Mesothelioma Navy Mesothelioma Diagnosis & Treatment 5

Question 1

Which combination immunotherapy regimen showed improved overall survival versus chemotherapy in the CheckMate 743 trial for pleural mesothelioma?

Accepted Answer

Nivolumab + ipilimumab

Answer

CheckMate 743 demonstrated that nivolumab (PD-1 inhibitor) plus ipilimumab (CTLA-4 inhibitor) improved median overall survival to 18.1 months versus 14.1 months with chemotherapy.

Question 2

What is the significance of 'PD-L1 expression' in mesothelioma treatment planning?

Accepted Answer

High PD-L1 expression may predict better response to immune checkpoint inhibitor therapy

Answer

PD-L1 expression on tumor cells may correlate with response to PD-1/PD-L1 inhibitors, helping guide immunotherapy decisions, though it is not an absolute predictor.

Question 3

Which palliative intervention is most appropriate for a mesothelioma patient experiencing severe dyspnea due to massive pleural effusion, when long-term surgery is not planned?

Accepted Answer

Therapeutic thoracentesis or indwelling pleural catheter placement

Answer

Draining the fluid via thoracentesis or placing a permanent drainage catheter rapidly relieves dyspnea caused by large pleural effusions in non-surgical candidates.

Question 4

A mesothelioma patient on cisplatin-based chemotherapy develops significant nephrotoxicity. Which modification is most appropriate?

Accepted Answer

Replace cisplatin with carboplatin, which has lower nephrotoxicity

Answer

Carboplatin is less nephrotoxic than cisplatin and is used as a substitution for patients who cannot tolerate cisplatin due to renal impairment.

Question 5

What is the role of PET-CT in mesothelioma staging and management compared to CT alone?

Accepted Answer

PET-CT detects distant metastatic disease and involved lymph nodes not apparent on CT, improving staging accuracy

Answer

PET-CT identifies metabolically active metastases and nodal involvement beyond what anatomical CT can show, preventing futile surgery in patients with occult distant disease.

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Mesothelioma Navy Mesothelioma Diagnosis & Treatment 5