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
Georgetown University, Department of Hematology/Oncology, Washington, DC, USA.
Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Nat Med. 2025 Sep 8. doi: 10.1038/s41591-025-03958-3.
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 .
Cochrane Database Syst Rev. 2023-1-17
Cochrane Database Syst Rev. 2025-1-8
Cochrane Database Syst Rev. 2018-7-12
N Engl J Med. 2025-6-1
Am Soc Clin Oncol Educ Book. 2025-6
J Clin Oncol. 2025-3-10
JTO Clin Res Rep. 2024-5-18
N Engl J Med. 2024-11-7
N Engl J Med. 2024-5-16