From the blog

Opdivo and Yervoy After Mesothelioma Surgery Improves Survival

Published: February 3, 2023

There might be more options for treating mesothelioma. A study looked at the combination of Opdivo and Yervoy after surgery. The study was performed at the Hyogo College of Medicine in Japan. Opdivo and Yervoy, which were recently approved for the treatment of mesothelioma, improved survival when administered after surgery. The six-month survival was 87 percent and the 12-month survival was 74.2 percent. Researchers believe that the combination could be very effective for post-surgery applications due to these results. There were higher rates of adverse effects in patients though. The combination of immunotherapy drugs is expected to improve results in patients with pleural mesothelioma, but currently, there are no studies that look at Opdivo and Yervoy as post operative treatments for pleural mesothelioma.

The study consisted of patients from the Hyogo College of Medicine treated January 2004 through October 2022. All patients had pleural mesothelioma and had some form of multimodal therapy. Patients received chemotherapy either before or after surgery. Most patients received a pleurectomy and decortication and some patients also had radiation. There were 41 patients treated with nivolumab (Opdivo) and ipilimumab (Yervoy) between June 2021 and July 2022. They received 360 mg of nivolumab by IV every three weeks and 1 mg/kg ipilimumab by IV every six weeks.

During the study, patients were evaluated every six to 12 weeks by radiological imaging. There was a partial response to treatment in 18 of the patients. A partial response means tumors had a considerable reduction in size. Thirteen of the patients had no response, known as stable disease. Ten of the patients saw an increase in tumor size. Objective response rate was 43.9 percent while the disease control rate was 75.6 percent. The median progression free survival, which means patients’ cancer did not grow for a certain period of time, was 7.3 months. Around half, or 20 out of 41 patients, had an ongoing response to the treatment. This means the treatment was effective after the trial was over. Multiple side effects including an inflamed pituitary gland, adrenal insufficiency, colitis, and hyperthyroidism were observed. The adverse effects were treatable with protocol specific guidelines, so the treatments were at least manageable, and the treatments were accessible to patients.

Opdivo and Yervoy were approved for the treatment of mesothelioma in October 2020.It was the first time a treatment was approved for mesothelioma in 15 years.  Patients are eligible for the treatment if they are not able to receive surgery. Citing a treatment that evaluated nivolumab as a second line therapy, researchers believe the combination of nivolumab and ipilimumab is important for the treatment of mesothelioma after surgery. The study had 34 patients and  the median overall survival was 17.3 months. Opdivo and Yervoy were approved because of Checkmate 743, a clinical trial that had an overall response rate of 39.6 percent and an overall increase of survival versus chemotherapy. Researchers from Hyogo believe treatment is crucial for cancer recurrence. A previous study saw a median overall survival of 24.1 months vs patients who only received supportive care only having a survival of 4.2 months. More research needs to be done on the treatment combination, but currently, the researchers believe the treatment could be effective despite adverse side effects. They believe more research to determine long-term survival, prognostic factors, and development of adverse effects needs to be performed.

Akifumi Nakamura et al., “Efficacy and safety of nivolumab with ipilimumab for recurrent malignant pleural mesothelioma after primary surgical intervention” International Journal of Clinical Oncology (January 7, 2023). [Link]
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