Institution: Peter MacCallum Cancer Centre WCLC 2022 | 1L treatment in mesothelioma: optimizing treatments for individual patients

The landmark study CheckMate 743 really changed the paradigm for first line treatment for mesothelioma back in 2021. Prior to that, there’s been no new developments in mesothelioma, really since 2003, in terms of standard upfront treatments, whereas this platinum pemetrexed really was the standard first line. Since the CheckMate 743 study has been published, ipilimumab and nivolumab has been established, I think, as the standard first-line treatment in our patients with mesothelioma. But the trouble is how do we select these patients? And I think at the moment there’s a real crucial need for developing and predictive biomarkers. Certainly my talk, we talk about the mixed results with regards to PDL-1 and the lack of clinical utility sandwich tumor mutational burden, as well as the lung immune prognostic index.

There are some promising predictive biomarkers that are coming out, such as the four gene inflammatory score, as well as looking at DNA repair deficiency, but these need further investigation to establish them as predictive biomarkers.

And lastly, traditional histology is really important for patient selection. We know that non epithelial subgroup mesothelioma are really the ones that benefit from ipilimumab-nivolumab because of the lack of benefit in this group with chemotherapy. But we also know in epithelium mesothelium that this group of patients also benefit from immune checkpoint inhibitors and they shouldn’t be deprived of that treatment either.