bims-mesote 2026-09-13 papers

bims-mesote

Biomed News

on Mesothelioma

Issue of 2026–09–13
six papers selected by
Laura Mannarino, Humanitas Research

Using an artificial intelligence tool to improve the recognition of pseudoprogression in pleural mesothelioma patients treated with immunotherapy: a case series.
Hyperthermic intrathoracic chemotherapy after cytoreductive surgery in malignant pleural mesothelioma: a single-center retrospective cohort study suggesting increased morbidity without survival benefit.
Long-term real-world outcomes of nivolumab+ipilimumab treatment of unresectable pleural mesothelioma: update of Meso-Immune GFPC 04-2021 study.
Prognostic value of SUVpeak and prognostic nutritional index in patients with pleural mesothelioma treated with platinum-based chemotherapy.
Pre-treatment Tumor Volume Growth Rate and Baseline Volume Measured by an Artificial Intelligence Program Predict Overall Survival in Patients With Pleural Mesothelioma Undergoing Deferred Systemic Therapy.
Erratum: Five-Year Clinical Outcomes With Nivolumab Plus Ipilimumab Versus Chemotherapy as First-Line Treatment for Unresectable Pleural Mesothelioma in CheckMate 743.

Transl Lung Cancer Res. 2026 Aug 31. 15(8): 254

Using an artificial intelligence tool to improve the recognition of pseudoprogression in pleural mesothelioma patients treated with immunotherapy: a case series.

Illaa Smesseim, Kalina Chupetlovska, Valerio Pugliese, Jacobus A Burgers, Kevin B W Groot Lipman.

   Background: Pseudoprogression, defined as initial radiological tumor growth followed by treatment response, can complicate treatment response assessment in patients receiving immunotherapy. In pleural mesothelioma (PM) patients treated with immunotherapy reliable identification of pseudoprogression remains challenging with the modified Response Evaluation Criteria in Solid Tumors (mRECIST) v1.1 criteria. Automated volumetric assessment using an artificial intelligence (AI) tool (ARTIMES) may provide additional insight into tumor response patterns. We aim to describe cases of pseudoprogression identified using the ARTIMES criteria in PM patients treated with immunotherapy.
Case Description: We performed a retrospective observational study of adult PM patients treated with immunotherapy at a tertiary center between January 1, 2013 and July 1, 2022. Tumor volumes were automatically segmented and quantified using the ARTIMES model. Patients demonstrating disease progression according to ARTIMES criteria followed by subsequent tumor volume decrease were evaluated for pseudoprogression. The results were presented in graphs depicting tumor volume, treatment duration, and the start and stop dates of immunotherapy. Among 368 PM patients treated with immunotherapy, 8 patients met inclusion criteria for confirmed pseudoprogression. All patients were male, with a median age of 67.5 years. Most patients had epithelioid histology (75.0%). All patients showed initial volumetric progression on early follow-up imaging, followed by objective tumor volume reduction either during continued immunotherapy or after treatment discontinuation. Volumetric tumor tracking enabled visualization of delayed responses that would have been difficult to interpret using standard imaging comparisons alone.
Conclusions: Pseudoprogression occurs in a subset of PM patients treated with immunotherapy. Automated volumetric tumor assessment can help identify pseudoprogression patterns. Integrating volumetric analysis with clinical evaluation may reduce premature discontinuation of potentially effective immunotherapy.

Keywords:  Artificial intelligence (AI); case series; immunotherapy; mesothelioma; pseudoprogression

DOI:  https://doi.org/10.21037/tlcr-2026-1-0207
J Thorac Dis. 2026 Aug 31. 18(8): 831

Hyperthermic intrathoracic chemotherapy after cytoreductive surgery in malignant pleural mesothelioma: a single-center retrospective cohort study suggesting increased morbidity without survival benefit.

Natalie Baldes, Fabian Doerr, Konstantinos Grapatsas, Balazs Hegedüs, Martin Metzenmacher, Dirk Theegarten, Christian Taube, Martin Schuler, Servet Bölükbas.

   Background: In the multimodal treatment of pleural mesothelioma (PM), hyperthermic intrathoracic chemotherapy (HITOC) has been investigated as an adjunct to cytoreductive surgery (CRS) to potentially improve local tumor control. The study aimed to evaluate the clinical impact of HITOC as an adjunct to CRS, specifically regarding overall survival (OS), postoperative morbidity and mortality, and operative duration.
Methods: This retrospective study compared patients who underwent CRS with HITOC to those without HITOC at our institution between 2010 and 2022. Primary endpoints included OS, operative time, and perioperative morbidity and mortality. Categorical variables were compared using the Fisher's exact test. Survival analyses were performed using the Kaplan-Meier method and compared via the log-rank test.
Results: A total of 114 patients underwent CRS for PM, including 14 with HITOC and 100 without. The mean age was 66 years, and 12 patients were female. The mean operative time was longer in the HITOC group (488 vs. 258 minutes). Postoperative morbidity (Clavien-Dindo Grade ≥ III) was significantly higher with HITOC [43 % vs. 10 %, odds ratio (OR) 6.07, 95 % confidence interval (CI): 1.77-20.76, P=0.007], while in-hospital mortality occurred in two patients (1.8 %), one in each group. Median OS was 13 months in the HITOC group vs. 27 months in the non-HITOC group (P=0.03).
Conclusions: In this retrospective single-center cohort, adjunctive HITOC was associated with significantly longer operative time, higher postoperative morbidity, and inferior OS compared with cytoreduction alone. Given the small HITOC sample size and potential residual confounding, these findings should be interpreted cautiously but raise concerns regarding the routine use of HITOC outside clinical trials and highlight the need for prospective comparative evaluation.

Keywords:  Pleural mesothelioma (PM); cytoreductive surgery (CRS); hyperthermic intrathoracic chemotherapy (HITOC)

DOI:  https://doi.org/10.21037/jtd-2026-1243
Lung Cancer. 2026 Sep 08. pii: S0169-5002(26)00683-5. [Epub ahead of print]221 109622

Long-term real-world outcomes of nivolumab+ipilimumab treatment of unresectable pleural mesothelioma: update of Meso-Immune GFPC 04-2021 study.

GFPC

   BACKGROUND: CheckMate-743 trial results led to nivolumab+ipilimumab becoming the standard first-line therapy for unresectable pleural mesothelioma (uPM), but real-world (rw) long-term follow-up evidence remains limited.
METHODS: This updated nationwide retrospective analysis of rw-efficacy and -safety of that combination therapy for uPM in a French early-access program (Meso-Immune) included progression-free survival (rw-PFS), overall survival (rw-OS), objective response rate (ORR) and immune-related adverse events (irAEs). Post-progression efficacies of second- and third-line therapies were also assessed.
RESULTS: Among 204 uPM patients (median age 75 years) included, histology was epithelioid for 152 (75%) and non-epithelioid for 52 (25%), 55% had breast-cancer-1-associated protein-1 (BAP1) loss. At median 30-month follow-up, median rw-(m)PFS (95% CI) lasted 6.3 (5.3-7.9) months, with 13.8% PFS rate. For the 117 (75%) and 67 (89%) patients given, respectively, second/third-line therapies: median rw-mPFS2/3 lasted 6.9 (6.1-8.2)/3.1 (2.6-5.3) months and ORR2 reached 28.2% (20.0-37.6%). mOS lasted 20.2 (17.6-23.0) months, with 23.5% of patients alive at 30 months; it was longer for epithelioid versus non-epithelioid uPM patients (22.3 versus 14.3 months). BAP1 loss did not impact PFS or OS. irAEs occurred in 68.6% of patients: grade ≥ 3 irAEs occurred in 24.2% of all treated patients; grade 5 irAEs occurred in 6.4%. Toxicities necessitated treatment discontinuation for 39.3% and hospitalization for 34.3%.
CONCLUSIONS: This rw-analysis showed that combination nivolumab+ipilimumab for uPM provided long-term durable clinical benefit, comparable to CheckMate-743, despite an older population, with subsequent therapies retaining efficacy, especially for epithelioid subtype. These findings support first-line nivolumab+ipilimumab standard-of-care and underscore the need to improve beyond second-line strategies.

Keywords:  Immunotherapy; Pleural mesothelioma; Real-world treatment

DOI:  https://doi.org/10.1016/j.lungcan.2026.109622
Transl Lung Cancer Res. 2026 Aug 31. 15(8): 243

Prognostic value of SUVpeak and prognostic nutritional index in patients with pleural mesothelioma treated with platinum-based chemotherapy.

Yoshiki Kato, Kosuke Hashimoto, Hisao Imai, Kyoichi Kaira, Reina Ishii, Naohito Hashimoto, Ou Yamaguchi, Atsuto Mouri, Hiroshi Kagamu, Ichiei Kuji.

   Background: Pleural mesothelioma (PM) is an aggressive malignancy with poor prognosis, and reliable prognostic biomarkers are needed to better inform clinical management. We retrospectively investigated the prognostic value of the Glasgow prognostic score (GPS), prognostic nutritional index (PNI), neutrophil-to-lymphocyte ratio (NLR), body mass index (BMI), and tumor glucose metabolism measured by 18F-fluorodeoxyglucose positron emission tomography (FDG-PET).
Methods: We retrospectively reviewed patients with PM treated with first-line platinum-pemetrexed chemotherapy at our institution (April 2007-December 2023; data cutoff, December 2024) and evaluated the prognostic value of these markers and baseline FDG-PET parameters.
Results: Among 79 patients diagnosed with PM, 51 who received first-line platinum-based chemotherapy with pemetrexed were analyzed. The median age was 69 (range, 42-81) years, 78% were male, and 67% had epithelioid histology. The objective response rate (ORR) was 27.5% [95% confidence interval (CI), 17.1-40.9%], and the disease control rate (DCR) was 72.5% (95% CI, 59.1-82.9%). The median progression-free survival (PFS) and overall survival (OS) were 5.8 (95% CI, 3.4-7.8) and 21.8 (95% CI, 13.4-33.5) months, respectively. Low PNI (≤45) was significantly associated with shorter OS than high PNI (>45) (18.8 vs. 28.5 months; P=0.04) and remained an independent prognostic factor in multivariable analysis (P=0.04). For 35 patients who underwent pretreatment 18F-FDG-PET, high peak standardized uptake value (SUVpeak) (>7.73) was significantly associated with worse OS than low SUVpeak (9.1 vs. 33.6 months; P<0.001) and remained an independent predictor in the multivariable analysis (P<0.001). None of the evaluated biomarkers significantly predicted PFS. GPS, NLR, and BMI showed no significant association with survival outcomes in the univariate analysis and were therefore not included in the multivariable models.
Conclusions: Low PNI and high SUVpeak significantly predicted poor OS in patients with PM treated with platinum-based chemotherapy. These factors may serve as practical prognostic indicators in this population.

Keywords:  Pleural mesothelioma (PM); overall survival (OS); peak standardized uptake value (SUVpeak); platinum-based chemotherapy; prognostic nutritional index (PNI)

DOI:  https://doi.org/10.21037/tlcr-2026-0393
JTO Clin Res Rep. 2026 Sep;7(9): 101040

Pre-treatment Tumor Volume Growth Rate and Baseline Volume Measured by an Artificial Intelligence Program Predict Overall Survival in Patients With Pleural Mesothelioma Undergoing Deferred Systemic Therapy.

Illaa Smesseim, Valerio Pugliese, Jacobus Burgers, Kevin Groot Lipman.

   Introduction: The optimal timing of systemic therapy in pleural mesothelioma remains debated, particularly for asymptomatic patients with a limited disease burden. Prior studies suggest that deferred treatment may not compromise overall survival (OS) in selected patients. Reliable prognostic markers to guide treatment timing are lacking. We investigated whether baseline tumor volume and pretreatment tumor growth rate, quantified using an artificial intelligence (AI)-based model, predict OS in patients deferring systemic therapy.
Methods: We conducted a single-center retrospective study including patients with pleural mesothelioma diagnosed between 2010 and 2025 who deferred systemic therapy for more than or equal to 3 months and had at least two pretreatment computed tomography scans. Total tumor volume and tumor growth rate (mL/mo) were automatically measured using the AI-based ARTIMES model. Optimal cutoffs were determined using receiver operating characteristic analysis. OS was analyzed using Kaplan-Meier estimates and Cox proportional hazards models.
Results: A total of 71 patients were included (median age 66.8 y; 80.3% male; Eastern Cooperative Oncology Group 0-1). The median deferral time was 8.0 months. Optimal cutoffs were 56.5 mL for baseline tumor volume and 67.8 mL/mo for tumor growth rate. Patients with a low baseline tumor volume had a significantly longer median OS compared with those with a high volume (30.95 versus 16.89 mo; p = 0.0066). Similarly, a low tumor growth rate was associated with improved OS (29.40 versus 14.59 mo; p = 0.00057). In multivariable analysis, sarcomatoid histology remained independently associated with worse OS (hazard ratio = 3.28, 95% confidence interval: 1.38-7.75, p = 0.007).
Conclusions: AI-derived baseline tumor volume and tumor growth rate are strong prognostic factors for OS in patients with pleural mesothelioma deferring systemic therapy. Patients with low baseline tumor volume and those with low tumor growth rate were significantly associated with a longer OS.

Keywords:  Artificial intelligence; Mesothelioma; Pleural mesothelioma; Tumor volume

DOI:  https://doi.org/10.1016/j.jtocrr.2026.101040
J Clin Oncol. 2026 Sep 09. JCO2602181

Erratum: Five-Year Clinical Outcomes With Nivolumab Plus Ipilimumab Versus Chemotherapy as First-Line Treatment for Unresectable Pleural Mesothelioma in CheckMate 743.

Arnaud Scherpereel, Paul Baas, Anna K Nowak, Anne S Tsao, Nobukazu Fujimoto, Solange Peters, Aaron S Mansfield, Sanjay Popat, Yolanda Bautista Aragon, Toby Talbot, Francesco Grossi, Dariusz Kowalski, Muhammet A Kaplan, Andrés Felipe Cardona, Raheela Soomro, Nan Hu, Adam Lee, Virginia Ip, Yu-Han Hung, Gérard Zalcman.

DOI: https://doi.org/10.1200/JCO-26-02181