Arnaud Scherpereel, MD, PhD
CHECKPOINT INHIBITION was effective against malignant pleural mesothelioma in the MAPS-2 study of the French Cooperative Thoracic Intergroup. At the 2017 ASCO Annual Meeting, researchers reported a disease control rate of up to 50% when patients were treated with immunotherapy after relapse in a malignancy that has had no effective second-line treatment options.1
This randomized, but noncomparative, phase II study was conducted in 125 patients with advanced mesothelioma who relapsed after 1 or 2 previous lines of therapy, including the pemetrexed (Alimta)/ platinum doublet. The primary endpoint was disease control rate at 12 weeks.
“Both nivolumab [Opdivo] alone and nivolumab plus ipilimumab [Yervoy] reached their primary endpoint in second- and third-line mesothelioma patients, meaningfully increasing the disease control rate at 12 weeks,” reported Arnaud Scherpereel, MD, PhD, a thoracic oncologist at the University Hospital of Lille in France. “Immunotherapy may provide a new therapeutic option as second-and third-line treatments for relapsing mesothelioma patients.”
The disease control rate was 44% for patients who received nivolumab at 3 mg/kg every 2 weeks and 50% for those who received nivolumab (same dose) plus ipilimumab at 1 mg/kg every 6 weeks in the first 108 eligible patients. These results are an improvement upon historical disease control rates of less than 30% seen with other second- and third-line therapies, Dr. Scherpereel said.
Survival and Toxicity
“PRELIMINARY SURVIVAL was also promising in both arms,” he said. At a median follow-up of 10.4 months for the 125 patients, median progression-free survival was 4.0 months with nivolumab and 5.6 months with nivolumab/ipilimumab, and median overall survival was 10.4 months with nivolumab but was not yet reached with the combination. Historically, median overall survival in the second-line setting usually ranges from 6 to 9 months, he pointed out.
“Side effects were rather mild overall, but severe side effects were slightly more common in the nivolumab/ipilimumab group,” he continued. “Toxicity was globally manageable.”
“This randomized phase II trial may be enough to support the use of immune checkpoint inhibitors in this setting,” Dr Scherpereel said. “But it is too early to conclude whether nivolumab alone or the combination of nivolumab and ipilimumab is better.” ■
DISCLOSURE: Dr. Scherpereel has been on advisory boards for AstraZeneca, Bristol-Myers Squibb, Boehringer-Ingelheim, MSD, and Roche. Bristol-Myers Squibb supplied nivolumab and ipilimumab and a research grant to IFCT for MAPS-2 biomarkers studies.
Anne Tsao, MD
STUDY DISCUSSANT Anne Tsao, MD, Director of the Mesothelioma Program at The University of Texas MD Anderson Cancer Center in Houston, indicated the response rates seen in the MAPS-2 trial are comparable to those demonstrated in smaller studies of pembrolizumab (Keytruda). She ...!-->!-->