The Use of Combination Immunotherapy in Mesothelioma

Solange Peters, MD, PhD, the president of the European Society of Medical Oncology (ESMO), discusses the use of immunotherapy for the treatment of mesothelioma.

According to Peters, mesothelioma is a rare disease without recent advances. There is some evidence that immunotherapy may work for a small portion of these patients. However, which patients may derive benefit from immunotherapy and when remains to be seen.

Data presented by Peters at the recent ESMO Congress found that an immunotherapy combination in the frontline setting may cause durable survival benefits in this patient population. Typically, immunotherapy is used in the later lines of treatment. According to Peters, even a year after ending therapy, 1 in 3 patients continue to show a response. 

0:08 | It is a rare disease entity where we have not been doing any significant advances. In the recent years, we've been seeing some signals that immunotherapy might work in a small proportion of patients, and this signal is in the later lines, second or third line of therapy. However, we are still unable to identify which patients. For example, one trial called the PROMISE-meso [NCT02991482] was a randomized trial of chemotherapy versus pembrolizumab in second the line. It couldn't reach statistical significance in favor of immunotherapy, because only a small proportion of mesothelioma patients did benefit from anti-PD-1 or anti PD-L1 only.

0:49 | So, what is interesting with this data I presented is, it is first of all the first data set showing that immunotherapy gives rise to a significant durable survival benefit. And it is a frontline strategy. So, before any chemo. So, it's really kind of a new paradigm. First of all, you establish Immunotherapy in mesothelioma, but you don't establish it as a late line but as a frontline. I think the difference here is duel immunotherapy, right? You have nivolumab [Opdivo] and low dose ipilimumab [Yervoy] up to 2 years, versus the usual platinum-based chemotherapy up to 6 cycles. But by having the duel immunotherapy and with a minimum of 3 years of follow up, you really can show this durable benefiting of overall survival with the hazard ratio of 0.734 of nivolumab and ipilimumab versus chemo. And this is really also proceeding in a wonderful duration of response. I would say to give some numbers in terms of duration of response, almost 1 patient out of 3 is still in response at 3 year despite all stop of the drugs at 2 years, so 1 year off treatment. So, it's really very interesting data. And it's the first time we have randomized data in mesothelioma for immunotherapy.