Original Article
Immune Checkpoint Inhibitor Uptake in Real-World Patients With Malignant Pleural Mesothelioma

https://doi.org/10.1016/j.jtocrr.2021.100188Get rights and content
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Abstract

Introduction

Since the July 2017 National Comprehensive Cancer Network (NCCN) malignant pleural mesothelioma (MPM) guideline revision recommended second-line immune checkpoint inhibitors (ICIs), studies have suggested a greater response to ICI among patients with nonepithelioid MPM. Nevertheless, little is known regarding adoption of ICI in routine practice and if uptake differs by histologic subtype. Our objectives were to evaluate the real-world uptake of second-line ICI among patients with MPM and to reveal its association with histologic subtype.

Methods

This was a multicenter, retrospective cohort study of real-world patients with MPM receiving at least two lines of systemic therapy between 2011 and 2019. We found the uptake of second-line ICI over time and evaluated the association between histologic subtype and ICI use, adjusting for relevant patient demographic and clinical factors.

Results

Among the 426 patients with MPM in our cohort, 310 had epithelioid and 116 nonepithelioid histologic subtype. The median age was 73 years (interquartile range: 67–78). Overall, 144 patients (33.8%) received second-line ICI and 282 (66.2%) traditional chemotherapy. ICI uptake began in early 2015 before the NCCN guideline revision and increased rapidly to 2019. After the 2017 NCCN guideline revision, patients with nonepithelioid MPM histologic subtypes had more than 3 times the odds of receiving second-line ICI (OR = 3.26; 95% confidence interval: 1.41–7.54).

Conclusions

Among real-world patients with MPM, second-line ICI uptake began over two years before the 2017 NCCN guideline recommendations and was associated with nonepithelioid histologic subtype after contemporary studies suggested increased clinical benefit in this population, reflecting prompt integration of scientific discovery into clinical practice.

Keywords

Mesothelioma
Immunotherapy
Histology
Real-world evidence
Uptake

Cited by (0)

Cite this article as: Kim RY, Mitra N, Bagley SJ, et al. Immune checkpoint inhibitor uptake in real-world patients with malignant pleural mesothelioma. JTO Clin Res Rep. 2021;2:100188.

Disclosure: Dr. Bagley reports receiving research funding to his institution from Eli Lilly and Company, Incyte Corp, GlaxoSmithKline, and Novocure and having a consulting role with Bayer and Novocure outside of the submitted work. Dr. Marmarelis reports receiving research funding to her institution from Eli Lilly and Company, Trizell, and AstraZeneca; having a consulting role with AstraZeneca, Novocure, and Boehringer Ingelheim; having stock in Gilead Sciences, Portola Pharmaceuticals, Merck, Bluebird Bio, Johnson & Johnson, and Pfizer; and receiving previous medical writing support from Novartis outside of the submitted work. Dr. Haas reports having a scientific advisory board role with Bronx Medical outside of the submitted work. Dr. Vachani reports receiving research funding to his institution from Allegro Diagnostics, Integrated Diagnostics, Janssen Research & Development, MagArray, and Bronchus Medical; having a consulting role with Allegro Diagnostics, Johnson & Johnson, Novocure, Ethicon, and AbbVie; and receiving travel support from Intuitive Surgical outside of the submitted work. The remaining authors declare no conflict of interest.