Kalkan Ziya, Ebinc Senar, Arcagok Murat, Bilici Ahmet, Yildiz Ozcan, Kilickap Saadettin, Guven Deniz Can, Tatli Ali Murat, Sumbul Ahmet Taner, Mandel Nil Molinas, Ozturk Akin, Bardakci Murat, Karakaya Serdar, Kaplan Muhammet Ali
Department of Medical Oncology, Mardin Training and Research Hospital, Mardin 47100, Türkiye.
Department of Medical Oncology, Van Yuzuncu Yil University Faculty of Medicine, Van 65100, Türkiye.
Medicina (Kaunas). 2025 Mar 31;61(4):638. doi: 10.3390/medicina61040638.
This study aimed to evaluate the effectiveness of immunotherapy compared to chemotherapy across different treatment lines in patients with pleural mesothelioma. It also sought to identify factors influencing the success of immunotherapy, such as histological subtype, PD-L1 expression, type of asbestos exposure, and metastatic status. A retrospective analysis was conducted with 60 patients diagnosed with pleural mesothelioma. Data on age, gender, histological subtype, and asbestos exposure were collected for all patients and PD-L1 expression was assessed in a subset of patients. Patients received either chemotherapy or immunotherapy as first-, second-, and third-line treatments, and progression-free survival (PFS) and treatment responses were evaluated. Among the 60 patients, 35 (58.3%) were male and the median age was 59 years. The majority (71.7%) had epithelioid histology and 28.3% had distant metastases. Asbestos exposure was documented in 65% of the cases. PD-L1 expression of ≥1% was found in 13 of 17 patients tested. First-line treatments included immunotherapy for 11 patients and chemotherapy for the others, with immunotherapy achieving median PFS of 9 months versus 6 months for chemotherapy, although the difference was not statistically significant. In third-line treatments, immunotherapy significantly outperformed chemotherapy with median PFS of 6 months compared to 3 months ( = 0.048). Absence of metastasis and prior asbestos exposure in an endemic region were linked to better immunotherapy outcomes. Immunotherapy shows increased efficacy in later treatment lines for pleural mesothelioma, especially for patients without metastases or with prior endemic asbestos exposure. Tailored therapeutic strategies should be further explored in prospective studies.
本研究旨在评估免疫疗法与化疗相比，在不同治疗线中对胸膜间皮瘤患者的有效性。研究还试图确定影响免疫疗法成功的因素，如组织学亚型、程序性死亡受体配体1（PD-L1）表达、石棉暴露类型和转移状态。对60例诊断为胸膜间皮瘤的患者进行了回顾性分析。收集了所有患者的年龄、性别、组织学亚型和石棉暴露数据，并对部分患者评估了PD-L1表达。患者接受化疗或免疫疗法作为一线、二线和三线治疗，并评估无进展生存期（PFS）和治疗反应。60例患者中，35例（58.3%）为男性，中位年龄为59岁。大多数（71.7%）为上皮样组织学类型，28.3%有远处转移。65%的病例记录有石棉暴露。在检测的17例患者中，13例（≥1%）的PD-L1表达呈阳性。一线治疗中，11例患者接受免疫疗法，其他患者接受化疗，免疫疗法的中位PFS为9个月，而化疗为6个月，尽管差异无统计学意义。在三线治疗中，免疫疗法显著优于化疗，中位PFS为6个月，而化疗为3个月（P = 0.048）。无转移和在地方病流行区曾有石棉暴露与更好的免疫疗法结果相关。免疫疗法在胸膜间皮瘤的后续治疗线中显示出更高的疗效，特别是对于无转移或曾有地方病流行区石棉暴露的患者。应在前瞻性研究中进一步探索定制的治疗策略。
