The following is a summary of “Meta-Analysis on the Combination of Chemotherapy With Programmed Death-Ligand 1 and Programmed Cell Death Protein 1 Blockade as First-Line Treatment for Unresectable Pleural Mesothelioma,” published in the January 2024 issue of Oncology by Tagliamento, et al.

A usual first-line treatment for pleural mesothelioma (PM) that can’t be removed is a combination of two immune checkpoint blockers. For a study, researchers sought to look into new ways to combine drugs, such as immune checkpoint blockers and antiangiogenic drugs. They wanted to determine how well the mix of chemo and immunotherapy worked by looking at information from other studies. This study looked at all the treatments that used first-line platinum-based chemotherapy and programmed death-ligand 1 and programmed cell death protein 1 agents in people with unresectable PM. 

They determined the major chance of life results and the weighted total share of disease reaction. There were 349 patients with unresectable PM from four studies who were included. Of these, 274 had epithelioid histology, and 75 had nonepithelioid histology. The overall objective responder rate was 59.2% (95% CI: 50.3%–67.9%), and the overall disease control rate was 92.2% (95% CI: 89.2%–94.8%). The objective response rate for epithelioid tumors was 64.5% vs. 46.4% (P < 0.001), and the disease control rate was 92.3% vs. 80.0% (P = 0.043). 

The odds ratios for disease response and disease control were 2.56 (95% CI: 1.51–4.32) and 3.37 (95% CI: 0.99–11.47), respectively. The overall survival rates at 6, 12, and 24 months were 88% (95% CI: 81%–93%), 71% (95% CI: 61%–79%), and 39% (95% CI: 34%–45%), respectively. The chance of progression-free survival was 63% (95% CI: 53%–71%) at 6 months and 25% (95% CI: 21%–31%) at 12 months. Chemoimmunotherapy as the first line of treatment for PM shows promise as a new way to treat the disease, with good mortality rates and a higher reaction rate, even for the epithelioid form. More research must be done to determine exactly where it fits in the treatment plan.

Source: sciencedirect.com/science/article/abs/pii/S1556086423007244