A real-world experience of second-line nivolumab in mesothelioma patients during the COVID-19 pandemic
Church, M. Taylor, Paul Summers, Yvonne J Rafee, Shereen Dixon, M. Clarke, L Cove-Smith, Laura
Church, M.
Taylor, Paul
Summers, Yvonne J
Rafee, Shereen
Dixon, M.
Clarke, L
Cove-Smith, Laura
Citations
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Abstract
Introduction: Treatment options beyond the first-line have
traditionally been limited in mesothelioma patients, and include
approaches such as re-challenge chemotherapy or clinical trials. The
COVID-19 pandemic put pressure on oncology services worldwide
and triggered numerous adaptations to traditional treatment
strategies. In mid-2020, NHS England approved the use of nivolumab
in the second-line for mesothelioma patients. While the recent
results of the CONFIRM trial support this approach, the real-world
implications of this decision remain to be fully evaluated.
Methods: Mesothelioma patients who commenced nivolumab
therapy in the second-line between August 2020 and February 2021
at Wythenshawe Hospital, UK, were included. Disease subtype,
cycles administered, reported adverse events, radiological response
and survival were collected from electronic patient records.
Results: Twenty-one patients were identified (17 epithelioid,
two sarcomatoid, one biphasic, one unknown); mean age 70
years (range 38-82). Adverse events included fatigue, nausea
and vomiting, diarrhoea, skin rash, mucositis and anorexia. There
was one myocardial infarction and another patient developed
hyperthyroidism. One patient died during treatment; two ceased
treatment due to clinical progression. Fifteen patients have received
a post-treatment CT scan; 12 (80%) had progressive disease, two
(13%) had a mixed response and one (7%) a partial response. Seven
patients are ongoing with treatment. Patients who discontinued
nivolumab received an average of 3.2 cycles of treatment (range
1–5); two subsequently received re-challenge chemotherapy, one
watchful waiting and ten best supportive care.
Conclusions: These results provide a real-world insight on
nivolumab use in mesothelioma. Nivolumab was generally well
tolerated, however the high proportion of patients with progressive
disease on radiological assessment highlights the need for improved
predictive biomarkers.
Description
Date
2021
Publisher
Collections
Keywords
Type
Meetings and Proceedings
Citation
Church M, Taylor P, Summers Y, Califano R, Rafee S, Dixon M, et al. A real-world experience of second-line nivolumab in mesothelioma patients during the COVID-19 pandemic. Lung Cancer . 2021 Jun;156:S31.