Journal club

Abstract

ONE STEP FORWARD IN THE FIGHT AGAINST MALIGNANT PLEURAL MESOTHELIOMA BUT NOT QUITE CHECKMATE Malignant pleural mesothelioma (MPM) is a highly aggressive cancer associated with prior asbestos exposure. Most patients present with unresectable disease and chemotherapy is their only option. Despite treatment with pemetrexed and platinumbased agent outcomes remains poor, however checkpoint inhibitor therapy has improved outcomes in other malignant diseases. Baas et al (Lancet 2021:397:375) report the interim analysis of a randomised clinical trial of nivolumab and ipilimumab compared with standard care. In this global, openlabel study participants, previously untreated, were randomised to receive nivolumab and ipilimumab (n=300) or pemetrexed and cisplatin/carboplatin (n=284). Immunotherapy resulted in an overall survival (OS) benefit of 18.1 months (95% CI 16.8 to 21.4) versus 14.1 months (12.4–16.2) in the chemotherapy group with a HR of 0.74 (96.6% CI 0.60 to 0.91). In subgroup analysis, while a modest improvement in OS was seen in the epithelioid group (18.7 months vs 16.5 months), a far greater effect was noted in the nonepithelioid group (18.1 months vs 8.8 months, HR 0.46 (0.31–0.68)). Safety profile was similar to that reported with the same combination used in lung cancer trials with a higher rate of discontinuation due to treatment toxicity (20% compared to 8%). The most common adverse effect with immunotherapy was diarrhoea (21%) and serious adverse event was colitis (3%). With CheckMate 743, it seems we have finally made some headway in the management of MPM, but as ever, patient selection remains key.