Sarcomatoid diffuse pleural mesothelioma in an 80-year-Old woman with long-term response to nivolumab plus ipilimumab: A case report

Our plain-English summary of Sarcomatoid diffuse pleural mesothelioma in an 80-year-Old woman with long-term response to nivolumab plus ipilimumab: A case report, by Y. Yoshida, H. Mizugaki, Y. Sato, et al (Respiratory Medicine Case Reports, 2025).

The study

• Authors: Y. Yoshida, H. Mizugaki, Y. Sato, K. Kuwahara, N. Yamada, H. Asahina, H. Yokouchi, Y. Matsuno, S. Oizumi
• Journal: Respiratory Medicine Case Reports
• Published: 2025;56:102242
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

An 80-year-old woman presented to our hospital with the chief complaint of left lateral thoracic pain. Chest computed tomography showed multiple nodular lesions in the left pleura and massive left pleural effusion. Based on clinical findings, imaging, and thoracoscopic pleural biopsy, a diagnosis of sarcomatoid diffuse pleural mesothelioma clinical T2N0M0 Stage IB was made. We administered nivolumab plus ipilimumab as first-line treatment, which resulted in significant reduction of pleural lesions and complete resolution of pleural effusion after two courses. No immune-mediated adverse events except fever were observed. Treatment was discontinued after 16 courses, with no disease recurrence for more than 2 years following the initial treatment. This case suggests that nivolumab plus ipilimumab can be an effective treatment option for older adults with pleural mesothelioma who maintain a good performance status.

© 2025 The Authors. Published by Elsevier Ltd.

In plain English

This case report from a cancer center in Sapporo, Japan, described one 80-year-old woman with sarcomatoid diffuse pleural mesothelioma, a cancer of the lining around the lung. She had left-sided chest pain, and scans showed fluid around the left lung and multiple nodules in the left pleura. She had never smoked, worked as a calligraphy teacher, and had no known occupational asbestos exposure or residence in an asbestos-contaminated environment. Her cancer was clinical T2N0M0 Stage IB, and surgery was judged inappropriate because of the tumor type. Her first treatment was the immunotherapy combination nivolumab plus ipilimumab. After two cycles, CT showed an 83% reduction in tumor size and the fluid had fully cleared. She had a fever after the first dose, classed as a Grade 2 infusion-related reaction. No immune-mediated adverse events were observed. Treatment, which lasted approximately two years, stopped after 16 courses at her request. She remained progression-free for more than 2 years counted from the start of treatment. The authors concluded that this combination may be an effective option for older adults with pleural mesothelioma, particularly those with good performance status.

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 (single patient)
• Who was studied: One 80-year-old woman, a never-smoker working as a calligraphy teacher, treated at NHO Hokkaido Cancer Center, Sapporo, Japan. She was diagnosed with sarcomatoid diffuse pleural mesothelioma, clinical T2N0M0 Stage IB.
• Exposure: No known occupational asbestos exposure or residence in an asbestos-contaminated environment. The treatment studied was first-line nivolumab plus ipilimumab.
• Main results:
  • After two cycles of nivolumab plus ipilimumab, chest CT showed an 83% reduction in tumor size and complete resolution of pleural effusion in this patient
  • The patient developed a fever within 24 hours of the first dose, classified as a Grade 2 infusion-related reaction
  • No immune-mediated adverse events were observed
  • Treatment was discontinued after 16 courses over approximately two years, at the patient's request
  • The patient remained progression-free for more than 2 years, measured from the initial treatment
  • Tumor tests showed retained BAP1 expression, MTAP loss, and low tumor PD-L1 expression (1%)
• The authors' conclusion: The authors concluded that nivolumab plus ipilimumab may be an effective treatment option for older adult patients with pleural mesothelioma, particularly those with a good performance status. They also concluded that further study of biomarkers is warranted.

Topics

Medical terms in this study, explained in our Lexicon: Sarcomatoid, Pleural Mesothelioma, Nivolumab (Opdivo), Ipilimumab (Yervoy), Pleura, Pleural Effusion, Pleural Biopsy, Performance Status.

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