Primary Outcome Measures
1. number of patients going to operating room for surgical resection [ Time Frame: 30 days of the initially planned date ]
Patients who experience a greater than 30 day toxicity induced delay of surgery will be counted as a failure for the primary feasibility endpoint.
Inclusion Criteria
- Age ≥ 18 years
- Karnofsky performance status > 70%
- Pathologic diagnosis of malignant pleural mesothelioma.
- At least one measurement must be >1.5 cm.
- Potentially resectable by pleurectomy/decortication, as assessed by thoracic surgeon
- Negative serum pregnancy test in women of childbearing potential
- Female patients of childbearing potential must agree to use a highly effective form of contraception for the duration of the study and for at least 5 months after the last administration of nivolumab and at least 6 months after last administration of pemetrexed, whichever is longer
- Male patients with female partners of childbearing potential must agree to use a highly effective form of contraception for the duration of the study and for at least 7 months after the last administration of nivolumab and at least 3 months after the last administration of pemetrexed, whichever is longer
- Adequate archival or fresh tissue for correlative analyses within 60 days prior to starting treatment as long as there was no interval cancer-directed therapy. If sufficient archival or fresh tissue is not available, then a repeat biopsy at baseline prior to starting study treatment will be required.
- Absolute neutrophil count ≥ 1000/mcL
- Total bilirubin ≤ 1.5 mg/dl
- AST and ALT ≤ 3.0 x upper limit of normal
- Creatinine ≤ 1.5 x upper limit of normal
- Negative HIV serology blood test
Exclusion Criteria
- Prior treatment with chemotherapy or immunotherapy for mesothelioma
- Autoimmune disease requiring systemic immune modulating treatment during the past two years
- Pregnant or lactating women
- Known active hepatitis B or hepatitis C
- Current use of systemic prednisone at dose ≥ 10 mg daily (or the equivalent dose with another corticosteroid)
- Serious concurrent medical illness or another active cancer requiring treatment
- Active pneumonitis
