Although the only FDA-approved regimen for the treatment of patients with pleural malignant mesothelioma is the chemotherapy combination of pemetrexed and cisplatin, clinical trials of combination immunotherapy are showing impressive overall survival (OS) data.
, Zalcman, head of Thoracic Oncology Department, Hôpital Bichat-Claude Bernard, Université Paris-Diderot, reviewed the MAPS2 trial and discussed the promise of immunotherapy in patients with mesothelioma.
OncLive: Can you comment on the MAPS2 results?
: We presented the updated results of the randomized phase II trial MAPS2, or IFCT-1501, on behalf of the French Intergroup. This was a trial assessing nivolumab, or nivolumab plus ipilimumab, in patients with mesothelioma in the second- or third-line setting. It was a noncomparative randomized trial, so we are not allowed to compare the 2 arms directly. The median follow-up was 15 months.
For OS, it is more complex. In the nivolumab arm, PD-L1–positive patients did better than the PD-L1–negative group. However, in the combination arm, the PD-L1 IHC had no influence on OS. Therefore, PD-L1 as a biomarker could be a good marker for nivolumab, but is not a good biomarker for the combination.
What is the first-line standard of care for patients with mesothelioma?
Currently, first-line mesothelioma treatment is based on the backbone of pemetrexed/cisplatin chemotherapy plus or minus bevacizumab (Avastin). The median OS ranges from 15 to 19 months and there is currently no recognized second-line treatment for this disease. Therefore, the positivity of this MAPS2 trial support the use of immunotherapy as second- and third-line therapy. This has actually been written as an option by the NCCN panel. The company developing these drugs is going to seek a breakthrough application with the FDA.
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