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Case Reports
. 2020 Dec 14;13(3):1483-1489.
doi: 10.1159/000512013. eCollection 2020 Sep-Dec.

Exceptional Regression of Malignant Pleural Mesothelioma with Pembrolizumab Monotherapy

Bernard F Hearon  1 , Kyle N Redelman  2 , Georges C Elhomsy  3 , Dennis F Moore Jr  4   5
Affiliations
Case Reports

Exceptional Regression of Malignant Pleural Mesothelioma with Pembrolizumab Monotherapy

Bernard F Hearon et al. Case Rep Oncol. .

Abstract

The lead author with clinical stage I malignant pleural mesothelioma, epithelioid type, highly programmed cell death ligand 1 (PD-L1) positive, and BAP1 negative, experienced a prompt and exceptionally favorable response to pembrolizumab monotherapy. After cessation of treatment due to immune-related endocrinopathies, complete metabolic response on interim PET/CT scan was achieved. Two years after initial diagnosis, unifocal tumor reactivation was addressed with successful pembrolizumab monotherapy rechallenge. Immunotherapy, typically not used as frontline treatment for malignant pleural mesothelioma, may provide an effective and durable response for some patients. Based on this single case study, epithelioid type tumors with strongly positive PD-L1 and BAP1-negative immunohistochemical markers may be well suited for treatment with immune checkpoint inhibitors such as pembrolizumab.

Keywords: Immune checkpoint inhibitor; Immune-related endocrinopathy; Malignant pleural mesothelioma regression; Pembrolizumab monotherapy; Programmed cell death ligand 1 expression; Therapeutic biomarkers.

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Conflict of interest statement

The authors have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Baseline imaging. Posteroanterior (a), left hemithorax (b), and lateral (c) chest radiographs showing upper lateral chest wall soft tissue mass. Coronal (d), sagittal (e), and axial (f) CT scan images revealing a 3.3 × 2.0 × 2.6 cm solid pleural-based mass at the periphery of the left upper lobe. Coronal (g), sagittal (h), and axial (i) PET scan images demonstrating multiple pleural-based 18F-FDG-avid nodules in the left hemithorax. The largest mass measured 3.4 × 1.9 × 2.9 cm wherein the maximum standardized uptake value was 10.3.
Fig. 2
Fig. 2
Interim imaging after the third pembrolizumab infusion, 7 weeks after the first treatment cycle. Posteroanterior (a), left hemithorax (b), and lateral (c) chest radiographs showing marked size reduction of the lateral chest wall mass. Coronal (d), sagittal (e), and axial (f) CT scan images confirming size reduction of the largest pleural-based nodule. Coronal (g), sagittal (h), and axial (i) PET scan images demonstrating significant interval regression of all 18F-FDG-avid masses. Residual hypermetabolic activity remained in only the largest mass where the maximum standardized uptake value was 2.6, indicating a remarkable 75% reduction in intensity.
See this image and copyright information in PMC

References

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