Related Experiment Video
Updated: Jan 29, 2026
Generation and Expansion of Primary, Malignant Pleural Mesothelioma Tumor Lines
Published on: April 21, 2022
Use of Immune Checkpoint Inhibitors in Mesothelioma
Patrick M Forde1, Arnaud Scherpereel2,3, Anne S Tsao4
1Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA.
Opinion Statement:
Recent advances in immunology have extended into the mesothelioma field. To date, only Japan has given regulatory approval to salvage nivolumab in chemo-refractory mesothelioma patients. The USA has included in the NCCN guidelines that pembrolizumab (in programmed death ligand 1 (PD-L1) immunohistochemistry (IHC)-positive patients) and nivolumab with or without ipilimumab (whatever the PD-L1 status is) are accepted salvage therapies. Based on the growing body of literature, it is anticipated that checkpoint inhibitors will receive regulatory approval in the USA and Europe soon for salvage therapy. Additional research efforts will determine whether earlier stage patients and frontline unresectable patients will benefit from the addition of immunotherapy to their treatment regimens. The realm of biomarker research has lagged behind in mesothelioma. In general, mesothelioma has less tumor mutation burden than other malignancies. Most of the single-agent salvage checkpoint inhibitor trials have shown a trend correlating higher PD-L1 immunohistochemistry (IHC) with responses. However, survival data remains immature and a larger number of patient outcomes are needed to ascertain the value of PD-L1 IHC as a predictive biomarker. Incorporation of translational studies in all immunotherapy trials and especially window-of-opportunity resectable studies should be supported and instituted in all future mesothelioma trials.
Insights
Immunotherapy, including checkpoint inhibitors like nivolumab and pembrolizumab, shows promise as a salvage therapy for mesothelioma. Further research is needed to confirm its effectiveness and explore its use in earlier stages of the disease.
Area of Science:
- Immunology
- Oncology
- Malignant Pleural Mesothelioma
Background:
- Immunotherapy has emerged as a significant advancement in cancer treatment, with recent progress extending into malignant pleural mesothelioma.
- Regulatory approval for salvage immunotherapy (nivolumab) exists in Japan for chemo-refractory mesothelioma patients.
- The USA includes pembrolizumab (for PD-L1 positive cases) and nivolumab (regardless of PD-L1 status) as accepted salvage therapies in NCCN guidelines.
Purpose of the Study:
- To review the current landscape and future potential of immunotherapy, specifically checkpoint inhibitors, in the treatment of malignant pleural mesothelioma.
- To highlight the status of regulatory approvals and guideline inclusions for immunotherapy in mesothelioma.
- To discuss the challenges and future directions in biomarker research for mesothelioma immunotherapy.
Main Methods:
- Review of current literature and clinical trial data on immunotherapy in mesothelioma.
- Analysis of regulatory approvals and clinical guidelines in Japan and the USA.
- Discussion of biomarker research, particularly programmed death ligand 1 (PD-L1) immunohistochemistry (IHC).
Main Results:
- Checkpoint inhibitors are increasingly recognized as salvage therapies for mesothelioma.
- While trends suggest a correlation between higher PD-L1 IHC and response to single-agent salvage checkpoint inhibitors, survival data is still immature.
- Mesothelioma generally exhibits a lower tumor mutation burden compared to other malignancies, complicating biomarker development.
Conclusions:
- Checkpoint inhibitors are anticipated to gain regulatory approval in the USA and Europe for salvage therapy in mesothelioma.
- Further research is crucial to determine the benefit of immunotherapy in earlier disease stages and for frontline unresectable patients.
- Incorporation of translational and window-of-opportunity studies is essential for future mesothelioma immunotherapy trials to advance biomarker discovery and treatment efficacy.
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