Nivolumab Immunotherapy in Malignant Mesothelioma: A Case Report Highlighting a New Opportunity for Exceptional Outcomes

• Published in: The American journal of case reports Vol. 19; pp. 783 - 789
• Main Authors: Jones, Riley G, Karthik, Felix, Dugar, Anushree, Kanagarajan, Karthik, Desai, Kalpan, Bhandari, Manish
• Format: Journal Article
• Language: English
• Published: United States International Scientific Literature, Inc 04-07-2018
• Subjects: Aged; Antibodies, Monoclonal - therapeutic use; Antineoplastic Agents - therapeutic use; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Humans; Immunotherapy; Male; Mesothelioma - drug therapy; Nivolumab; Pleural Neoplasms - drug therapy; Treatment Outcome
• ISSN: 1941-5923; 1941-5923
• DOI: 10.12659/AJCR.909584

BACKGROUND Malignant pleural mesothelioma (MPM) is a highly lethal cancer with a median survival of ~12 months even with aggressive intervention. Frontline therapy relies on systemic cisplatin and pemetrexed chemotherapy and has a response rate of ~35-41%; currently, there are no US Food and Drug Administration approved second-line therapies for MPM. Herein, we present a patient with MPM who experienced rapid disease progression after standard therapy but who had an exceptional and sustained response to immune checkpoint inhibition with single agent nivolumab. CASE REPORT A 68-year-old male with a history of work-related asbestos exposure was diagnosed with MPM. He was treated with primary resection followed by systemic chemotherapy with cisplatin and pemetrexed. When chemotherapy failed, he was switched to immunotherapy with nivolumab and achieved an exceptional response. CONCLUSIONS We report the first case of a patient with MPM who experienced rapid disease progression after standard therapy but had an exceptional and sustained response to immune checkpoint inhibition with single agent nivolumab. As outcomes with traditional chemotherapy regimens remain disappointing, there is a substantial need for new approaches to MPM; our case highlights a new therapeutic opportunity even in the face of aggressive disease. Indeed, a new era of investigation utilizing immunotherapy for mesothelioma is beginning, with much anticipation.