Immunotherapy in Malignant Pleura Mesothelioma: Real-world Data from a Tertian hospital in chest diseases.

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Malignant Pleura Mesothelioma (MPM) is a disease with a dismal prognosis and many years of therapeutic stagnancy. Recently, the approval of immunotherapy either as dual checkpoint inhibition (CTLA-4+PD-1) or as a combination with chemotherapy has raised hope and expectations. Real-world applicability is a field of increasing interest. Methods: We use data from a Tetrian hospital for chest diseases and Center of Excellence for thoracic malignancies. Results: We reviewed 77 patients with MPM from January 2019 to January 2024. Forty-six had ICIs as part of their systemic therapy, 24 as 2nd line and beyond, with 16 taking anti-PD1 as monotherapy until disease progression, and the remaining 22 as 1st line, with Ipilimumab and nivolumab dual inhibition for maximum 2 years. Forty-two had epithelioid subtype, 3 biphasic and 1 sarcomatoid. The median PFS and OS were 7 (95% CI: 4.5-9.4) and 26 months (95% CI:17.57-34.43), respectively, for the Ipi-Nivo regimen and 6 months (95% CI: 3-9.1) and 27 months (95% CI:15.62-38.37) for anti-PD1 monotherapy. Conclusions: The involvement of ICIs in the treatment landscape is the only step forward we have taken for many decades to manage MPM. Rear-world applicability is in accordance with the evidence of RCTs. Biomarker-informed approaches are crucial for tailored therapy in mesothelioma.

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