Safety of First-Line Nivolumab Plus Ipilimumab in Very Old (≥ 80 Years) Patients With Unresectable Malignant Pleural Mesothelioma: A Retrospective Single-Center Case Series

Our plain-English summary of Safety of First-Line Nivolumab Plus Ipilimumab in Very Old (≥ 80 Years) Patients With Unresectable Malignant Pleural Mesothelioma: A Retrospective Single-Center Case Series, by T. Shimamoto, Y. Morimoto, N. Nitta, et al (Curēus, 2024).

The study

• Authors: T. Shimamoto, Y. Morimoto, N. Nitta, R. Yoshida, N. Tani
• Journal: Curēus
• Published: 2024;16(1):e52714
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Nivolumab plus ipilimumab as the first-line treatment results in superior survival outcomes in patients with malignant pleural mesothelioma (MPM). However, its safety in old (≥ 80 years) patients with MPM has not been elucidated yet. Three male patients with MPM, aged 80-90 years, were treated with nivolumab plus ipilimumab as the first-line treatment in our hospital. All of them discontinued the treatment due to adverse events. The overall survival from treatment initiation was 2.5, 3.5, and 4.0 months, respectively. Nivolumab plus ipilimumab should be used cautiously in very old patients with MPM.

Copyright © 2024, Shimamoto et al.

In plain English

This was a retrospective case series of three men with malignant pleural mesothelioma, aged 80, 90 and 80, treated at one hospital in Kyoto, Japan. All three received two immunotherapy drugs, nivolumab plus ipilimumab, as their first treatment. One had been exposed to asbestos in the building trade and one in plumbing work. The third had worked at construction sites for eight years. All three stopped treatment because of adverse events. Two developed pneumonitis (lung inflammation), and one of them also had cancer progression. The 90-year-old developed aspiration and died about two months after starting treatment. The article's table gives survival from the start of treatment as 3.5, 2.5 and 4.0 months, with a median of 3.5 months. The authors said this was shorter than in the main trial of this treatment. The case text gives 4.5 months for the first man. Two men had a performance status score of 2, which the authors said may have affected outcomes. The authors concluded the treatment should be used with caution in very old patients and called for larger studies. With three patients, the series describes individual outcomes, not rates.

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: Retrospective single-center case series (three cases)
• Who was studied: Three male patients aged 80, 90 and 80 years with unresectable malignant pleural mesothelioma (one sarcomatoid, two epithelioid), treated at Kyoto Kuramaguchi Medical Center, Japan; treatment dates not given
• Exposure: The treatment studied was nivolumab (360 mg every 3 weeks) plus ipilimumab (1 mg/kg every 6 weeks) as first-line treatment. Asbestos exposure was reported for Case 1 (building trade) and Case 3 (plumbing work). Case 2 had worked at construction sites for eight years, and the article does not state asbestos exposure for Case 2. No fiber types were given.
• Main results:
  • All three patients discontinued treatment due to adverse events: pneumonitis in Cases 1 and 3, and aspiration (grade 5) in Case 2
  • Case 1 (80-year-old man, sarcomatoid) developed grade 2 pneumonitis after the second cycle, and treatment was stopped. Disease was stable. He recovered from the pneumonitis but died of aspiration 4.5 months after treatment began (the table gives overall survival of 3.5 months).
  • Case 2 (90-year-old man, epithelioid) presented with aspiration and died two months after starting treatment (the table gives 2.5 months). Best response was stable disease.
  • Case 3 (80-year-old man, epithelioid) had pneumonitis and mesothelioma progression at 1.8 months. Pneumonitis improved with methylprednisolone, but he died four months after treatment began.
  • Across the three patients, median progression-free survival was 2.5 months and median overall survival was 3.5 months from treatment start. The authors said both were shorter than in the pivotal trial.
• The authors' conclusion: The authors concluded that first-line nivolumab plus ipilimumab should be used with caution in very old patients with mesothelioma, and that large-scale studies are needed.
• Limitations the authors state:
  • Two patients had a performance status score of 2, a group not eligible for the CheckMate 743 trial. The authors suggested this may have contributed to poor outcomes.

Topics

Medical terms in this study, explained in our Lexicon: Nivolumab (Opdivo), Ipilimumab (Yervoy), Unresectable, Pleural Mesothelioma, Overall Survival.

Related studies

• Five-Year Clinical Outcomes With Nivolumab Plus Ipilimumab Versus Chemotherapy as First-Line Treatment for Unresectable Pleural Mesothelioma in CheckMate 743 — A. Scherpereel, P. Baas, et al. (2026)
• Cost-effectiveness of nivolumab plus ipilimumab as first-line treatment for American patients with unresectable malignant pleural mesothelioma — Z.M. Ye, Z.Q. Tang, et al. (2022)
• Cost-effectiveness analysis of nivolumab plus ipilimumab versus chemotherapy as the first-line treatment for unresectable malignant pleural mesothelioma — L. Yang, X. Cao, et al. (2022)
• First-line nivolumab plus ipilimumab for unresectable MPM in China: a cost-effectiveness analysis — L. Yang, X. Song, et al. (2023)
• First-Line Nivolumab Plus Ipilimumab in Inoperable Epithelioid Malignant Pleural Mesothelioma: Real-World Experience From an Indian Tertiary Care Center — A. Shah, A. Agarwal, et al. (2026)
• Follow-up after first-Line nivOlumab plus ipilimumab in patients with diffuse pleuRal mesotheliomA: a real-world Dutch cohort study-FLORA — L.H. Douma, M.M. Hofman, et al. (2025)

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