Real-World Outcomes of Patients With Malignant Pleural Mesothelioma Receiving a Combination of Ipilimumab and Nivolumab as First- or Later-Line Treatment

Sabine Schmid; Lisa Holer; Katrin Gysel; Kira-Lee Koster; Sacha I Rothschild; Laura A Boos; Lorenz Frehner; Sabine Cardoso Almeida; Christian Britschgi; Yannis Metaxas; Michael Mark; Patrizia Froesch; Wolf-Dieter Janthur; Anna Allemann; Christine Waibel; Catherine Von der Mühll-Schill; Martin Früh; Laetitia A Mauti

doi:10.1016/j.jtocrr.2024.100735

Real-World Outcomes of Patients With Malignant Pleural Mesothelioma Receiving a Combination of Ipilimumab and Nivolumab as First- or Later-Line Treatment

JTO Clin Res Rep. 2024 Oct 15;5(12):100735. doi: 10.1016/j.jtocrr.2024.100735. eCollection 2024 Dec.

Authors

Sabine Schmid¹, Lisa Holer², Katrin Gysel², Kira-Lee Koster³, Sacha I Rothschild^{4

5}, Laura A Boos⁶, Lorenz Frehner¹, Sabine Cardoso Almeida⁷, Christian Britschgi^{6

7}, Yannis Metaxas⁸, Michael Mark^{9

10}, Patrizia Froesch¹¹, Wolf-Dieter Janthur¹², Anna Allemann¹³, Christine Waibel⁵, Catherine Von der Mühll-Schill¹⁴, Martin Früh^{1

3}, Laetitia A Mauti⁷

Affiliations

¹ Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
² Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland.
³ Department of Medical Oncology and Hematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
⁴ Department of Medical Oncology, University Hospital Basel, Basel, Switzerland.
⁵ Department of Oncology/Hematology, Cantonal Hospital Baden, Baden, Switzerland.
⁶ Department of Medical Oncology and Hematology, University Hospital Zürich, Zürich, Switzerland.
⁷ Department of Medical Oncology and Hematology, Cantonal Hospital Winterthur, Winterthur, Switzerland.
⁸ Department of Medical Oncology, Cantonal Hospital Münsterlingen, Münsterlingen, Switzerland.
⁹ Department of Medical Oncology, Cantonal Hospital Chur, Chur, Switzerland.
¹⁰ Università della Svizzera Italiana, Lugano, Switzerland.
¹¹ Department of Medical Oncology, Istituto Oncologico della Svizzera Italiana, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.
¹² Department of Medical Oncology, Cantonal Hospital Aarau, Aarau, Switzerland.
¹³ Department of Medical Oncology, Cantonal Hospital Lucerne, Lucerne, Switzerland.
¹⁴ Department of Medical Oncology, Claraspital Basel, Basel, Switzerland.

Abstract

Objectives: On the basis of the positive results of CheckMate-743, first-line (1L) treatment of malignant pleural mesothelioma (MPM) with the combination of ipilimumab and nivolumab (ipi-nivo) has become a standard-of-care. Furthermore, patients who received 1L platinum/pemetrexed chemotherapy are often considered for second or further-line (2L+) ipi-nivo on the basis of MAPS2 results. Here we report on real-world survival and safety outcomes of ipi-nivo for patients with MPM in Switzerland.

Methods: Twelve cancer centers contributed data to this retrospective cohort. Baseline characteristics including age, sex, histology, programmed death-ligand 1 expression, Eastern Cooperative Oncology Group performance status (ECOG PS), and previous/subsequent therapies were collected. The efficacy and safety outcomes were assessed by local investigators.

Results: Of the 109 patients with MPM treated with ipi-nivo between November 2017 and March 2023 (median follow-up of 16.6 months) 75% had epithelioid, 9% biphasic, and 16% sarcomatoid histology. The median age was 72 years; 91% were males, and 83% had an ECOG PS of 0 to 1. Ipilimumab in combination with nivolumab was given as 1L in 43% and as 2L+ treatment in 57% of patients. The objective response rate was 21% in 1L and 15% in 2L+. Median progression-free survival was 6.5 and 2.8 months, respectively. Median overall survival (OS) from the start of ipi-nivo was 12.6 months for 1L and 6.9 months for 2L+. No differences in OS were observed depending on age and programmed death-ligand 1 expression. Nevertheless, the median OS was significantly worse in patients with an ECOG PS of 2 or higher than those with an ECOG PS of 0 to 1 (2.4 versus 11.9 months, p < 0.001). Treatment-related adverse events (TRAEs) of any grade related to ipi-nivo treatment occurred in 65 patients (62%). The highest-grade TRAE was 1 to 2 in 58% of these patients and 3 or higher in 42% Treatment discontinuation due to a TRAE occurred in 22% of patients.

Conclusion: In this real-world cohort of patients with MPM treated with ipi-nivo survival outcomes were inferior to those reported in the CheckMate-743 and MAPS2 trials, whereas safety outcomes were similar.

Keywords: Ipilimumab; Malignant pleural mesothelioma; Nivolumab; Outcome; Real-world.