Brief report: Real-world toxicity and survival of combination immunotherapy in pleural mesothelioma—RIOMeso
Abstract
Background: Australia has one of the highest rates of asbestos-associated diseases. Mesothelioma remains an area of unmet need with a 5-year overall survival of 10%. First-line immunotherapy with ipilimumab and nivolumab is now a standard of care for unresectable pleural mesothelioma following the CheckMate 743 trial, with supportive data from the later line single-arm MAPS2 trial. RIOMeso evaluates survival and toxicity of this regimen in real-world practice. Methods: Demographic and clinicopathologic data of Australian patients treated with ipilimumab and nivolumab in first- and subsequent-line settings for pleural mesothelioma were collected retrospectively. Survival was reported using the Kaplan-Meier method and compared between subgroups with the log-rank test. Toxicity was investigator assessed using Common Terminology Criteria for Adverse Events version 5.0. Results: A total of 119 patients were identified from 11 centers. The median age was 72 years, 83% were male, 92% had Eastern Cooperative Oncology Group less than or equal to 1, 50% were past or current smokers, and 78% had known asbestos exposure. In addition, 50% were epithelioid, 19% sarcomatoid, 14% biphasic, and 17% unavailable. Ipilimumab and nivolumab were used first line in 75% of patients. Median overall survival (mOS) was 14.5 months (95% confidence interval [CI]: 13.0–not reached [NR]) for the entire cohort. For patients treated first line, mOS was 14.5 months (95% CI: 12.5–NR) and in second- or later-line patients was 15.4 months (95% CI: 11.2–NR). There was no statistically significant difference in mOS for epithelioid patients compared with nonepithelioid (19.1 mo [95% CI: 15.4–NR] versus 13.0 mo [95% CI: 9.7–NR], respectively, p = 0.064). Furthermore, 24% of the patients had a Common Terminology Criteria for Adverse Events grade greater than or equal to 3 adverse events, including three treatment-related deaths. Colitis was the most frequent adverse event. Conclusions: Combination immunotherapy in real-world practice has poorer survival outcomes and seems more toxic compared with clinical trial data. This is the first detailed report of real-world survival and toxicity outcomes using ipilimumab and nivolumab treatment of pleural mesothelioma.
Document Type
Journal Article
Date of Publication
4-1-2024
Volume
19
Issue
4
PubMed ID
38036250
School
School of Medical and Health Sciences
Copyright
free_to_read
Publisher
Elsevier
Recommended Citation
McNamee, N., Harvey, C., Gray, L., Khoo, T., Lingam, L., Zhang, B., Nindra, U., Yip, P. Y., Pal, A., Clay, T., Arulananda, S., Itchins, M., Pavlakis, N., Kao, S., Bowyer, S., Chin, V., Warburton, L., Pires da Silva, I., John, T., Solomon, B., Alexander, M., & Nagrial, A. (2024). Brief report: Real-world toxicity and survival of combination immunotherapy in pleural mesothelioma—RIOMeso. DOI: https://doi.org/10.1016/j.jtho.2023.11.014
Comments
McNamee, N., Harvey, C., Gray, L., Khoo, T., Lingam, L., Zhang, B., . . . Nagrial, A. (2024). Brief report: Real-world toxicity and survival of combination immunotherapy in pleural mesothelioma—RIOMeso. Journal of Thoracic Oncology, 19(4), 636-642. https://doi.org/10.1016/j.jtho.2023.11.014