Remarkable Antitumor Effects and Serious Multiple Immune-Related Adverse Events in Malignant Pleural Mesothelioma: Two Case Reports

Our plain-English summary of Remarkable Antitumor Effects and Serious Multiple Immune-Related Adverse Events in Malignant Pleural Mesothelioma: Two Case Reports, by K. Harada, H. Irie, A. Mitsuishi, et al (Case Reports in Oncological Medicine, 2025).

The study

• Authors: K. Harada, H. Irie, A. Mitsuishi, T. Fukui, N. Takada, R. Nagaoka, Y. Funatsu, H. Koh
• Journal: Case Reports in Oncological Medicine
• Published: 2025;2025:8768823
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

We describe two patients who experienced serious multiple immune-related adverse events (irAEs), treatment interruption, and steroid administration. Despite these challenges, they achieved a remarkable antitumor effect beyond the expected. Various carcinomas demonstrated a possible correlation between the antitumor effect of immune checkpoint inhibitors and the intensity of irAEs, but few studies report on malignant pleural mesothelioma (MPM). Our two cases exhibited much stronger irAEs than usual. These two cases still demonstrated a complete response (CR) or near CR partial response, indicating a correlation between irAEs and the antitumor effect in MPM.

Copyright © 2025 Koharu Harada et al. Case Reports in Oncological Medicine published by John Wiley & Sons Ltd.

In plain English

This case report describes two men with malignant pleural mesothelioma treated in Tachikawa, Tokyo, Japan, with first-line nivolumab plus ipilimumab, two immune checkpoint inhibitor drugs. The article does not report asbestos exposure. The first patient, aged 74, had Stage I disease. He developed several immune-related side effects, including Grade 3 colitis, meningitis and hepatitis. His treatment was repeatedly interrupted and he needed steroids. A PET-CT scan one year after treatment began showed a complete response. He had no recurrence within 20 months, when follow-up ended because he moved. The second patient, aged 55, had Stage IV disease that had reached an adrenal gland. He developed pneumonitis, meningitis, an inflamed pituitary gland and thyroid problems, and also needed steroids. After four cycles his tumor had markedly shrunk (a partial response). After 20 courses of nivolumab alone he showed no progression, with a tiny adrenal nodule remaining. The authors concluded that the two cases suggest a potential association between the occurrence, number and severity of these side effects and the drugs' effect against the tumor.

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 of two patients
• Who was studied: Two male patients with malignant pleural mesothelioma (MPM) at Tachikawa Hospital, Tokyo, Japan. Case 1 was a 74-year-old man with Stage I disease (cT1N0M0). Case 2 was a 55-year-old man with Stage IV disease (cT4N1M1), including a right adrenal gland tumor. Dates are not given.
• Exposure: No asbestos exposure is reported. The treatment studied was first-line nivolumab (240 mg every 2 weeks) plus ipilimumab (1 mg/kg every 6 weeks). Case 2 was later switched to nivolumab alone after seven courses.
• Main results:
  • Case 1 developed multiple immune-related adverse events: colitis (Grade 3), meningitis (Grade 3), hepatitis (Grade 3), renal dysfunction (Grade 2) and dermatitis (Grade 1). Treatment was repeatedly interrupted and steroids were given.
  • Case 1: a PET-CT scan 1 year after treatment initiation showed complete response.
  • Case 1 had no recurrence within 20 months, when follow-up ended because of relocation.
  • Case 2: early enlargement of the tumor and the pleural effusion was considered pseudoprogression, and treatment was continued.
  • Case 2 developed meningitis (Grade 3), hyperthyroidism (Grade 1), hypothyroidism (Grade 2), hypophysitis (Grade 3) and pneumonitis (Grade 1).
  • Case 2: a PET-CT scan after four cycles showed marked tumor shrinkage, judged as partial response.
  • Case 2 was switched to nivolumab monotherapy after seven courses. After 20 courses of nivolumab monotherapy there was no progression, with only a tiny nodule remaining in the right adrenal gland.
• The authors' conclusion: The authors concluded that the cases reveal a potential association between the occurrence, number and severity of immune-related adverse events and antitumor efficacy in MPM. They also stressed managing these adverse events appropriately.

Topics

Medical terms in this study, explained in our Lexicon: Immune-Related Adverse Events, Pleural Mesothelioma, Carcinoma, checkpoint inhibitors.

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