The increasing incidence and poor outcome associated with MPM requires identification of effective treatment options. Initial data have demonstrated beneficial effects of IO in MPM, however recent results of clinical studies with immune checkpoint inhibitors (CPI) are not so encouraging. The aim of this study is to evaluate the outcomes of p with MPM treated with immunotherapy in clinical trials at our institution.
20 MPM p treated with IO at Vall d´Hebron Institute of Oncology between September 2012 and December 2016 were reviewed. Survival data were calculated by the Kaplan-Meier method. The associations of type of immunotherapy with outcomes were assessed with Cox regression models.
Patient’s characteristics: median age 63 years (45-77 years), males: 62%, performance status (PS) 1:86%, asbestos exposure: 82%, stage III at diagnosis: 51%, epithelial subtype: 82%. All p were treated with chemotherapy, 90% received cisplatin plus pemetrexed as first line with median progression free survival (PFS) of 9.1 months (m;CI95% 7.6-10.7). Clinical trial with IO was offered as second-line regimen in 65% and third line in 35%. Target of IO was CTLA4: 60%, PD-1: 25% and other CPI single agent 15% (LAG3, GITR, CD40). Overall, disease control rate at 4 months was 40%. Reason for treatment discontinuation was toxicity in 20% of cases. Median PFS with IO in second line was 5.6 m (2.7-NR) and in third line 3.7 m (1.4-NR, p = 0.77). Different outcomes were seen according to target selected: with PD-1 median PFS of 8.6 m (4.2-NR) and with CTLA4 of 4.2 m (2.2-NR), significantly longer than 1.9 m (0.7-NR) with other CPI (p 0.05 all comparisons).
In our single institution series of previously treated MPM, IO associates with prolonged disease control in a subgroup of patients, with longest benefit seen with anti PD-1 therapies. Further research with predictive biomarkers of IO in MPM is needed.
Clinical trial identification
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All authors have declared no conflicts of interest.