Doctors use neoadjuvant treatment to control or even shrink tumors before mesothelioma surgery. The fear is the therapy won’t be effective, and the delay in surgery will make an operation too risky.

Atezolizumab, an immune checkpoint inhibitor, seems to help when added to neoadjuvant chemotherapy.

Atezolizumab plus pemetrexed and cisplatin was safe and effective for all 25 malignant pleural mesothelioma patients in a clinical trial. The study was for patients with stage 1‑3 diseases. None of the participants had severe reactions to atezolizumab with chemotherapy.

According to MedWire News, the findings were presented at the IASLC 2021 World Conference on Lung Cancer. Dr. Anne Tsao, a mesothelioma specialist at MD Anderson Cancer Center in Houston, Texas, presented them.


Survival and Safety Data With Atezolizumab

There were 28 patients enrolled, and 25 received two cycles of atezolizumab. They received 1,200 mg plus cisplatin and pemetrexed. The latter two drugs are chemotherapy agents for mesothelioma. Twenty‑one patients received four cycles. Each cycle occurs three weeks apart.

Eighteen of the 29 patients (64%) had a partial response or stable disease. Partial response means the tumors shrank slightly. Stable disease means the tumors remain the same size.

They advanced to surgery with either pleurectomy with decortication or extrapleural pneumonectomy. Both of the surgeries are radical operations but proven to add 3‑5 years of survival when completed.

The main issue is few patients are eligible for surgery when diagnosed. Neoadjuvant treatment, if effective, can shrink the tumors enough to make surgery an option. This is why doctors are interested in making improvements to neoadjuvant therapy.

Of the 18 surgery patients, 15 received atezolizumab maintenance for at least one year after the operation. Three are still receiving atezolizumab.

The median progression‑free survival since the start of neoadjuvant treatment was 18.6 months. The median overall survival couldn’t be calculated, but it’s likely more than two years.

Tsao said the “trial highlights the challenging nature of neoadjuvant therapy”, according to MedWire News. She added more research is needed “to identify the biomarkers” to determine the appropriate therapies for patients.


What Is Atezolizumab?

Atezolizumab is an immune checkpoint inhibitor. It’s an immunotherapy that blocks the PD‑L1 and PD‑1 protein receptors. These receptors link and cause T‑cells to ignore mesothelioma cells.

Atezolizumab activates T‑cells properly against cancer cells like mesothelioma. In fact, atezolizumab was one of the immunotherapy drugs in a successful peritoneal mesothelioma clinical trial. Adding immunotherapy to chemotherapy can make both therapies better at killing cancer.

Immunotherapy makes the immune system stronger, and chemotherapy cells weaken cancer cells. A stronger immune system with the help of chemotherapy agents can make it easier to kill cancer cells.

Atezolizumab is only available in clinical trials. Mesothelioma patients can enroll in clinical studies to receive new and investigative therapies. Email our registered nurse, Karen Ritter, for help enrolling. She’s a patient advocate and can be reached at

    Sources & Author

Devin Goldan image

About the Writer, Devin Golden

Devin Golden is the content writer for Mesothelioma Guide. He produces mesothelioma-related content on various mediums, including the Mesothelioma Guide website and social media channels. Devin's objective is to translate complex information regarding mesothelioma into informative, easily absorbable content to help patients and their loved ones.

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