For patients with pleural mesothelioma who are eligible for surgery, treatment options have remained frustratingly limited for decades. Chemotherapy before or after surgery offered modest benefits at best, and survival outcomes remained poor even for patients with operable disease.
New research published in the journal Lung Cancer offers a meaningful reason for hope. A phase 2 clinical trial is studying perioperative immunotherapy, which involves immune checkpoint inhibitors given both before and after surgery.
Researchers have found the approach to be safe, feasible, and associated with substantially longer survival than historical expectations.
For patients with operable mesothelioma, this research represents the first clinical evidence that combining immunotherapy with surgery could significantly improve survival.
The findings add to a growing body of evidence that immunotherapy for mesothelioma isn’t a last resort — it may be most powerful when introduced earlier and strategically paired with surgery.
What Is Perioperative Immunotherapy for Mesothelioma?
Perioperative immunotherapy simply means receiving immunotherapy as part of surgery. Instead of relying on surgery alone, doctors give immunotherapy before surgery to help the immune system recognize and attack the cancer. Some patients may continue immunotherapy after mesothelioma surgery to help target remaining cancer cells.
Researchers hope this two-step approach gives the immune system a better chance to fight mesothelioma throughout treatment while lowering the risk of the cancer returning.
In this study, patients received:
- Nivolumab (Opdivo®) alone or Opdivo + ipilimumab (Yervoy®) before surgery
- Surgery to remove as much of the cancer as possible
- Additional treatment after surgery, which could include chemotherapy or radiation therapy, plus up to 1 year of Opdivo immunotherapy
The trial enrolled patients with epithelioid or biphasic mesothelioma — the two mesothelioma cell types most likely to be candidates for surgery.
Talk with a mesothelioma specialist through our Free Doctor Match service to learn whether you’re a candidate for surgery and immunotherapy.
Study Finds Perioperative Immunotherapy Is Safe and Shows Encouraging Results
The trial met its primary goals for safety and feasibility, giving researchers confidence to continue studying this approach in larger clinical trials.
Researchers also reported several promising findings:
- More than 80% of patients safely proceeded to surgery after receiving immunotherapy.
- Patients who received the combination of Opdivo + Yervoy had a median overall survival of 28.6 months.
- Side effects were manageable and consistent with what doctors already know about these immunotherapy drugs.
- Blood tests measuring circulating tumor DNA (ctDNA) may help identify which patients are responding best to treatment.
“This is the first published clinical trial to show that perioperative combination immune checkpoint blockade is not only feasible but potentially beneficial in resectable mesothelioma,” said Dr. Valsamo Anagnostou of Johns Hopkins Kimmel Cancer Center, a senior researcher for this study.
“The approach mirrors what we’ve seen succeed in lung cancer, and opens a door for patients with mesothelioma, where very few options exist,” explained Dr. Anagnostou.
The Role of Liquid Biopsy and ctDNA Monitoring
Researchers also explored whether a simple blood test could show how well immunotherapy was working before surgery.
This type of blood test, called a liquid biopsy, looks for tiny pieces of DNA that cancer cells release into the bloodstream. These fragments, known as circulating tumor DNA (ctDNA), can give doctors another way to monitor how a patient’s cancer is responding to treatment.
The results were encouraging:
- Patients whose ctDNA was no longer detectable before surgery generally lived longer and went longer without their cancer returning.
- Patients whose ctDNA levels dropped by at least 95% during immunotherapy also had better outcomes.
- When ctDNA remained detectable, patients were more likely to see their cancer progress sooner, even if imaging scans hadn’t yet shown obvious changes.
While more research is needed, these findings suggest that liquid biopsies could eventually help doctors tell much earlier whether immunotherapy is working. That could make it easier to adjust treatment plans sooner.
What This Means for Patients with Operable Mesothelioma
For years, patients diagnosed with early-stage mesothelioma have been offered surgery as their primary treatment, either through an extrapleural pneumonectomy or a pleurectomy with decortication.
This study suggests that adding immunotherapy before and after the procedure may improve life expectancy by giving the immune system more time to recognize and attack cancer cells.
Here are a few things worth discussing with your care team:
- Ask whether immunotherapy before surgery could be an option based on your diagnosis and overall health.
- Find out if you qualify for a clinical trial studying perioperative immunotherapy for mesothelioma.
- Consider visiting a specialized mesothelioma center with experience in surgery, immunotherapy, and other multimodal treatments.
- Ask about your mesothelioma cell type, since this study focused on patients with biphasic and epithelioid mesothelioma.
Because this was a phase 2 clinical trial, larger studies are still needed before this perioperative immunotherapy becomes standard treatment. Even so, the findings add to growing evidence that immunotherapy may be most effective earlier in the course of treatment rather than being a last-ditch effort.
This research also complements recent advances in the treatment of inoperable mesothelioma. The 5-year update from the CheckMate 743 trial showed that Opdivo + Yervoy significantly extended survival compared to chemotherapy alone.
How Mesothelioma Hope Can Help
At Mesothelioma Hope, we understand that a mesothelioma diagnosis raises urgent questions about what treatment options are truly available — and whether surgery, immunotherapy, or a combination makes the most sense for your individual case.
Our team can help you:
- Find experienced mesothelioma doctors who specialize in immunotherapy
- Compare mesothelioma treatments, including surgery when appropriate
- Learn about available clinical trials studying perioperative immunotherapy
- Join support groups with other patients navigating similar decisions
- Explore financial assistance to help cover the cost of medical care
“A big part of being a nurse navigator is helping patients feel less lost in the health care system. Part of my day-to-day is explaining confusing things in simple language and helping patients understand what questions to ask or where to turn for support.”
Call us at (866) 608-8933 or download our Free Immunotherapy Guide to get started.
