Skip to main content
NCBI home page
Immunotherapy logoLink to Immunotherapy
. 2025 Jul 21;17(10):703–708. doi: 10.1080/1750743X.2025.2535941

Neoadjuvant immunotherapy in a solitary, isolated peritoneal mesothelioma involving the abdominal wall: a case report

Parsa Charkhchi a, Ryan Le b, Taryn E Cazzolli c, Raina R Flores a,c, Roberto A Martinez a,d, Supreet Kaur a,e, Mio Kitano a,f,✉
PMCID: PMC12355671  PMID: 40686009

ABSTRACT

Mesothelioma is a rare neoplasm with a minority of cases originating from the peritoneum. Patients are generally treated with a combination of cytoreductive surgery, hyperthermic intraperitoneal chemotherapy, and various systemic therapies. In recent years, expression of programmed death ligand 1 (PD-L1) has been investigated in mesothelioma with implications for targeted therapy. In this case report, we present a patient with solitary isolated peritoneal mesothelioma of the right flank with abdominal and chest wall involvement and high PD-L1 positivity. The patient demonstrated a remarkable metabolic response to neoadjuvant immunotherapy using nivolumab and ipilimumab, which was followed by a successful surgical resection. Pathological evaluation revealed a complete pathological response, highlighting the effectiveness of the treatment strategy.

KEYWORDS: Peritoneal mesothelioma, solitary peritoneal mass, neoadjuvant immunotherapy, nivolumab, ipilimumab, PD-L1, immune checkpoint inhibitors

Plain Language Summary

Peritoneal mesothelioma is a rare and aggressive cancer that forms in the lining of the abdomen. Most patients receive surgery and chemotherapy, but outcomes are often poor, and there is no widely agreed-upon best treatment. In this report, we describe the case of a 51-year-old man who had a single, large tumor on the right side of his abdomen. After testing, the tumor was found to express high levels of a protein called PD-L1, which can make cancers more responsive to certain immunotherapies.

The patient received a combination of two immunotherapy drugs – nivolumab and ipilimumab – before surgery. This treatment led to a dramatic reduction in the tumor’s activity and size. Surgery was then performed to remove the tumor along with part of the liver and two ribs. After surgery, testing showed that no live cancer cells remained. The patient continued immunotherapy and remained free of cancer 3 years later.

This case highlights a promising treatment approach for selected patients with peritoneal mesothelioma using immunotherapy before surgery. More research is needed, but this strategy could offer hope to patients with similar tumors, especially when the cancer expresses PD-L1.

1. Introduction

Mesothelioma is a rare neoplasm with an incidence of 2500–3000 cases annually in the United States [1]. The majority of cases are pleural mesothelioma (PM), while peritoneal mesothelioma (PeM) makes up approximately 10% of all cases [2,3]. The incidence of mesothelioma has not declined despite the restriction of asbestos use in many countries worldwide, suggesting that there may be other environmental exposures at play [4,5]. Median survival for PeM is estimated at less than 1 year [3]. Further investigation into treatment options is warranted to improve outcomes in such a lethal disease.

There is no consensus over the optimal treatment for PeM, and most clinical data comes from retrospective single-center studies with inherent selection biases due to its rarity. Diffuse PeM has been historically treated with a combination of systemic chemotherapy, surgery, and radiotherapy in some cases [6]. The median survival with such therapies has been around 1 year for patients that have undergone therapy and about 6 months for untreated patients [7,8]. With the advent of more modern therapies such as cytoreductive therapy (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), the median survival has improved substantially [9–12]. The pooled data from 1,047 PeM patients in a systematic review and meta-analysis by Helm et al. indicated improved 1-, 3-, and 5-year survival rates of 84%, 59%, and 42%, respectively, with CRS and HIPEC. Additionally, early postoperative intraperitoneal chemotherapy (EPIC) and cisplatin-based peritoneal chemotherapy were associated with better 5-year survival [9]. In a study by Verma et al., at median follow-up of 50 months, median OS for patients that underwent observation, received chemotherapy only, CRS alone, CRS/chemo, and CRS/HIPEC was 6, 17, 21, 52, and 61 months, respectively (p < 0.001) [12]. Additionally, a study from Milan demonstrated superior survival with adjuvant chemotherapy versus neoadjuvant therapy when combined with CRS-HIPEC for PeM, favoring this approach for resectable cases [13]. Conversely, a single-center study of 47 patients with PeM found neoadjuvant chemotherapy did not worsen survival versus adjuvant therapy (HR 0.64, p = 0.62) and effectively reduced tumor burden/ascites without compromising surgery eligibility. These results challenge prior concerns about neoadjuvant chemotherapy, demonstrating its feasibility for symptom control and surgical optimization [14]. Historically, for patients with unresectable disease, systemic therapy with pemetrexed and platinum-based chemotherapy have been the standard of care [15].

Recent research has shown potential for the use of immunotherapy for mesothelioma. Combination therapy with nivolumab (OPDIVO) and ipilimumab (YERVOY) was approved by the FDA in 2020 as a first-line treatment for unresectable PeM [16,17]. Nivolumab is a monoclonal antibody that inhibits programmed cell death protein-1 (PD-1), a receptor expressed on the surface of T cells. When PD-1 binds to its ligand, PD-L1, which is often overexpressed on tumor cells, the immune response is suppressed. By blocking this interaction, nivolumab prevents immune evasion by the tumor, enhancing the body’s anti-tumor response. Similarly, ipilimumab is a monoclonal antibody that targets cytotoxic T-lymphocyte antigen 4 (CTLA-4), a receptor that downregulates T-cell activity upon binding its ligands, CD80/CD86. Inhibiting this interaction enhances T-cell activation, proliferation, and infiltration into tumors [18].

Data on nivolumab use in PeM is limited to case reports, with several patients showing favorable responses. At least four patients responded well to second-line nivolumab after conventional chemotherapy [19–21]. While a 74-year-old woman with unresectable diffuse PeM achieved a 12-month response to first-line nivolumab and ipilimumab [22]. Another patient with sarcomatoid-predominant PeM demonstrated partial response to nivolumab followed by successful cytoreductive surgery with HIPEC, resulting in 5-year disease-free survival [23]. Conversely, a 75-year-old man with peritoneal mesothelioma and liver metastases experienced a rapid progression and death 51 days after starting nivolumab [24]. A case of pericardial mesothelioma with peritoneal dissemination showed a response to nivolumab despite renal dysfunction and poor performance status [25]. In addition, a phase 2 trial of atezolizumab (PD-1 inhibitor) plus bevacizumab (VEGF inhibitor) in relapsed/refractory PeM demonstrated promising and durable efficacy (35% objective response rate, 17.6-month median progression-free survival) with an acceptable safety profile, supporting its potential as a salvage therapy [26]. These reports highlight the potential benefits of nivolumab and ipilimumab in selected cases while underscoring the need for further research to optimize patient selection and monitor adverse effects.

2. Case presentation

We present the case of a 51-year-old male with a past medical history of type 2 diabetes, hypertension, and coronary artery disease who presented with 2 months of right upper quadrant abdominal pain radiating to his back. The pain was initially intermittent but then became constant and was described as a “knot-like” sensation. The patient denied nausea, vomiting, diarrhea, cough, or chest pain, but reported a loss of appetite, fatigue, and unintentional weight loss. His social history was notable for 10 years of employment in construction. He never smoked and had no family history of cancer. During the initial visit, vital signs were within normal limits and physical exam showed a very tender right flank mass that was bulging 12–15 cm in external circumference. Initial pertinent positive labs showed the following: albumin 2.6 g/dL (L), globulin 4.9 g/dL (H), alkaline phosphatase 223 IU/L (H), WBC 22,000 per microliter (H), hemoglobin 12.4 g/dL (L), hematocrit 40.6%, and platelets 460,000 per microliter (H).

A right upper quadrant ultrasound showed an avascular, hypoechoic mass located along the right flank measuring approximately 8.4 × 7.6 × 8.0 cm. A computed tomography (CT) scan of his abdomen/pelvis showed a right upper abdominal wall heterogeneously enhancing necrotic mass up to 10 cm with extension into the right 10th and 11th ribs with associated pathologic fractures, adjacent abdominal wall musculature and abdominal cavity causing extrinsic compression of segment 5 of the liver (Figure 1). A magnetic resonance imaging (MRI) scan done a month later confirmed the previous findings, with a new mass size of 11.4 × 9.0 × 9.2 cm.

Figure 1.

Figure 1.

Open in a new tab

Contrast-enhanced CT scan (coronal view) demonstrating a heterogeneously enhancing necrotic mass in the right upper abdominal wall, measuring approximately 10 cm. The mass invades the 10th and 11th ribs, causing pathologic fractures, and extrinsic compression on the liver.

An initial core needle biopsy (CNB) was performed but was non-diagnostic due to extensive necrosis. Subsequently, a right flank incisional biopsy was conducted, revealing a poorly differentiated malignant epithelioid neoplasm with extensive necrosis occupying more than 80% of the tissue, and chronic inflammatory infiltrate (Figure 2(a,b)). Immunohistochemical profiling was diffusely positive for AE1/3, Ck7, and calretinin with weak focal nuclear staining with GATA3 and weak focal to negative staining with WT1. MOC-31, BerEp4, Ck20, p63, CK 5/6, PAX8, arginase, Glypican-3, TTP-1, Napsin A, HER-2, CD30, CD45LCA, CD31, SMA, desmin, S100 were all negative. The PD-L1 combined positive score was 70. CancerTYPE ID gene expression assay showed a 96% probability of mesothelioma. Guardant 360 liquid biopsy test showed high microsatellite instability (MSI-H), PALB2 R414 mutation with 42% allele frequency, STK11 mutation with 7.7% allele frequency, NRAS Q61R mutation with 0.01% allele frequency, EGFR amplification, KIT amplification, and TP53 mutation with 11.8% allele frequency. Positron emission tomography (PET) showed a 3 mm left lower lobe lung nodule in addition to the previously known mass. The maximum standardized uptake value (SUV) was 21 (Figure 3). A subsequent esophagogastroduodenoscopy (EGD) was negative for any primary GI malignancy.

Figure 2.

Figure 2.

Open in a new tab

(a) Low-power image (100×) of the tumor showing a poorly differentiated epithelioid malignant neoplasm with cohesive large epithelioid cells arranged in poorly defined cords and nests separated by a delicate vascular meshwork. Intermixed with the malignant cells is a chronic inflammatory infiltrate. (b) High-power image (400×) of the malignant epithelioid cells exhibiting abundant eosinophilic cytoplasm, large vesicular nuclei with moderate to marked pleomorphism, prominent nucleoli, and mitotic figures including atypical mitoses. (c) Low-power image (100×) of the tumor showing complete necrosis with no viable tumor cells identified following neo-adjuvant treatment.

Figure 3.

Figure 3.

Open in a new tab

Coronal (a) and axial (c) positron emission tomography (PET) images taken pre-immunotherapy, alongside corresponding post-immunotherapy images (b,d) demonstrate a reduction in lesion size from 10.1 cm to 8.1 cm. Additionally, there is a marked decrease in FDG avidity, with the standardized uptake value (SUV) decreasing from 12.4 to 3.1.

Due to the high PD-L1 expression of the tumor, four cycles of Nivolumab 360 mg and Ipilimumab 118.4 mg (1 mg/kg) were administered intravenously for four cycles. A repeat PET scan showed decreased size (8.1 cm, previously 10.1 cm) with an SUV of 3. Which was reduced compared to the initial SUV of 12.4 (Figure 3). There was unchanged involvement of the liver and ribs. A repeat CT scan showed a significant decrease in the amount of enhancement of the tumor. During this time, the patient reported resolution of pain and some weight gain. The patient developed hypothyroidism as an immunotherapy related adverse event. A diagnostic laparoscopy was done which did not demonstrate diffuse involvement of the peritoneum. Next, exploratory laparotomy with en-bloc resection of the right flank abdominal wall mass was done, with resection of full thickness right flank abdominal wall to include the incisional biopsy scar, posterior sector partial hepatectomy, and resection of right ribs 10 and 11. The defect was closed with a pedicled latissimus dorsi flap closure with intra-peritoneal underlay placement of Strattice mesh. The patient developed a hematoma at the laparotomy site requiring formal washout, debridement, and delayed primary closure. Additionally, he contracted COVID-19 infection post-operatively but eventually made a full recovery.

Final pathology revealed an extensive necrosis with no viable tumor consistent with the prior diagnosis of mesothelioma (Figure 2(c)). It measured 10 cm in its greatest dimension. A necrotic tumor was present within vascular spaces, raising the possibility of lymphovascular invasion. Although there was no definite viable tumor remaining, the necrotic tumor extended to ink at the postero-superior margin and to within 1 mm of ink at postero-inferior, lateral anterior-superior, and medial anterior-superior margins. The patient was discussed with the multi-disciplinary team and adjuvant radiation therapy was entertained, but it was not done due to no evidence of viable tumor, wound complications, and COVID-19 infection. The patient received adjuvant immunotherapy for total of 2 years.

Two years after the initial surgery, the patient developed an enlarging fluid collection at the surgical site within the right chest wall. Multiple aspirations were performed, all returning negative for malignancy or infection. The patient was subsequently taken to the OR for wound exploration and washout for recurrent fluid re-accumulation despite aspiration, which eventually started to drain externally. During the surgery, multiple biopsies were obtained, showing no evidence of recurrence. It was noted that the patient had a large, unincorporated piece of the Strattice mesh within an abscess cavity. The cavity was thoroughly irrigated, the mesh was explanted, and the patient was discharged home with a negative pressure dressing. His wound healed uneventfully, and he remains with no evidence of disease 3 years from the initial surgery.

3. Discussion

Treatment of PeM is challenging and highly nuanced, with no clear consensus due to the rarity of the disease. Historically, management has included systemic chemotherapy, palliative surgery, and occasionally radiotherapy, offering a median survival of around 1 year for treated patients and just 6 months for those untreated [6–8].

With the advent of more modern therapies such as CRS and HIPEC, the median survival has improved substantially [9–12]. Systemic chemotherapy is usually offered to patients who are not candidates for CRS-HIPEC due to unresectable disease or medical comorbidities, and there is no consensus on regimen or timing of perioperative chemotherapy. Regimens are usually extrapolated from data on PeM. According to current guidelines from the National Comprehensive Cancer Networks (NCCN), options for systemic therapy in unresectable PeM are first pemetrexed plus cisplatin plus bevacizumab; then pemetrexed plus cisplatin; or nivolumab plus ipilimumab [27].

PeM has a high frequency of PD-L1 expression with studies estimating a rate of 31–64% of PD-L1 positivity [28–30], but the significance of PD-L1 remains undefined in PeM and PeM alike [31]. Additionally, studies on the association of PD-L1 expression in PeM and OS have yielded mixed results [28–30,32].

FDA approval for nivolumab plus ipilimumab treatment of PeM was based on Checkmate-743 [33]. After 3-year minimum follow-up, nivolumab plus ipilimumab continued to provide survival benefit with a median OS of 18.1 versus 14.1 months and a 3-year OS rate of 23% versus 15% [17]. While other studies have demonstrated survival benefit in PeM with nivolumab alone over placebo and nivolumab plus ipilimumab over nivolumab alone [34,35], Checkmate-743 demonstrated significant improvement in survival in PeM patients with non-epithelioid histology using nivolumab plus ipilimumab over standard-of-care chemotherapy [33]. The NCCN also has recommended nivolumab plus ipilimumab as the preferred option for eligible patients with PeM and biphasic or sarcomatoid histology who are not eligible for surgery [27]. While a limited number of cases have shown promising responses to nivolumab in PeM, there is insufficient data to draw definitive conclusions about the broader use of immunotherapy in this condition [19–23,25,36].

In response to the need for improved adjuvant strategies, the MESOPEC trial is evaluating adjuvant dendritic cell-based immunotherapy (DCBI) after CRS-HIPEC in patients with epithelioid peritoneal mesothelioma. This phase II trial aimed to assess feasibility, defined as successful administration of three DCBI doses in ≥75% of patients. All 16 patients who underwent CRS-HIPEC received DCBI without severe toxicity. Median progression-free survival was 12 months; median overall survival was not reached. Immunologic analyses showed increased activation of CD4+ T-helper and NK cells, with a rise in CD8+ effector memory cells correlating with longer PFS [37]. Another trial is evaluating whether adding atezolizumab to carboplatin/pemetrexed/bevacizumab improves response rates in newly diagnosed PeM, compared to chemotherapy/bevacizumab alone, with optional surgery for eligible patients [38]. In a phase I trial, Adusumilli et al. demonstrated intrapleural delivery of mesothelin-targeted CAR T-cell therapy was safe in 27 patients with pleural mesothelioma, with 39% showing persistent CAR T cells in blood for >100 days. When combined with pembrolizumab (18 patients), the regimen achieved a 23.9-month median overall survival (83% 1-year survival), including 2 complete metabolic responses, supporting further evaluation of this combination immunotherapy for solid tumors [39].

To our knowledge, this is the first reported case of PeM presenting as a solitary, isolated peritoneal lesion invovling the abdominal wall without diffuse peritoneal involvement, which also exhibited high PD-L1 positivity, and complete pathological response. Immunotherapy in PeM has typically been utilized as a second-line treatment following CRS and conventional chemotherapy. However, in this case, nivolumab and ipilimumab were used as first-line neoadjuvant therapy which resulted in complete pathological response and durable disease free interval, suggesting a potential role for neoadjuvant checkpoint inhibitor therapy in PeM. Further research is needed to clarify the therapeutic potential of this approach in PeM.

Acknowledgments

The authors would like to thank the multidisciplinary team at The University of Texas Health Science Center for their collaboration and support in managing this case.

Funding Statement

This paper was not funded.

Article highlights

  • Peritoneal mesothelioma (PeM) is a rare and aggressive malignancy, often diagnosed late due to nonspecific symptoms and limited awareness.

  • This case presents an uncommon solitary, isolated PeM mass involving the abdominal wall without diffuse peritoneal spread with high PD-L1 expression.

  • The patient was treated with neoadjuvant immune checkpoint inhibitors (nivolumab and ipilimumab), leading to marked tumor regression and a complete pathological response on surgical resection.

  • Surgery included en-bloc resection of the tumor, involved abdominal wall, two ribs, and partial liver, followed by complex reconstruction using a latissimus dorsi flap and mesh.

  • The patient remained disease-free for three-year post-treatment, supporting the potential for long-term control using a neoadjuvant immunotherapy-first approach in selected cases.

  • Clinicians should consider PD-L1 testing in PeM patients to identify candidates for immunotherapy, especially in cases where resection is technically challenging or delayed.

  • This case suggests that neoadjuvant immunotherapy may be a viable strategy for localized PeM, but further research is needed to define patient selection criteria and long-term outcomes.

Authors’ contributions

All authors contributed to the conception, drafting, and revision of this manuscript. PC and RL were responsible for data acquisition and manuscript drafting. TC and RF provided pathological analysis. SK and RM performed the surgical procedure and contributed to the clinical discussion. MK conceptualized the case report and supervised the writing process. All authors read and approved the final version.

Disclosure statement

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Reviewer disclosure

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Ethical declaration

Written informed consent was obtained from the patient for publication of this case report and accompanying images.

References

Papers of special note have been highlighted as either of interest (•) or of considerable interest (••) to readers.

  • 1.Yang H, Testa JR, Carbone M.. Mesothelioma epidemiology, carcinogenesis, and pathogenesis. Curr Treat Options Oncol. 2008;9(2–3):147–157. doi: 10.1007/s11864-008-0067-z [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2.Teta MJ, Mink PJ, Lau E, et al. US mesothelioma patterns 1973–2002: indicators of change and insights into background rates. Euro J Cancer Prev. 2008;17(6):525–534. doi: 10.1097/CEJ.0b013e3282f0c0a2 [DOI] [PubMed] [Google Scholar]
  • 3.Rodríguez D, Cheung MC, Housri N, et al. Malignant abdominal mesothelioma: defining the role of surgery. J Surg Oncol. 2009;99(1):51–57. doi: 10.1002/jso.21167 [DOI] [PubMed] [Google Scholar]
  • 4.Mazurek JM, Syamlal G, Wood JM, et al. Malignant mesothelioma mortality - United States, 1999–2015. MMWR Morb Mortal Wkly Rep. 2017;66(8):214–218. doi: 10.15585/mmwr.mm6608a3 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 5.Baumann F, Carbone M.. Environmental risk of mesothelioma in the United States: an emerging concern-epidemiological issues. J Toxicol Environ Health B Crit Rev. 2016;19(5–6):231–249. doi: 10.1080/10937404.2016.1195322 [DOI] [PubMed] [Google Scholar]
  • 6.Mirarabshahii P, Pillai K, Chua TC, et al. Diffuse malignant peritoneal mesothelioma–an update on treatment. Cancer Treat Rev. 2012;38(6):605–612. doi: 10.1016/j.ctrv.2011.10.006 [DOI] [PubMed] [Google Scholar]
  • 7.Yates DH, Corrin B, Stidolph PN, et al. Malignant mesothelioma in south east England: clinicopathological experience of 272 cases. Thorax. 1997;52(6):507–512. doi: 10.1136/thx.52.6.507 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8.Eltabbakh GH, Piver MS, Hempling RE, et al. Clinical picture, response to therapy, and survival of women with diffuse malignant peritoneal mesothelioma. J Surg Oncol. 1999;70(1):6–12. doi: 10.1002/(SICI)1096-9098(199901)70:1<6::AID-JSO2>3.0.CO;2-X [DOI] [PubMed] [Google Scholar]
  • 9.Helm JH, Miura JT, Glenn JA, et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for malignant peritoneal mesothelioma: a systematic review and meta-analysis. Ann Surg Oncol. 2015;22(5):1686–1693. doi: 10.1245/s10434-014-3978-x [DOI] [PubMed] [Google Scholar]; • This systematic review and meta-analysis showed that cytoreductive surgery and hyperthermic intraperitoneal chemotherapy may increase the median survival in peritoneal mesothelioma.
  • 10.Greenbaum A, Alexander HR. Peritoneal mesothelioma. Transl Lung Cancer Res. 2020;9(Suppl 1):S120–S132. doi: 10.21037/tlcr.2019.12.15 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11.de Boer NL, van Kooten JP, Damhuis RAM, et al. Malignant peritoneal mesothelioma: patterns of care and survival in the Netherlands: a population-based study. Ann Surg Oncol. 2019;26(13):4222–4228. doi: 10.1245/s10434-019-07803-z [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12.Verma S, Miles D, Gianni L, et al. Trastuzumab emtansine for HER2-positive advanced breast cancer. N Engl J Med. 2012;367(19):1783–1791. doi: 10.1056/NEJMoa1209124 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 13.Chatterjee A, Kusamura S, Baratti D, et al. Impact of perioperative systemic chemotherapy on survival for patients who have diffuse malignant peritoneal mesothelioma treated with CRS-HIPEC. Ann Surg Oncol. 2024;31(1):556–566. doi: 10.1245/s10434-023-13640-y [DOI] [PubMed] [Google Scholar]
  • 14.Wang X, Katz SI, Roshkovan L, et al. A single-center retrospective cohort study evaluating the role of neoadjuvant chemotherapy in malignant peritoneal mesothelioma. JCO. 2020;38(15_suppl):e21093–e21093. doi: 10.1200/JCO.2020.38.15_suppl.e21093 [DOI] [Google Scholar]
  • 15.Nagata Y, Sawada R, Takashima A, et al. Efficacy and safety of pemetrexed plus cisplatin as first-line chemotherapy in advanced malignant peritoneal mesothelioma. JPN J Clin Oncol. 2019;49(11):1004–1008. doi: 10.1093/jjco/hyz104 [DOI] [PubMed] [Google Scholar]
  • 16.Research C for DE and . FDA approves nivolumab and ipilimumab for unresectable malignant pleural mesothelioma. FDA; [Internet]. 2024. [cited 2024 Sep 3]. [Google Scholar]
  • 17.Peters S, Scherpereel A, Cornelissen R, et al. First-line nivolumab plus ipilimumab versus chemotherapy in patients with unresectable malignant pleural mesothelioma: 3-year outcomes from CheckMate 743. Ann Oncol. 2022;33(5):488–499. doi: 10.1016/j.annonc.2022.01.074 [DOI] [PubMed] [Google Scholar]
  • 18.Wei SC, Levine JH, Cogdill AP, et al. Distinct cellular mechanisms underlie anti-CTLA-4 and anti-PD-1 checkpoint blockade. Cell. 2017;170(6):1120–1133.e17. doi: 10.1016/j.cell.2017.07.024 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 19.Tanaka T, Miyamoto Y, Sakai A, et al. Nivolumab for malignant peritoneal mesothelioma. BMJ Case Rep. 2020;13(11):e237721. doi: 10.1136/bcr-2020-237721 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 20.Foote MB, Shia J, Zauderer MG, et al. Treatment of platinum nonresponsive metastatic malignant peritoneal mesothelioma with combination chemoimmunotherapy. J Immunother. 2022;45(2):100–103. doi: 10.1097/CJI.0000000000000399 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21.Tang L-K, Li Z-K, Xiang Y-L, et al. Metachronous double primary malignant tumors with nasopharyngeal carcinoma and diffuse malignant peritoneal mesothelioma accompanied with paraneoplastic syndromes treated with nivolumab: a case report. Medicine (Baltimore). 2023;102(30):e34349. doi: 10.1097/MD.0000000000034349 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 22.Reveneau M-F, Masliah-Planchon J, Fernandez M, et al. Major response of a peritoneal mesothelioma to nivolumab and ipilimumab: a case report, molecular analysis and review of literature. Front Oncol [Internet]. 2024. [cited 2024 Sep 4];14. doi: 10.3389/fonc.2024.1410322 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 23.Sugarbaker PH. Response to nivolumab followed by complete cytoreductive surgery with HIPEC resulted in long-term survival in a patient with sarcomatoid-predominant biphasic peritoneal mesothelioma. A case report. Int J Surg Case Rep. 2023;107:108359. doi: 10.1016/j.ijscr.2023.108359 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 24.Ikushima H, Sakatani T, Ohara S, et al. Cisplatin plus pemetrexed therapy and subsequent immune checkpoint inhibitor administration for malignant peritoneal mesothelioma without pleural lesions: case report. Medicine (Baltimore). 2020;99(22):e19956. doi: 10.1097/MD.0000000000019956 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 25.Fujiwara S, Kano Y, Maejima Y, et al. Clinical response of primary malignant pericardial mesothelioma with peritoneal dissemination to Nivolumab. Intern Med. 2024;63(4):513–519. doi: 10.2169/internalmedicine.1707-23 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 26.Raghav KPS, Overman MJ, Liu S, et al. A phase II trial of atezolizumab and bevacizumab in patients with relapsed/refractory and unresectable malignant peritoneal mesothelioma. JCO. 2020;38(15_suppl):9013–9013. doi: 10.1200/JCO.2020.38.15_suppl.9013 [DOI] [Google Scholar]
  • 27.Ettinger DS, Wood DE, Stevenson J, et al. Mesothelioma: peritoneal, version 2.2023, NCCN clinical practice guidelines in Oncology. J Natl Compr Canc Netw. 2023;21(9):961–979. doi: 10.6004/jnccn.2023.0045 [DOI] [PubMed] [Google Scholar]
  • 28.Khanna S, Thomas A, Abate-Daga D, et al. Malignant mesothelioma effusions are infiltrated by CD3+ T cells highly expressing PD-L1 and the PD-L1+ tumor cells within these effusions are susceptible to ADCC by the anti–PD-L1 antibody avelumab. J Thorac Oncol. 2016;11(11):1993–2005. doi: 10.1016/j.jtho.2016.07.033 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 29.Chapel DB, Stewart R, Furtado LV, et al. Tumor PD-L1 expression in malignant pleural and peritoneal mesothelioma by Dako PD-L1 22C3 pharmDx and Dako PD-L1 28–8 pharmDx assays. Hum Pathol. 2019;87:11–17. doi: 10.1016/j.humpath.2019.02.001 [DOI] [PubMed] [Google Scholar]
  • 30.Valmary-Degano S, Colpart P, Villeneuve L, et al. Immunohistochemical evaluation of two antibodies against PD-L1 and prognostic significance of PD-L1 expression in epithelioid peritoneal malignant mesothelioma: a RENAPE study. Eur J Surg Oncol. 2017;43(10):1915–1923. doi: 10.1016/j.ejso.2017.05.009 [DOI] [PubMed] [Google Scholar]
  • 31.Mansfield AS, Brown RJ, Sammon C, et al. The predictive and prognostic nature of programmed death-ligand 1 in malignant pleural mesothelioma: a systematic literature review. JTO Clin Res Rep. 2022;3(5):100315. doi: 10.1016/j.jtocrr.2022.100315 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 32.Gazivoda VP, Kangas-Dick AW, Greenbaum AA, et al. Expression of PD-L1 in patients with malignant peritoneal mesothelioma: a pilot study. J Surg Res. 2022;277:131–137. doi: 10.1016/j.jss.2022.04.005 [DOI] [PubMed] [Google Scholar]
  • 33.Baas P, Scherpereel A, Nowak AK, et al. First-line nivolumab plus ipilimumab in unresectable malignant pleural mesothelioma (CheckMate 743): a multicentre, randomised, open-label, phase 3 trial. Lancet. 2021;397(10272):375–386. doi: 10.1016/S0140-6736(20)32714-8 [DOI] [PubMed] [Google Scholar]; •• FDA approval for nivolumab plus ipilimumab treatment of PeM was based on Checkmate-743. After 3-year minimum follow-up, nivolumab plus ipilimumab continued to provide survival benefit for patients.
  • 34.Fennell DA, Ewings S, Ottensmeier C, et al. Nivolumab versus placebo in patients with relapsed malignant mesothelioma (CONFIRM): a multicentre, double-blind, randomised, phase 3 trial. Lancet Oncol. 2021;22(11):1530–1540. doi: 10.1016/S1470-2045(21)00471-X [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 35.Scherpereel A, Mazieres J, Greillier L, et al. Nivolumab or nivolumab plus ipilimumab in patients with relapsed malignant pleural mesothelioma (IFCT-1501 MAPS2): a multicentre, open-label, randomised, non-comparative, phase 2 trial. Lancet Oncol. 2019;20(2):239–253. doi: 10.1016/S1470-2045(18)30765-4 [DOI] [PubMed] [Google Scholar]
  • 36.Kitadai R, Shimoi T, Sudo K, et al. Efficacy of second-line treatment and prognostic factors in patients with advanced malignant peritoneal mesothelioma: a retrospective study. BMC Cancer. 2021;21(1):294. doi: 10.1186/s12885-021-08025-x [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 37.Dietz MV, Quintelier KLA, van Kooten JP, et al. Adjuvant dendritic cell-based immunotherapy after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients with malignant peritoneal mesothelioma: a phase II clinical trial. J Immunother Cancer. 2023;11(8):e007070. doi: 10.1136/jitc-2023-007070 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 38.Mansfield AS, Goodrich A, Foster NR, et al. Phase 2 randomized trial of neoadjuvant or palliative chemotherapy with or without immunotherapy for peritoneal mesothelioma (Alliance A092001). JCO. 2022;40(16_suppl):TPS8598–TPS8598. doi: 10.1200/JCO.2022.40.16_suppl.TPS8598 [DOI] [Google Scholar]
  • 39.Adusumilli PS, Zauderer MG, Rivière I, et al. A phase I trial of regional mesothelin-targeted CAR T-cell therapy in patients with malignant pleural disease, in combination with the anti–PD-1 agent pembrolizumab. Cancer Discov. 2021;11(11):2748–2763. doi: 10.1158/2159-8290.CD-21-0407 [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Immunotherapy are provided here courtesy of Taylor & Francis

RESOURCES