Immune checkpoint inhibitors (ICIs) may be superior to chemotherapy as second-line treatment for malignant pleural mesothelioma (MPM), according to research published in Lung Cancer.

The researchers noted that ICIs have produced mixed results as second-line therapy in MPM trials, so the team set out to evaluate the effectiveness of second-line ICIs in a real-world setting.

The researchers conducted a retrospective cohort study of 176 patients with MPM who received second-line therapy from 2015 to 2019. The patients’ median age was 75 years, 77% of patients were White, 74% were men, and 67% had epithelioid histology.

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There were 115 patients who received ICI treatment and 61 patients who received chemotherapy. In the ICI group, 80 patients received pembrolizumab, 31 received nivolumab, and 4 received nivolumab plus ipilimumab. In the chemotherapy group, 48 patients received gemcitabine, 11 received vinorelbine, and 2 received gemcitabine plus vinorelbine.

The median overall survival was significantly longer with ICIs than with chemotherapy — 8.7 months and 5 months, respectively (adjusted hazard ratio, 0.52; 95% CI, 0.34-0.81; P =.001). The estimated 12-month overall survival rate was 36.7% and 15.6%, respectively.

The overall mortality rate was 91.8% among patients who received chemotherapy and 79.1% among patients who received ICIs (P =.031).

“Our findings suggest that ICI may benefit patients with advanced MPM and progression after initial platinum-based chemotherapy,” the researchers wrote. “Further investigation is needed to determine the role of ICI therapy in MPM patients with disease progression after first-line therapy and if outcomes vary by histologic subtype.”


Kim RY, Li Y, Marmarelis ME, Vachani A. Comparative effectiveness of second-line immune checkpoint inhibitor therapy versus chemotherapy for malignant pleural mesothelioma. Lung Cancer. Published online July 17, 2021. doi:10.1016/j.lungcan.2021.06.017