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The following is a summary of “Nivolumab and ipilimumab in the real-world setting in patients with mesothelioma,” published in the December 2023 issue of Pulmonology by Dumoulin et al.
The combined administration of nivolumab (anti-PD-1) and ipilimumab (anti-CTLA-4) has emerged as a frontline treatment regimen for pleural mesothelioma, significantly enhancing patient survival rates. Nonetheless, a notable proportion of individuals encounter severe treatment-related adverse events (TRAEs), resulting in the premature cessation of therapy. This study presents novel insights derived from real-world data encompassing the outcomes of treating malignant mesothelioma with nivolumab plus ipilimumab across two specialized mesothelioma centers. Conducted retrospectively, this analysis encompassed data collection from 184 patients undergoing nivolumab plus ipilimumab therapy for mesothelioma between January 2021 and August 2022.
The median follow-up duration stood at 12.1 months. Distinctly, the investigation focused on documenting severe grade 3–4 TRAEs and assessing various treatment efficacy parameters, including overall response rate (ORR), duration of response (DOR), disease control rate (DCR), median progression-free survival (mPFS), and median overall survival (mOS). Results revealed that 27.7% of patients experienced severe grade 3–4 TRAEs, contributing to treatment discontinuation in 25.0% of cases. Despite the observed challenges, the treatment regimen demonstrated an overall response rate of 21.7% (95% CI 15.7–27.7) and a median duration of response at 5.7 months (IQR 3.2–8.7). The disease control rate at 12 weeks was also recorded at 56.0% (95% CI 48.8–63.2), while the median progression-free survival was estimated at 5.5 months (95% CI 4.1–6.9). Notably, the median overall survival was identified as 14.1 months (95% CI 11.1–18.2), highlighting some positive aspects despite the challenges encountered with severe adverse events.
This study underscores the efficacy of the nivolumab plus ipilimumab combination in a real-world setting, revealing comparable outcomes to clinical trial data but concurrently emphasizing the substantial risk of severe treatment-related adverse events, subsequently leading to treatment cessation in a considerable fraction of patients. These findings underscore the need for a balanced consideration of efficacy and safety profiles in real-world treatment administration.
Source: sciencedirect.com/science/article/pii/S0169500223009789