Recurrent malignant peritoneal mesothelioma: Is immune checkpoint inhibitor-related treatment with Nivolumab und Ipilimumab an option?

Summary Mesothelioma is a malignant tumour of serosa membranes. The most common origin is from the visceral pleura. The malignant peritoneal mesothelioma (MPM) origins from the peritoneal serous mesothelium and is rarer. Due to its rarity, there are few research trials for treatment in comparison with malignant pleural mesothelioma. According to current literature standard first-line therapy is cytoreductive surgery followed by early postoperative chemotherapy or heated intraperitoneal chemotherapy (HIPEC). Anti- PD-L1-treatment could be a new option.

Clinical history and findings A 70 years old patient with MPM went through cytoreductive surgery and HIPEC-therapy in our department using Doxorubicin and Cisplatin followed by IV chemotherapy with Cisplatin and Pemetrexed. Three years after first diagnosis, a CT scan revealed the first recurrence. Re-induction was carried out with 6 cycles of Carboplatin and Pemetrexed. After another three years, because of the second recurrence another intraperitoneal debulking was carried out. Cytostatic chemotherapy with Gemcitabine for a total of 6 cycles was intended. However, therapy had to be stopped after just one cycle due to pronounced toxicity. In the following year, another CT scan showed progression.

Therapy and clinical course In analogy to studies for therapy of pleural mesothelioma and after testing for PD-L1 expression (TPS 8%, CPS 9 %, IC 8 %), treatment with a combination of Nivolumab (240mg qw2) and Ipilimumab (1mg/kg KG qw6) was initiated. Treatment was discontinued after 2 months due to catheter-associated sepsis. Follow-up visits now show stable disease over 6 months.

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Artikel online veröffentlicht:
11. Oktober 2022