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World J Clin Oncol. Apr 24, 2022; 13(4): 267-275
Published online Apr 24, 2022. doi: 10.5306/wjco.v13.i4.267
Tsunami of immunotherapy reaches mesothelioma
Xabier Mielgo-Rubio, Ana Cardeña Gutiérrez, Verónica Sotelo Peña, Maria Virginia Sánchez Becerra, Andrea María González López, Adriana Rosero, Juan Carlos Trujillo-Reyes, Felipe Couñago
Xabier Mielgo-Rubio, Maria Virginia Sánchez Becerra, Andrea María González López, Department of Medical Oncology, Hospital Universitario Fundación Alcorcón, Alcorcón 28922, Madrid, Spain
Ana Cardeña Gutiérrez, Department of Medical Oncology, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Canarias 38010, Spain
Verónica Sotelo Peña, Department of Medical Oncology, Hospital Virgen de La Luz, Cuenca 16002, Spain
Adriana Rosero, Department of Medical Oncology, Hospital Universitario Del Henares, Coslada 28822, Madrid, Spain
Juan Carlos Trujillo-Reyes, Department of Thoracic Surgery, Hospital Universitari de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona 08029, Spain
Felipe Couñago, Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid, Pozuelo de Alcorcón 28223, Madrid, Spain
Felipe Couñago, Department of Radiation Oncology, Hospital La Luz, Madrid 28003, Spain
Felipe Couñago, Medicine Department, Universidad Europea de Madrid, Villaviciosa de Odón 28670, Madrid, Spain
Author contributions: All authors contributed equally to the elaboration of the manuscript.
Conflict-of-interest statement: Xabier Mielgo-Rubio declares the following conflicts of interest: Advisory role; Boehringer-Ingelheim, Astra Zeneca, Brystol Myers Squibb. Speakers’ bureau; Roche, Astra Zeneca, Brystol Myers Squibb, MSD, Abbott. Research funding; Brystol Myers Squibb. Rest of authors declare declare any conflicts of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xabier Mielgo-Rubio, MD, Doctor, Staff Physician, Department of Medical Oncology, Hospital Universitario Fundación Alcorcón, Budapest 1, Alcorcón 28922, Madrid, Spain. xmielgo@hotmail.com
Received: April 3, 2021
Peer-review started: April 3, 2021
First decision: July 6, 2021
Revised: September 4, 2021
Accepted: April 3, 2022
Article in press: April 3, 2022
Published online: April 24, 2022
Abstract

Malignant pleural mesothelioma (MPM) is the most common type of malignant mesothelioma. It is a rare tumor linked to asbestos exposure and is associated with a poor prognosis. Until very recently, patients with advanced or unresectable disease had limited treatment options, primarily based on doublet chemotherapy with cisplatin and pemetrexed. In 2020 and 2021, after more than a decade with no major advances or new drugs, two phase III clinical trials published results positioning immunotherapy as a promising option for the first- and second-line treatment of MPM. Immunotherapy has revolutionized the treatment of many cancers and is also showing encouraging results in malignant mesothelioma. Both immune checkpoint inhibition and dual cytotoxic T-lymphocyte–associated antigen 4 and programmed death-ligand 1 pathway blockade resulted in significantly improved overall survival in randomized phase III trials. In the CheckMate 743 trial, first-line therapy with nivolumab plus ipilimumab outperformed standard chemotherapy, while in the CONFIRM trial, nivolumab outperformed placebo in patients previously treated with chemotherapy. These two trials represent a major milestone in the treatment of MPM and are set to position immunotherapy as a viable alternative for treatment-naïve patients and patients with progressive disease after chemotherapy.

Keywords: Mesothelioma, Malignant pleural mesothelioma, Immunotherapy, Immune checkpoint inhibitors, Cytotoxic T-lymphocyte–associated antigen 4, Programmed cell death protein 1, Nivolumab, Ipilimumab, Immunotherapy combo, CheckMate 743, CONFIRM

Core Tip: Malignant pleural mesothelioma (MPM) is the most common type of malignant mesothelioma and is associated with a poor prognosis. The treatment options for advanced MPM were limited until very recently, when the results from two phase III trials showed improved survival in patients treated with immunotherapy. In the first trial, CheckMate 743, nivolumab plus ipilimumab as first-line therapy achieved better overall survival than standard chemotherapy, while in the second trial, CONFIRM, nivolumab vs placebo significantly improved overall survival in patients previously treated with chemotherapy. In this article, we discuss recent advances and highlights in the treatment of MPM.