Sarcomatoid mesothelioma is the toughest cell histology for this cancer. Most surgeons won’t operate on these cases, and chemotherapy does little to slow tumor growth.
For these patients with few options, immunotherapy is their best option.
A study out of Germany showed how immunotherapy adds months of survival to cases of sarcomatoid mesothelioma. The improvement in outcome is far less for the other cell type: epithelioid mesothelioma. One mesothelioma specialist in the United States affirms his belief in immunotherapy as a first‑line treatment for rare sarcomatoid cases.
The German Institute for Quality and Efficiency in Health Care provided immunotherapy to all cases of malignant mesothelioma. Most people had epithelioid histology, while around 20% had a sarcomatoid diagnosis.
The study gave patients Opdivo and Yervoy, two immunotherapy drugs for mesothelioma. Opdivo and Yervoy are approved, as a substitute for chemotherapy, for unresectable cases. These two immune checkpoint inhibitors target specific protein receptors on cancer cells and T‑cells. Blocking the receptors allows T‑cells to target mesothelioma cells more effectively.
Epithelioid patients survived on average 19 months with immunotherapy, compared to just 16 months with mesothelioma chemotherapy. For sarcomatoid cases, the difference was larger:
- 17 months for immunotherapy
- 9 months for chemotherapy
“For patients with non‑epithelioid tumour histology, there is an indication of considerable added benefit,” the researchers wrote. “An added benefit of nivolumab plus ipilimumab compared to a combination of pemetrexed and platinum‑containing chemotherapy is not proven for patients with epithelioid tumour histology.”
Dr. Wickii Vigneswaran is the Director of Thoracic Surgery at Loyola University Health System. He said the hospital’s protocol is to recommend immunotherapy as a first‑line therapy for sarcomatoid mesothelioma. For epithelioid cases, he said the approach is chemotherapy and then hopefully surgery.
He’s not the only doctor believing in histology affecting therapy. A report in the JTO Clinical and Research Reports states non‑epithelioid cases are three times more likely than epithelioid cases to receive immune checkpoint inhibitors.
Sources & Author
- Nivolumab + ipilimumab: Added benefit in pleural mesothelioma with non-epithelioid tumour histology. American Association for the Advancement of Science. Retrieved from: https://www.eurekalert.org/news-releases/930445. Accessed: 10/05/2021.
- Immune Checkpoint Inhibitor Uptake in Real-World Patients With Malignant Pleural Mesothelioma. JTO Clinical and Research Reports. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/34590032/. Accessed: 10/13/2021.
Sources & Author