Jones Riley G, Karthik Felix, Dugar Anushree, Kanagarajan Karthik, Desai Kalpan, Bhandari Manish
Department of Internal Medicine, University of Florida, Gainesville, FL, USA.
Department of Internal Medicine, The Christ Hospital, Cincinnati, OH, USA.
Am J Case Rep. 2018 Jul 4;19:783-789. doi: 10.12659/AJCR.909584.
BACKGROUND Malignant pleural mesothelioma (MPM) is a highly lethal cancer with a median survival of ~12 months even with aggressive intervention. Frontline therapy relies on systemic cisplatin and pemetrexed chemotherapy and has a response rate of ~35-41%; currently, there are no US Food and Drug Administration approved second-line therapies for MPM. Herein, we present a patient with MPM who experienced rapid disease progression after standard therapy but who had an exceptional and sustained response to immune checkpoint inhibition with single agent nivolumab. CASE REPORT A 68-year-old male with a history of work-related asbestos exposure was diagnosed with MPM. He was treated with primary resection followed by systemic chemotherapy with cisplatin and pemetrexed. When chemotherapy failed, he was switched to immunotherapy with nivolumab and achieved an exceptional response. CONCLUSIONS We report the first case of a patient with MPM who experienced rapid disease progression after standard therapy but had an exceptional and sustained response to immune checkpoint inhibition with single agent nivolumab. As outcomes with traditional chemotherapy regimens remain disappointing, there is a substantial need for new approaches to MPM; our case highlights a new therapeutic opportunity even in the face of aggressive disease. Indeed, a new era of investigation utilizing immunotherapy for mesothelioma is beginning, with much anticipation.
恶性胸膜间皮瘤（MPM）是一种高度致命的癌症，即使进行积极干预，中位生存期也约为12个月。一线治疗依赖于顺铂和培美曲塞全身化疗，缓解率约为35%-41%；目前，美国食品药品监督管理局尚未批准用于MPM的二线治疗方法。在此，我们报告一例MPM患者，该患者在标准治疗后疾病迅速进展，但对单药纳武单抗免疫检查点抑制治疗有显著且持续的反应。病例报告：一名68岁男性，有职业性石棉接触史，被诊断为MPM。他接受了原发灶切除，随后接受顺铂和培美曲塞全身化疗。化疗失败后，他改用纳武单抗免疫治疗并取得了显著疗效。结论：我们报告了首例MPM患者，该患者在标准治疗后疾病迅速进展，但对单药纳武单抗免疫检查点抑制治疗有显著且持续的反应。由于传统化疗方案的疗效仍然令人失望，MPM急需新的治疗方法；我们的病例突出了即使面对侵袭性疾病也存在的新治疗机会。事实上，利用免疫疗法治疗间皮瘤的新时代即将开启，令人期待。
