CheckMate 743: first-line nivolumab plus ipilimumab in unresectable pleural mesothelioma
Dual immunotherapy with nivolumab and ipilimumab lengthened survival compared with platinum-pemetrexed chemotherapy in pleural mesothelioma, the first improvement in first-line treatment in almost twenty years, with the largest gain in non-epithelioid tumours.
Overview
Phase 3 trial of 605 patients with untreated unresectable malignant pleural mesothelioma randomised to nivolumab plus ipilimumab or platinum plus pemetrexed.
Median overall survival was 18.1 versus 14.1 months (hazard ratio 0.74); in non-epithelioid histology it was 18.1 versus 8.8 months (hazard ratio 0.46), while the difference in epithelioid disease was small. Three-year survival was 23 versus 15 percent.
- Median overall survival 18.1 vs 14.1 months; hazard ratio 0.74.
- Non-epithelioid: 18.1 vs 8.8 months; hazard ratio 0.46.
Nivolumab-ipilimumab is the preferred first-line treatment for non-epithelioid pleural mesothelioma and an option in epithelioid disease alongside chemo-immunotherapy.
- Open-label; early crossing of survival curves indicates some patients do worse without chemotherapy.
- Epithelioid benefit was modest.
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