Prospects for the use of pembrolizumab in the treatment of previously untreated patients with advanced malignant pleural mesothelioma
Summary. Resume. Malignant pleural mesothelioma (MPM) is a rare tumor, the occurrence of which is associated with the negative impact of asbestos on the human body. In recent years, there has been a decrease in the incidence of MPMs among the population of highly developed countries, which is probably due to the implementation of the national complete ban of use asbestos in these countries. However, in countries with medium and low development, the trend towards an increase in the number of cases of MPM continues to persist. In most patients with MPM, the disease is diagnosed at late inoperable stages. According to the guidelines of the European Respiratory Society/European Society of Thoracic Surgeons/European Association for Cardio-Thoracic Surgery/European Society for Radiotherapy and Oncology on the management of patients with MPM, the recommendation of the National Comprehensive Cancer Network (NCCN) 2023 and the national guideline «Mesothelioma of the pleura» 2022, the option of first-line therapy for inoperable patients with MPM is chemotherapy (pemetrexed and cisplatin/carboplatin) with or without bevacizumab. In a case of ineffective of first line of chemotherapy, the use of immune checkpoint inhibitors (for example, anti-PD-1 drugs (pembrolizumab)) can be considered as second-line therapy. Thus, in the 2021 European Society for Medical Oncology guidelines, it is noted that in patients who have not previously received immunotherapy, the use of pembrolizumab in the second line of therapy has similar results to the appointment of chemotherapy in monotherapy (recommendation level II, C). In addition, the final results of the IND227 open-label international randomized phase 3 study in patients with previously untreated advanced MPM showed that the use of pembrolizumab in combination with standard chemotherapy with platinum drugs and pemetrexed in the 1st line of therapy led to a significant improvement in overall survival, survival-free progression and objective response rate regardless of the level of programmed cell death ligand-1 (PD-L1) expression, which opens the new perspectives in the treatment of previously untreated patients with MPM.
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