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ABSTRACT
Introduction: Platinum-based chemotherapy is the current first-line standard therapy for unresectable malignant pleural mesothelioma (MPM). Recently, immune-checkpoint inhibitors (ICI) have been intensively investigated as treatment options for this disease. Nivolumab, an anti-programmed cell death (PD)-1 agent, was one of the first drugs used and is representative of available ICIs.
Areas covered: This review discusses previous relevant reports and current ongoing trials of nivolumab. The efficacy and safety of nivolumab have been investigated mostly in second-line or later treatment settings as both monotherapy and in combination with other ICIs. Particularly, nivolumab monotherapy yielded promising efficacy with an objective response rate of 29% and median overall survival of 17.3 months in salvage settings in the single-arm, Japanese phase 2 trial (MERIT). Notably, the study led to Japanese approval of nivolumab for unresectable recurrent MPM. Several trials with monotherapy or cotherapy with nivolumab have commenced, including randomized trials of nivolumab monotherapy vs. placebo in the salvage setting, and cotherapy with nivolumab and ipilimumab vs. the platinum doublet in the frontline setting.
Expert opinion: Nivolumab seems like a reasonable option for unresectable, relapsed MPM despite the lack of randomized trial data. Ongoing pivotal trials will confirm its efficacy.
Declaration of interest
K Hotta has received honoraria outside the current work from AstraZeneca, Ono Pharmaceutical,
BMS, MSD, Eli Lilly Japan, Nihon Kayaku, Taiho Pharmaceutical, and Chugai Pharmaceutical. K Hotta has received research funding outside of the current work from AstraZeneca, BMS, and Eli Lilly Japan. N Fujimoto has received consultancy fees from Boehringer Ingelheim, Ono, Bristol-Myers Squibb, Kyorin, and Kissei, and honoraria or research funding from Ono, Boehringer Ingelheim, Bristol-Myers Squibb, Eli Lilly Japan, and MSD in the subject matter discussed in this manuscript.
N Fujimoto also has received research funding outside of the current work from Hisamitsu, Chugai,
Taiho, Novartis, and GlaxosmithKline. T Kozuki reports grants and personal fees from Chugai Pharmaceutical Co., grants and personal fees from AstraZeneca, grants and personal fees from Eli Lilly Japan, personal fees from Taiho, grants and personal fees from Bristol-Myers, personal fees from Ono, personal fees from MSD, personal fees from Pfizer Japan, personal fees from Kyowa Hakko Kirin, personal fees from Nippon Beohringer Ingelheim, grants from Merck Biophama, outside the submitted work. K Aoe has received consultancy fees from Boehringer Ingelheim, Ono, and
Bristol-Myers Squibb, and honoraria or research funding from Ono, Bristol-Myers Squibb, Eli Lilly Japan, Kissei and MSD in the subject matter discussed in this manuscript. K Aoe also has received research funding outside of the current work from Novartis. AstraZeneca, Ono, Bristol-Myers Squibb, and MSD. K Kiura reports grants from Daiichi-Sankyo, Taiho, Chugai, Teijin, Pfizer,
Beohringer Ingelheim, Nipponkayaku, Shionogi, Ono, Kyorin, MSD, and BMS, outside the submitted work. K Kiura also reports personal fees from AZ, Lilly, Novartis, BMS, Chugai, Pfizer, Taiho, Ono,
Beohringer Ingelheim, and MSD, outside the submitted work. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.
Reviewer disclosures
One of the reviewers on this manuscript has received consulting fees from Epizyme, Aldeyra, Novocure, and Atara; speaking honorarium from Medical Learning Institute; research funding to MSK: MedImmune, Epizyme, Polaris, Sellas Life Sciences, Bristol-Myers Squibb, Millenium, Roche, and Curis; and holds a leadership position in the Mesothelioma Applied Research Foundation (uncompensated). Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.
Supplementary data
The supplementary data for this article can be accessed here.
