Author of

• 18606

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  P3.03 - Poster Session with Presenters Present (ID 473)

  • Event: WCLC 2016
  • Type: Poster Presenters Present
  • Track: Mesothelioma/Thymic Malignancies/Esophageal Cancer/Other Thoracic Malignancies
  • Presentations: 1
  • Moderators:
  • Coordinates: 12/07/2016, 14:30 - 15:45, Hall B (Poster Area)

  • 18668

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    P3.03-062 - Response to Pembrolizumab in a Malignant Pleural Mesothelioma with Sarcomatoid Histology: A Case Report (ID 5763)

    14:30 - 14:30  |  Author(s): V. Wienhausen-Wilke
    • Abstract

    Background:
    Malignant pleural mesothelioma is a rare thoracic malignancy with a poor prognosis. The only proven treatment is chemotherapy with cisplatinum and pemetrexed. However, mesothelioma with the sarcomatoid histological subtype is generally poorly responsive to chemotherapy. A recent small case series in malignant mesothelioma with positive staining for PD-L1 has shown an encouraging response to pembrolizumab, including patients with sarcomatoid histology.
    
    Methods:
    A 59 year-old male patient with a history of asbestos exposure presented with dyspnea and right-sided thoracic pain, ECOG 0-1. CT-scanning showed extensive nodular masses on the right pleura up to 17 x 6 cm in size with compression of the lung but no effusion. A biopsy taken under sonographic guidance revealed a malignant pleural mesothelioma of the sarcomatoid subtype. The interdisciplinary team recommended palliative chemotherapy, radiation of the painful thoracic wall infiltrations, but no surgery. During chemotherapy, performance deterioriated (ECOG 1 - 2). After two cycles of cisplatin and pemetrexed, CT-scanning showed progressive disease with an increase of the largest mass to 22 x 8.5 cm. PD-L1 staining was positive in 80% of tumor cells. An immuno-oncological therapy with the PD-L1 inhibitor pembrolizumab was started and tolerated without relevant adverse effects.
    
    Results:
    After 7 weeks of pembrolizumab, the patient was well (ECOG 0). A CT-scan showed a dramatic decrease of the pleural nodules, the largest measuring 8 x 2 cm. At time of submission, the response is ongoing.
    
    Conclusion:
    Immuno-oncological therapy of refractory malignant pleural mesothelioma with sarcomatoid histology and positivity for PD-L1 may represent a well tolerated and effective therapy applicable in routine clinical care.