Neoadjuvant Atezolizumab, Cisplatin, Pemetrexed Combination Therapy Meets Safety Criteria for Treatment of Pleural Mesothelioma

The treatment of pleural mesothelioma with neoadjuvant cisplatin and pemetrexed plus atezolizumab (CPA), followed by surgical resection and maintenance atezolizumab, successfully met its safety criteria, according to data presented at the IASLC 2021 World Conference on Lung Cancer. Safety was defined as an absence of grade 4 to 5 immune-related adverse events (AEs) occurring as a result of treatment. Currently, there have been no treatment-related AEs reported that were more serious than grade 3.

“Neoadjuvant cisplatin and pemetrexed plus atezolizumab followed by surgical resection and maintenance atezolizumab met safety criteria,” said Anne Tsao, MD, of the MD Anderson Cancer Center in Houston, in a press release. “Sixty percent of eligible patients proceeded to maintenance atezolizumab, and additional monitoring will assess efficacy and long-term toxicity outcomes.”

The investigators followed 28 participants who had either epithelioid or biphasic histology, whose disease was resectable by pleurectomy/decortication (P/D) or extrapleural pneumonectomy (EPP), who underwent extended surgical staging with mediastinoscopy or endobronchial ultrasound and laparoscopy, and who did not receive chemotherapy or immunotherapy prior to the study. Patients were then divided into a P/D cohort and an EPP cohort. Participants received 4 cycles of neoadjuvant CPA, followed by resection, radiation for the EPP cohort, and 1 year of maintenance atezolizumab.

Of the 28 eligible patients enrolled in the study, 25 received at least 2 cycles of neoadjuvant CPA, 18 underwent surgery, and 15 received maintenance atezolizumab. P/Ds were planned for 24 of the patients, whereas 4 patients had planned EPPs. Neoadjuvant therapy was completed by 21 of the study participants, with 7 patients not proceeding to resection either due to toxicity, disease progression, or death. The single treatment-related death occurred from sepsis associated with nonimmune-related renal and respiratory failure.

Surgical resection was performed on 18 patients with stable disease or partial response, with 17 participants receiving a P/D and 1 receiving EPP. One patient did not receive a protocol-specified surgery due to progressive disease, and 1 patient had a fatal cardiovascular event following surgery. Sixteen patients registered to receive maintenance atezolizumab for 1 year, with 1 patient deemed ineligible because of inadequate hematologic function.

The study enrollment period was between November 2017 and May 2020. Currently, 3 patients remain on ongoing maintenance atezolizumab therapy.

REFERENCE

Neoadjuvant atezolizumab in combination with cisplatin/pemetrexed and as maintenance for resectable pleural mesothelioma meets safety criteria [news release]. EurekAlert; September 12, 2021. Accessed September 15, 2021. https://www.eurekalert.org/news-releases/927588.