Salvage Resection After Immunotherapy in Refractory Malignant Pleural Mesothelioma

A 78-year old man presenting with epithelial malignant pleural mesothelioma (MPM) underwent multidisciplinary review at our institution. We offered surgical resection with adjuvant chemotherapy, but the patient declined. After 6 months, his disease progressed, and he opted for dual immunotherapy with ipilimumab and nivolumab; however, pneumonitis developed after treatment initiation. Immunosuppression controlled the pneumonitis, but his MPM progressed, so salvage surgical resection was offered. Left extrapleural pneumonectomy was successfully performed with an unremarkable recovery. Final pathology revealed stage III biphasic mesothelioma. This report demonstrates the feasibility of salvage resection for progression of MPM after immunotherapy.