Gradual progress in the management of mesothelioma and thymoma

Oliver Gautschi, MD, Luzerner Kantonsspital, Lucerne, Switzerland

Which innovative strategies for the treatment of patients with unresectable malignant pleural mesothelioma you do deem promising?

This is an important field where little progress has been made in the past. At ESMO 2021, updated results of the randomized CheckMate-743 trial of nivolumab plus ipilimumab versus chemotherapy were presented by Prof. Peters [1]. The overall survival benefit was pronounced in patients with PD-L1–positive or non-epithelioid mesotheliomas, although there was an OS benefit in the total population. In Switzerland, the nivolumab/ipilimumab combination is now approved for the treatment of PD-L1–positive or non-epithelioid mesotheliomas. Chemotherapy still plays a role for other patients. Ongoing trials will tell if we should treat other patients with immunotherapy plus chemotherapy in the future.

What can presently be said about immunotherapeutic approaches in the setting of thymoma and thymic carcinoma?

We are speaking about orphan diseases. Most thymic tumors are resectable or respond to chemotherapy. Patients with non-resectable thymic tumors are usually treated with several lines of systemic therapy including chemotherapy, corticosteroids, or tyrosine kinase inhibitors. Dr. Girard presented the results of the NIVOTHYM trial, a European trial assessing nivolumab in pretreated patients [2]. NIVOTHYM confirmed the activity of PD-L1 checkpoint inhibition in thymic tumors, with a response rate of 12 %. However, there is considerable toxicity because patients can develop autoimmune complications. Currently, I recommend immunotherapy for thymic tumors only in the setting of a clinical trial. The NIVOTHYM trial remains open for enrolment, the second cohort is currently ongoing to assess the combination of nivolumab plus ipilimumab.

REFERENCES

1. Peters S et al., First-line nivolumab plus ipilimumab vs chemotherapy in patients with unresectable malignant pleural mesothelioma: 3-year update from CheckMate 743. ESMO 2021, LBA65
2. Girard N et al., Efficacy and safety of nivolumab for patients with pre-treated type B3 thymoma and thymic carcinoma: Results from the EORTC-ETOP NIVOTHYM phase II trial. ESMO 2021, LBA66

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