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Perioperative nivolumab or nivolumab plus ipilimumab in resectable diffuse pleural mesothelioma: a phase 2 trial and ctDNA analyses.

作者信息

Reuss Joshua E, Lee Paul K, Mehran Reza J, Hu Chen, Ke Suqi, Jamali Amna, Najjar Mimi, Niknafs Noushin, Wehr Jaime, Oner Ezgi, Meng Qiong, Pereira Gavin, Hosseini-Nami Samira, Sausen Mark, Zahurak Marianna, Battafarano Richard J, Hales Russell K, Friedberg Joseph, Sepesi Boris, Deutsch Julie S, Cottrell Tricia, Taube Janis, Illei Peter B, Smith Kellie N, Pardoll Drew M, Tsao Anne S, Brahmer Julie R, Anagnostou Valsamo, Forde Patrick M

机构信息

Georgetown University, Department of Hematology/Oncology, Washington, DC, USA.

Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

出版信息

Nat Med. 2025 Sep 8. doi: 10.1038/s41591-025-03958-3.


DOI:10.1038/s41591-025-03958-3
PMID:40921804
Abstract

Immune checkpoint blockade (ICB) is standard of care in advanced diffuse pleural mesothelioma (DPM), but its role in the perioperative management of DPM is unclear. In tandem, circulating tumor DNA (ctDNA) ultra-sensitive residual disease detection has shown promise in providing a molecular readout of ICB efficacy across resectable cancers. This phase 2 trial investigated neoadjuvant nivolumab and nivolumab/ipilimumab in resectable DPM along with tumor-informed liquid biopsy residual disease assessments. Patients with resectable epithelioid/biphasic DPM enrolled sequentially to nivolumab 240 mg every 2 weeks (q2w) for three cycles (Arm A, n = 16) or nivolumab 3 mg kg q2w for three cycles plus ipilimumab 1 mg kg on cycle 1 (Arm B, n = 14), followed by surgery, optional chemotherapy and/or radiotherapy, and nivolumab 480 mg q4w for 1 year. Co-primary endpoints included safety and feasibility; key exploratory endpoints included progression-free survival (PFS), overall survival (OS) and ctDNA analyses. The trial met its primary endpoints, and, in Arms A and B, 81.3% and 85.7% of patients proceeded to surgery, respectively. Treatment was safe, with a single dose-limiting toxicity in each arm. In Arm A, median PFS and OS were 9.6 months (95% confidence interval (CI): 2.5-27.7) and 19.3 months (95% CI: 14.9-34.7), respectively. In Arm B, median PFS and OS were 19.8 months (7.1-not reached) and 28.6 months (20.4-not reached), respectively. Persistent ctDNA was detected during neoadjuvant therapy in patients who did not undergo complete surgical resection due to disease progression (Fisher's exact test, P = 0.00013). Patients with detectable ctDNA on cycle 3 and pre-surgery had shorter PFS (log-rank test, P = 0.027 and P = 0.0059, respectively); this association was more pronounced when quantitative ctDNA changes were considered (log-rank test, P = 1.8 × 10). Our findings support the feasibility of neoadjuvant ICB and the clinical utility of ctDNA analyses to capture residual disease in resectable DPM. ClinicalTrials.gov identifier: NCT03918252 .

摘要

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本文引用的文献

[1]
Perioperative Durvalumab in Gastric and Gastroesophageal Junction Cancer.

N Engl J Med. 2025-6-1

[2]
Liquid Biopsy Approaches for Cancer Characterization, Residual Disease Detection, and Therapy Monitoring.

Am Soc Clin Oncol Educ Book. 2025-6

[3]
Whole-genome sequencing of cell-free DNA reveals DNA of tumor origin in plasma from patients with colorectal adenomas.

Mol Oncol. 2025-4

[4]
Ultrasensitive ctDNA detection for preoperative disease stratification in early-stage lung adenocarcinoma.

Nat Med. 2025-1

[5]
Treatment of Pleural Mesothelioma: ASCO Guideline Update.

J Clin Oncol. 2025-3-10

[6]
Individualized Cell-Free DNA Monitoring With Chromosomal Junctions for Mesothelioma.

JTO Clin Res Rep. 2024-5-18

[7]
Plasma ctDNA as a Treatment Response Biomarker in Metastatic Cancers: Evaluation by the RECIST Working Group.

Clin Cancer Res. 2024-11-15

[8]
Neoadjuvant Nivolumab and Ipilimumab in Resectable Stage III Melanoma.

N Engl J Med. 2024-11-7

[9]
Perioperative Nivolumab in Resectable Lung Cancer.

N Engl J Med. 2024-5-16

[10]
Extended pleurectomy decortication and chemotherapy versus chemotherapy alone for pleural mesothelioma (MARS 2): a phase 3 randomised controlled trial.

Lancet Respir Med. 2024-6

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