Pembrolizumab Prolongs Overall Survival in First-Line Treatment of Pleural Mesothelioma

Pleural mesothelioma is an aggressive cancer affecting the lining of the lungs and is usually associated with asbestos exposure. Recent research offers a new treatment option for patients with advanced pleural mesothelioma. The Lancet published a study suggesting that combining the immunotherapy drug pembrolizumab with platinum-pemetrexed-based chemotherapy can significantly improve survival in people with this serious disease.

This phase 3, multicenter, open-label study examined patients with previously untreated advanced pleural mesothelioma who were not eligible for surgery. Of the 440 participants, 218 received chemotherapy alone and 222 received chemotherapy with pembrolizumab.

Findings

According to the study results:

• Median overall survival among patients receiving chemotherapy with pembrolizumab was 17.3 months, compared with 16.1 months (HR 0.79; 95% CI 0.64–0.98, p=0·0324) with chemotherapy alone.
• The two-year overall survival rate was 39% and the three-year rate was 25% among patients treated with the addition of pembrolizumab, compared with 33% and 17%, respectively, with chemotherapy alone.
• Median progression-free survival was 7.13 months in the pembrolizumab treatment group and 7.16 months in the chemotherapy-only group.
• The objective response rate was 62% in the pembrolizumab group and 38% in the chemotherapy-only group.

Treatment-related adverse events of any grade were frequent in both groups: 98% versus 95%. The most common were fatigue and nausea. Diarrhea, skin effects and myelosuppression were more common among patients receiving pembrolizumab. Grade 3-4 (serious) adverse events occurred in 27% of patients receiving pembrolizumab and 15% of those receiving chemotherapy alone.

Conclusion

In light of these results, adding pembrolizumab to platinum-pemetrexed chemotherapy appears to improve overall survival, progression-free survival and objective response rates regardless of PD-L1 expression. This regimen, familiar from the treatment of non-small cell lung cancer, offers a new first-line treatment option for unresectable pleural mesothelioma.

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Image description: The article image was generated by ChatGPT 4.0 using the prompt: “An abstract artistic depiction of the lining of the lungs.”

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