Mesothelioma: first-line dual immunotherapy holds promise

  • WCLC 2020
  • 8 Aug 2020

  • curated by Pavankumar Kamat
  • Univadis Clinical Summaries
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Takeaway

  • Chemotherapy-free management of previously untreated mesothelioma may be possible with the immunotherapy combination of nivolumab plus ipilimumab (nivo+ipi).

Why this matters

  • The findings suggest that dual immunotherapy in the first-line treatment of mesothelioma could be a new standard of care.

Study design

  • Interim analysis of phase 3 CheckMate 743 trial: 605 patients with treatment-naive pleural mesothelioma were randomly assigned (1:1) to receive nivo+ipi for up to 2 years or chemotherapy (pemetrexed plus cisplatin or carboplatin) until disease progression or unacceptable toxicity.
  • Funding: Bristol-Myers Squibb.

Key results

  • Nivo+ipi was associated with a significant improvement in median OS vs chemotherapy:
    • 18.1 vs 14.1 months;
    • HR, 0.74 (P=.0020).
  • OS benefit of nivo+ipi was almost similar for epithelioid (18.7 months) and nonepithelioid tumor subtypes (18.1 months).
  • There was no difference between the 2 arms in PFS. 
  • Nivo+ipi was associated with a greater median duration of response (11.0 months) vs chemotherapy (6.7 months).
  • At 24 months, 32% of patients in the nivo+ipi arm were experiencing a response vs 8% in the chemotherapy arm.
  • Overall, treatment-related adverse event (TRAE) rates were almost similar between the 2 arms; however, nivo+ipi was associated with more grade 3 or 4 serious TRAEs than chemotherapy (15 vs 6).

Limitations

  • Study is ongoing.