Atezolizumab Regimen Safe in Resectable Mesothelioma

Use of atezolizumab (Tecentriq) as part of neoadjuvant therapy and again as maintenance met predetermined safety criteria for patients with resectable pleural mesothelioma, according to trial results presented at the virtual World Conference on Lung Cancer (WCLC).

Study author Boris Sepesi, MD, of the MD Anderson Cancer Center in Houston, points out that this was merely a feasibility trial to look at safety, and lays out the next steps.

Following is a transcript of his remarks:

This was a feasibility trial of chemotherapy plus atezolizumab. So phase I trial that was looking essentially at safety and feasibility. By no means was a goal of this trial to make any kind of comparisons between chemotherapy and the regimen that has been used. So cisplatin plus pemetrexed [Alimta] versus that plus atezolizumab.

This trial was not powered by any means to show the benefit of these drugs. And as I mentioned before, there’s a tremendous heterogeneity in terms of treatment of mesothelioma, that is where the surgical regimens are being used. There are people in institutions around the world and even within the United States, where patients with what’s considered surgically resectable mesothelioma undergo surgery upfront without any neoadjuvant regimens.

So when we make a comparison to these data that we have over here, that we have not reached, for example in overall survival, we have not reached median overall survival, and I don’t necessarily have the exact number, but just looking at the Kaplan-Meier curves it appears to me that the median follow-up may be around 20 months. But I want to be very careful about overstating some of these results until this trial is completed, until the results are analyzed. The results also need to be analyzed in patients with mesothelioma based on their nodal status for example. I know that at MD Anderson, in patients who have N0, so they don’t have any disease within the lymph nodes and are surgically treated with multimodality regimens, median survival is approximately 20 months.

So again, I don’t want to overstate the findings, this trial still need to come to its conclusion to make its final comments about safety and feasibility. However, the preliminary results that I have presented, I think sort of speak for themselves. It’s going to take us a while to make advancements, I think in terms of phase III trials and getting new regimens. It took us at least 10 to 15 years to go from the regimen of chemotherapy plus pemetrexed to nivolumab [Opdivo] plus ipilimumab [Yervoy] in unresectable mesothelioma, that was the trial that was recently published within the last year that has basically established immunotherapy as a potential option for mesothelioma patients.

So mesothelioma is still an extremely difficult disease to treat and everything that was mentioned about participating on clinical trials, advocating for these patients, reaching out to people who are even outside of the main institutions to come to main institutions that do research and that specialize in these complex treatments — I think all of them would advance not only results, but also care for patients, as it was mentioned.