Blockade With Nivolumab in Patients With Recurrent Malignant Pleural Mesothelioma — J. Quispel-Janssen, V. van der Noort, et al. (2018)
• Dual control of antitumor CD8 T cells through the programmed death-1/programmed death-ligand 1 pathway and immunosuppressive CD4 T cells: regulation and counterregulation — A.J. Currie, A. Prosser, et al. (2009)
• Analysis of expression of PTEN/PI3K pathway and programmed cell death ligand 1 (PD-L1) in malignant pleural mesothelioma (MPM) — S. Cedrés, S. Ponce-Aix, et al. (2016)
• Prognosis of patients with malignant mesothelioma by expression of programmed cell death 1 ligand 1 and mesothelin in a contemporary cohort in Finland — D. Vizcaya, B. Farahmand, et al. (2020)
• Prognostic and clinicopathological utility of programmed death-ligand 1 in malignant pleural mesothelioma: A meta-analysis — F. Zhang, W. Gong (2020)
• Programmed cell death 1 ligand 1 (PD-L1) expression is associated with poor prognosis of malignant pleural mesothelioma patients with good performance status — E. Rrapaj, L. Giacometti, et al. (2021)

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