Pembrolizumab as Palliative Immunotherapy in Malignant Pleural Mesothelioma

Yannis Metaxas, Gareth Rivalland, Laetitia A. Mauti, Dirk Klingbiel, Steven Kao, Sabine Schmid, Anna K. Nowak, Oliver Gautschi, Tammo Bartnick, Brett G. Hughes, Hasna Bouchaab, Sacha I. Rothschild, Nick Pavlakis, Sibylle Wolleb, Ulf Petrausch, Kenneth O'Byrne, Patrizia Froesch, Melanie Löffler-Baumann, Susanne Pratsch-Peter, Prudence RussellWalter Mingrone, Spasenija Savic, Bibhusal Thapa, Martin Früh, Miklos Pless, Roger von Moos, Thomas John

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64 Citations (Scopus)


Introduction: There is no approved second-line treatment for malignant pleural mesothelioma (MPM). On the basis of promising early results, pembrolizumab was used off-label in Switzerland and Australia. We investigated outcomes in association with clinicopathological features and expression of programmed death ligand 1 (PD-L1). Methods: Registry data in Australia and Switzerland were pooled. Patient characteristics, including age, sex, histological subtype, and previous treatments were captured. Outcomes were assessed locally. PD-L1 expression was categorized as negative (<5%), intermediate (5%-49%), and high (≥50%). Results: A total of 93 patients (48 from Switzerland and 45 from Australia) were treated; 68 patients (73%) had epithelioid MPM, and 67 (72%) had an Eastern Cooperative Oncology Group performance status of 0 or 1. Pembrolizumab was the second-line treatment in 48 of 93 patients (52%). PD-L1 expression results were available for 66 patients (71%). Most (68%) were negative, 18% were intermediate, and 14% were high for PD-L1 expression. In the full cohort, the overall response rate (ORR) was 18%, the median progression-free survival (mPFS) was 3.1 months, and the median overall survival was 7.2 months. In patients with an Eastern Cooperative Oncology Group performance status of 0 or 1 and only one previous systemic treatment (n = 35), the ORR was 37%, the mPFS was 3.7 months, and the median overall survival was 10.2 months. The nonepitheloid histological subtype showed an improved ORR (24% versus 16% [p = 0.54) and mPFS (5.6 versus 2.8 months [p = 0.02]). Compared with intermediate and negative PD-L1 expression, high PD-L1 expression was associated with an improved ORR (44% versus 42% versus 11% [p = 0.01]) and mPFS (6.2 versus 3.9 versus 2.7 months [p = 0.04]). Toxicity was as expected. Conclusion: These real-world data demonstrate similar response rates but inferior survival compared with those in early-phase trials. High PD-L1 expression and nonepitheloid histological subtype were associated with greater activity. Anti–PD-L1 immunotherapy is a reasonable second-line therapy in patients with MPM.

Original languageEnglish
Pages (from-to)1784-1791
Number of pages8
JournalJournal of Thoracic Oncology
Issue number11
Publication statusPublished - 1 Nov 2018


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