A real-world experience of second-line nivolumab in mesothelioma patients during the COVID-19 pandemic

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.