Primary Outcome Measures
- To assess the percentage of successful completion of a neoadjuvant double chemotherapy / double immunotherapy regimen followed by surgery in a selected group of T2-T3 (according to TNM 9) patients with pleural mesothelioma.
Secondary Outcome Measures
- Toxicity of the neoadjuvant double chemotherapy / double immunotherapy regimen and surgery.
- Efficay of neoadjuvant double chemotherapy / double immunotherapy regimen in inoperable T2-3 PM patients.
- Quality of life during the neoadjuvant double chemotherapy / double immunotherapy regimen and surgery.
Inclusion Criteria
- Capable of written informed consent and adherence to study procedures
- Pathologically confirmed PM (epithelioid), cT2-3 N0-1 M0 according to UICC TNM 9 and considered inoperable by the Multidisciplinary Tumor Board of UZA/UZG at the start of the trail. They only enter the second surgical stage when becoming operable after neoadjuvant therapy
- Aged 18 years or older
- World Health Organization (WHO) Performance Status 0-1
- Fit for systemic chemotherapy, immunotherapy and surgery according to good clinical practice
- No pregnancy allowed: women of childbearing potential have to take adequate contraception to avoid pregnancy; men need to take adequate contraception (usage of a condom) to avoid pregnancy in female partners
Exclusion Criteria
- Operable PM patients according to TNM 9 criteria (T1) or inoperable PM patients who will not have a chance to become operable after neoadjuvant treatment according to TNM 9 criteria (some T3, all T4, N2-3, M1)
- Contralateral mediastinal (N2) or distant metastatic disease (evaluated by PET and chest CT)
- Patients unfit for systemic chemotherapy, immunotherapy or intrathoracic surgery. Patients with an active autoimmune disease or who have had prior splenectomy, an active/acute infection requiring antibiotics, a chronic infection (e.g. HIV, hepatitis B or C) or have a serious cardiac disease are unfit for systemic therapy because their immune system is not properly functioning
- Hypersensitivity or contraindications to the active substance or to any of the excipients of the medications (platinum salts, pemetrexed, ipilimumab, nivolumab) used in this study
- Concurrent active malignancy other than basal cell carcinoma of the skin or in situ carcinoma of the cervix including brain metastases
- Prior treatment with chemotherapy, immunotherapy, surgery (except for diagnostic thoracoscopy) or thoracic RT (including prophylactic tract irradiation)
- Patients with significantly altered mental status or with psychological, familial, sociological or geographical conditions potential hampering compliance with the study as decided by the investigator
