Complete Pathological Response After Neoadjuvant Chemo-Immunotherapy in Malignant Pleural Mesothelioma

Tostes, Francinne T.; Zugman, Miguel; Paes, Vítor Ribeiro; Schvartsman, Gustavo

doi:10.3389/fonc.2022.836751

Cited by 3 publications

(1 citation statement)

References 8 publications

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“…Limited experiences with these agents before surgery are currently documented in short reports. Tostes et al (6) reported a pCR in a patient with epithelioid PM who underwent surgery after neoadjuvant therapy with cisplatin, pemetrexed, and off-label pembrolizumab. While the concept of resectable PM is currently under debate (7), the utilization of ICIs or ICIs combined CT in the pre-operative setting holds promise for new therapeutic opportunities in PM.…”

Section: Discussionmentioning

confidence: 99%

Pathological complete response in a patient with pleural mesothelioma treated with immunotherapy: a case report

Faccioli,

Grosso,

Dell’Amore

et al. 2024

Front. Oncol.

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The role of immunotherapy in the multimodal treatment for pleural mesothelioma (PM) is still under investigation, particularly in the preoperative setting. Pathological complete response (pCR) has been previously described after chemotherapy and immunotherapy; however, there is no prior experience reported with immunotherapy alone before surgery. We report the case of a 58-year-old male with biphasic PM treated with immunotherapy, resulting in a major clinical partial response. Following a multidisciplinary evaluation between thoracic surgeons, medical oncologists, pathologists, radiologists and radiation oncologists, the patient underwent surgery with radical intent through a right extended pleurectomy/decortication (eP/D). Histopathological examination of the specimen confirmed a pathological Complete Response (pCR). This case supports the feasibility and potential efficacy of combining preoperative immunotherapy with surgery in the management of advanced PM.

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Section: Discussionmentioning

confidence: 99%

Pathological complete response in a patient with pleural mesothelioma treated with immunotherapy: a case report

Faccioli,

Grosso,

Dell’Amore

et al. 2024

Front. Oncol.

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Primary Intrahepatic Mesothelioma: Case Series and Systematic Review of Literature

Jia,

Tan,

Gao

et al. 2024

J Gastrointest Canc

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Surgery for pleural mesothelioma in multimodality setting: comparison between surgical techniques in a high-volume centre

Faccioli,

Dell’Amore,

Lorenzoni

et al. 2024

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES Pleural mesothelioma (PM) is an aggressive disease linked to asbestos exposure, presenting significant treatment challenges. The recommended approach is multimodal treatment, even if the concept of resectable PM and the superiority of one surgical technique over the other [(extended) pleurectomy decortication [(E)PD] vs extra-pleural pneumonectomy (EPP)] are matter of debates. The aim of this study is to compare the two techniques in terms of short- and long-term outcomes at a high-volume center. METHODS Clinical data from PM patients who underwent radical surgery [(E)PD and EPP] between 1994 and 2022 were collected. A propensity score weighting approach was used for non-random intervention allocation. Survival distribution was estimated using Kaplan–Meier method and the association with outcomes was evaluated using a weighted Cox Proportional Hazard Models. RESULTS Among 254 patients, 125 (49%) underwent EPP and 129 (51%) (E)PD. The 90-day mortality was higher in the EPP group (7.2% vs 0%; p = 0.01). No difference in 1-,3- and 5-year survival was found: 65.8%, 26%, 17% for EPP and 75.5%, 39.7% and 21.3% for (E)PD; p = 0.39). The multivariable weighted Cox model identified no increased risk of death (HR 1.25; p = 0.49) or recurrence (HR 1.05; p = 0.858) in the EPP group. Pre-operative total lung capacity (TLC) was significantly associated with a reduced risk of death (HR 0.96; p = 0.023) and recurrence (HR 0.97; p = 0.019) at follow-up while preoperative disease burden to a higher risk of recurrence (HR 1.01; p = 0.02). CONCLUSIONS Our experience showed acceptable short- and long-term outcomes in both procedures, making EPP still an option only for carefully selected patients at high volume center. Surgery, although recently debated, should be performed exclusively in expert centers to minimize post-operative risks. The identification of new prognostic factors is crucial for better selecting patients who may benefit from surgery within the context of multimodal treatment.

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Complete Pathological Response After Neoadjuvant Chemo-Immunotherapy in Malignant Pleural Mesothelioma

Cited by 3 publications

References 8 publications

Pathological complete response in a patient with pleural mesothelioma treated with immunotherapy: a case report

Pathological complete response in a patient with pleural mesothelioma treated with immunotherapy: a case report

Primary Intrahepatic Mesothelioma: Case Series and Systematic Review of Literature

Surgery for pleural mesothelioma in multimodality setting: comparison between surgical techniques in a high-volume centre

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