\[Research Progress of Immune Checkpoint Inhibitors in Malignant Pleural Mesothelioma\]

Our plain-English summary of [Research Progress of Immune Checkpoint Inhibitors in Malignant Pleural Mesothelioma], by Y. Huang, Q. Meng (Zhongguo Fei Ai Za Zhi = Chinese Journal of Lung Cancer, 2021).

The study

• Authors: Y. Huang, Q. Meng
• Journal: Zhongguo Fei Ai Za Zhi = Chinese Journal of Lung Cancer
• Published: 2021;24(6):441-446
• Type of article: Review
• Language: Chinese
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma (MPM) is a malignant tumor with strong invasiveness, low survival rate and lack of effective treatment options. As the only first-line treatment plan for the advanced MPM, combination of pemetrexed and cisplatin chemotherapy have been existing since the last 20 years. Immunotherapy has long been considered as a potential treatment plan for MPM, mainly including immune checkpoint inhibitors (ICIs), immunotoxin therapy, anti-cancer vaccine and adoptive T-cell therapy. This review focuses on summarizing the current research status of immune checkpoint inhibitors in MPM, discusses the effect of tumor heterogeneity on ICIs treatment, and describes that the biomarker-oriented immunotherapy is a new vision for the realization of individualized treatment of MPM. .

In plain English

This article was a Chinese-language review of published research on immune checkpoint inhibitors, a type of immunotherapy drug, in malignant pleural mesothelioma. It did not study patients itself and did not examine asbestos exposure. Its introduction stated, citing another source, that asbestos exposure is the causative factor in 80% of patients. The authors described differences in tumour subtypes and immune cells between patients, then summarized drug trials. As first-line treatment, the CheckMate 743 trial reported median overall survival of 18.1 months with ipilimumab plus nivolumab versus 14.1 with chemotherapy. In previously treated patients, PROMISE-meso reported a higher response rate with pembrolizumab than chemotherapy (22% vs 6%) but did not show superiority, with median progression-free survival of 2.5 versus 3.4 months; DETERMINE found tremelimumab did not significantly exceed placebo on progression-free or overall survival. The CONFIRM trial reported a survival benefit with nivolumab in patients with the epithelioid subtype. The authors called PD-L1 controversial as a marker for predicting who benefits. They concluded the drugs bring long-term survival benefit to only some patients and called for more research into predictive biomarkers.

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: Review of published research (narrative review); no original patient data
• Who was studied: No patients were studied directly. The review summarized published clinical trials of immune checkpoint inhibitors in patients with malignant pleural mesothelioma. Its tables list 12 trials of the drugs as salvage treatment (after earlier treatment) and 6 trials as first-line treatment, 3 of which were described as ongoing or recruiting.
• Exposure: Not an asbestos exposure study. The treatments reviewed were immune checkpoint inhibitors: the CTLA-4 inhibitors ipilimumab and tremelimumab, the PD-1 inhibitors nivolumab and pembrolizumab, and the PD-L1 inhibitors durvalumab, avelumab and atezolizumab. The introduction states, citing another source (reference 2), that asbestos exposure is the causative factor in 80% of patients.
• Main results:
  • The review reported that the phase III CheckMate 743 trial (first-line treatment of advanced MPM) found median overall survival of 18.1 months in the ipilimumab plus nivolumab group and 14.1 months in the chemotherapy group (HR=0.74, P=0.002).
  • The review reported that the phase III PROMISE-meso trial (second-line pembrolizumab vs single-agent chemotherapy with gemcitabine or vinorelbine) found an objective response rate of 22% with pembrolizumab and 6% with chemotherapy. Median progression-free survival was 2.5 months with pembrolizumab and 3.4 months with chemotherapy, and the trial failed to show superiority of PD-1 treatment.
  • The review reported that the randomized DETERMINE trial of tremelimumab alone found that median progression-free and overall survival did not significantly exceed the placebo group.
  • The review reported that in the phase III CONFIRM trial, median overall survival in the epithelioid subgroup was 9.4 months with nivolumab and 6.6 months with placebo (HR=0.71, P=0.021).
  • The authors stated that PD-L1 as a predictive biomarker for MPM treatment has been controversial.
• The authors' conclusion: The authors concluded that immune checkpoint inhibitor treatment of advanced MPM has made progress and offers options beyond standard chemotherapy. Because it brings long-term survival benefit to only some patients, they called for further research into biomarkers that can predict treatment effect.

Topics

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

Medical terms in this study, explained in our Lexicon: checkpoint inhibitors, Pleural Mesothelioma, Pemetrexed (Alimta), Cisplatin, Chemotherapy, Immunotherapy, Biomarker.

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• Increased frequency of anti-Ma2 encephalitis associated with immune checkpoint inhibitors — A. Vogrig, M. Fouret, et al. (2019)
• Nephrotic syndrome with acute kidney injury due to combination therapy of immune checkpoint inhibitors: a case report and review of the literature — R. Saiki, K. Katayama, et al. (2024)
• Safety and efficacy of PD-1/PD-L1 immune checkpoint inhibitors in patients with pre-treated advanced stage malignant mesothelioma: a systematic review and meta-analysis — A. Zafar, A.A. Rashid, et al. (2024)
• Immune checkpoint inhibitor-induced nephrotic syndrome: a pharmacovigilance analysis of 404 FAERS cases and literature case series — J. Ye, J. Huang, et al. (2025)

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