Background: Dual immune checkpoint blockers (ICBs) regimen represents a standard first-line therapy in unresectable pleural mesothelioma (PM). Novel combination strategies, including ICBs and antiangiogenic drugs, are currently under investigation in this setting. We aimed to assess the efficacy of chemo-immunotherapy combination by reference of literature evidence. Methods: A systematic review and meta-analysis of trials with first-line platinum-based chemotherapy associated with anti-PD(L)1 agents in unresectable PM. We estimated weighted summary proportion of disease response, along with landmark probability of survival outcomes. Results: 349 patients with unresectable PM from four trials (DREAM, PrE0505, JME-001, IND.227) were included, 79% (n=274) with epithelioid and 21% (n=75) with non-epithelioid histologic type. In aggregate, objective response rate (ORR) was 59.2% (95%CI: 50.3%-67.9%) and disease control rate (DCR) was 92.2% (95%CI: 89.2%-94.8%). Comparing epithelioid vs. non-epithelioid tumors, the ORR was 64.5% vs. 46.4%, (p<0.001) and the DCR was 92.3% vs. 80.0%, (p=0.043), with on odds ratio of 2.56 (95%CI: 1.51-4.32) for disease response and of 3.37 (95%CI: 0.99-11.47) for disease control. Aggregated estimated probability of progression-free survival was 63% (95%CI: 53%-71%) at 6 months and 25% (95%CI: 21%-31%) at 12 months, whereas 6-, 12- and 24-month overall survival rates were 88% (95%CI: 81%-93%), 71% (95%CI: 61%-79%) and 39% (95%CI: 34%-45%), respectively. Conclusion: According to our analysis, first-line chemo-immunotherapy shows promise as a potential novel treatment approach for PM, exhibiting encouraging survival outcomes and an enhanced response rate, including for the epithelioid subtype. Ongoing studies are necessary to establish its precise placement within the treatment algorithm.

Meta-Analysis on the Combination of Chemotherapy With Programmed Death-Ligand 1 and Programmed Cell Death Protein 1 Blockade as First-Line Treatment for Unresectable Pleural Mesothelioma.

Di Maio, Massimo;Bironzo, Paolo;Novello, Silvia;
2024-01-01

Abstract

Background: Dual immune checkpoint blockers (ICBs) regimen represents a standard first-line therapy in unresectable pleural mesothelioma (PM). Novel combination strategies, including ICBs and antiangiogenic drugs, are currently under investigation in this setting. We aimed to assess the efficacy of chemo-immunotherapy combination by reference of literature evidence. Methods: A systematic review and meta-analysis of trials with first-line platinum-based chemotherapy associated with anti-PD(L)1 agents in unresectable PM. We estimated weighted summary proportion of disease response, along with landmark probability of survival outcomes. Results: 349 patients with unresectable PM from four trials (DREAM, PrE0505, JME-001, IND.227) were included, 79% (n=274) with epithelioid and 21% (n=75) with non-epithelioid histologic type. In aggregate, objective response rate (ORR) was 59.2% (95%CI: 50.3%-67.9%) and disease control rate (DCR) was 92.2% (95%CI: 89.2%-94.8%). Comparing epithelioid vs. non-epithelioid tumors, the ORR was 64.5% vs. 46.4%, (p<0.001) and the DCR was 92.3% vs. 80.0%, (p=0.043), with on odds ratio of 2.56 (95%CI: 1.51-4.32) for disease response and of 3.37 (95%CI: 0.99-11.47) for disease control. Aggregated estimated probability of progression-free survival was 63% (95%CI: 53%-71%) at 6 months and 25% (95%CI: 21%-31%) at 12 months, whereas 6-, 12- and 24-month overall survival rates were 88% (95%CI: 81%-93%), 71% (95%CI: 61%-79%) and 39% (95%CI: 34%-45%), respectively. Conclusion: According to our analysis, first-line chemo-immunotherapy shows promise as a potential novel treatment approach for PM, exhibiting encouraging survival outcomes and an enhanced response rate, including for the epithelioid subtype. Ongoing studies are necessary to establish its precise placement within the treatment algorithm.
2024
19
1
166
172
https://www.sciencedirect.com/science/article/abs/pii/S1556086423007244?via=ihub
Meta-analysis,PD-(L)1, blockade combination, first-line treatment, unresectable pleural mesothelioma
Tagliamento, Marco; Di Maio, Massimo; Remon, Jordi; Bironzo, Paolo; Genova, Carlo; Facchinetti, Francesco; Aldea, Mihaela; Le Pechoux, Cecile; Novello, Silvia; Barlesi, Fabrice; Besse, Benjamin; Planchard, David
File in questo prodotto:
File Dimensione Formato  
Manuscript brief report rev1_clean version.docx

Accesso riservato

Tipo di file: POSTPRINT (VERSIONE FINALE DELL’AUTORE)
Dimensione 60.35 kB
Formato Microsoft Word XML
60.35 kB Microsoft Word XML   Visualizza/Apri   Richiedi una copia
Manuscript+brief+report+rev1_clean+version.pdf

Accesso aperto con embargo fino al 08/08/2024

Tipo di file: POSTPRINT (VERSIONE FINALE DELL’AUTORE)
Dimensione 162.95 kB
Formato Adobe PDF
162.95 kB Adobe PDF   Visualizza/Apri   Richiedi una copia

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2318/1926991
Citazioni
  • ???jsp.display-item.citation.pmc??? 1
  • Scopus 0
  • ???jsp.display-item.citation.isi??? ND
social impact