Mesothelioma Therapy Immunotherapy and Targeted Therapy 1 — Questions and Answers
Question 1: Which immunotherapy regimen received FDA approval for first-line treatment of unresectable pleural mesothelioma?
- Pembrolizumab monotherapy
- Nivolumab + ipilimumab (Correct answer)
- Atezolizumab + bevacizumab
- Durvalumab + tremelimumab
Correct answer: Nivolumab + ipilimumab
Nivolumab + ipilimumab (CheckMate 743) received FDA approval in 2020 as first-line treatment for unresectable pleural mesothelioma.
Question 2: Nivolumab is classified as which type of immunotherapy?
- CTLA-4 inhibitor
- PD-1 checkpoint inhibitor (Correct answer)
- CAR-T cell therapy
- Cancer vaccine
Correct answer: PD-1 checkpoint inhibitor
Nivolumab is a PD-1 checkpoint inhibitor that blocks the PD-1 receptor on T cells, restoring their ability to attack cancer cells.
Question 3: Ipilimumab targets which immune checkpoint?
- PD-1
- PD-L1
- CTLA-4 (Correct answer)
- LAG-3
Correct answer: CTLA-4
Ipilimumab is a CTLA-4 inhibitor that blocks this immune checkpoint, enhancing T-cell activation and anti-tumor immune responses.
Question 4: In the CheckMate 743 trial, nivolumab + ipilimumab showed the greatest benefit in which mesothelioma subgroup?
- Epithelioid cell type
- Non-epithelioid (sarcomatoid/biphasic) cell type (Correct answer)
- Stage I patients
- Patients with prior surgery
Correct answer: Non-epithelioid (sarcomatoid/biphasic) cell type
Non-epithelioid mesothelioma (sarcomatoid/biphasic types) showed the greatest benefit from nivolumab + ipilimumab compared to chemotherapy in CheckMate 743.
Question 5: What is a common immune-related adverse event (irAE) associated with checkpoint inhibitors in mesothelioma?
- Nephrotoxicity and neuropathy
- Colitis, pneumonitis, hepatitis, and endocrinopathies (Correct answer)
- Myelosuppression only
- Alopecia and nail changes
Correct answer: Colitis, pneumonitis, hepatitis, and endocrinopathies
Checkpoint inhibitors commonly cause immune-related adverse events including colitis, pneumonitis, hepatitis, and endocrinopathies due to T-cell overactivation.
Question 6: High-dose corticosteroids are used to treat severe immune-related adverse events (irAEs) from checkpoint inhibitors. Why?
- To enhance anti-tumor immunity
- To suppress the overactive immune response causing organ damage (Correct answer)
- To improve drug absorption
- To prevent infection only
Correct answer: To suppress the overactive immune response causing organ damage
High-dose corticosteroids suppress the T-cell mediated immune overactivation responsible for tissue damage in severe irAEs.
Mesothelioma Therapy Immunotherapy and Targeted Therapy 1
Which immunotherapy regimen received FDA approval for first-line treatment of unresectable pleural mesothelioma?