Discordant Response to Nivolumab Plus Ipilimumab and Identification of BRAF V600E Mutation in Biphasic Malignant Pleural Mesothelioma: Case Report
Therapeutic advancement for malignant pleural mesothelioma (MPM) has been limited. Combination immunotherapy with nivolumab plus ipilimumab is a frontline treatment option for advanced MPM that is typically deployed for patients with sarcomatoid or biphasic MPM. Here, we present a case of biphasic M...
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Elsevier
2025-05-01
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| Series: | JTO Clinical and Research Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666364325000360 |
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| author | Olivia Wilkins, DO Adedamola Omogbehin, MD Peter J. Bergquist, MD Chul Kim, MD, MPH Stephen V. Liu, MD Joshua E. Reuss, MD |
| author_facet | Olivia Wilkins, DO Adedamola Omogbehin, MD Peter J. Bergquist, MD Chul Kim, MD, MPH Stephen V. Liu, MD Joshua E. Reuss, MD |
| author_sort | Olivia Wilkins, DO |
| collection | DOAJ |
| description | Therapeutic advancement for malignant pleural mesothelioma (MPM) has been limited. Combination immunotherapy with nivolumab plus ipilimumab is a frontline treatment option for advanced MPM that is typically deployed for patients with sarcomatoid or biphasic MPM. Here, we present a case of biphasic MPM that exhibited a unique response pattern to first-line treatment with nivolumab plus ipilimumab, with brisk response in pleural and mediastinal sites of disease, but rapid progression in osseous/soft tissue sites of disease complicated by pathologic spinal cord compression. Pathologic findings from bony metastasis at progression found pure epithelioid histology without any evidence of sarcomatoid differentiation. Next-generation sequencing of this specimen revealed a BRAF V600E mutation, and the patient was subsequently treated with dabrafenib plus trametinib, achieving ongoing clinical and imaging response in all sites of the disease, including bones. This case supports the use of next-generation sequencing profiling in MPM, particularly in circumstances in which novel discordant response patterns are observed. |
| format | Article |
| id | doaj-art-cfe08f8f98a1443ea0d9bc8f91d4ab2d |
| institution | Kabale University |
| issn | 2666-3643 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTO Clinical and Research Reports |
| spelling | doaj-art-cfe08f8f98a1443ea0d9bc8f91d4ab2d2025-08-20T03:49:33ZengElsevierJTO Clinical and Research Reports2666-36432025-05-016510082010.1016/j.jtocrr.2025.100820Discordant Response to Nivolumab Plus Ipilimumab and Identification of BRAF V600E Mutation in Biphasic Malignant Pleural Mesothelioma: Case ReportOlivia Wilkins, DO0Adedamola Omogbehin, MD1Peter J. Bergquist, MD2Chul Kim, MD, MPH3Stephen V. Liu, MD4Joshua E. Reuss, MD5Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DCDepartment of Radiation Oncology, MedStar Washington Hospital Center, Washington, DCDepartment of Radiology, Georgetown University, Washington, DCLombardi Comprehensive Cancer Center, Georgetown University, Washington, DCLombardi Comprehensive Cancer Center, Georgetown University, Washington, DCLombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; Corresponding author. Address for correspondence: Joshua E. Reuss, MD, Georgetown Lombardi Comprehensive Cancer Center, Lombardi Cancer Center Podium B, 3800 Reservoir Rd NW, Washington, DC 20007.Therapeutic advancement for malignant pleural mesothelioma (MPM) has been limited. Combination immunotherapy with nivolumab plus ipilimumab is a frontline treatment option for advanced MPM that is typically deployed for patients with sarcomatoid or biphasic MPM. Here, we present a case of biphasic MPM that exhibited a unique response pattern to first-line treatment with nivolumab plus ipilimumab, with brisk response in pleural and mediastinal sites of disease, but rapid progression in osseous/soft tissue sites of disease complicated by pathologic spinal cord compression. Pathologic findings from bony metastasis at progression found pure epithelioid histology without any evidence of sarcomatoid differentiation. Next-generation sequencing of this specimen revealed a BRAF V600E mutation, and the patient was subsequently treated with dabrafenib plus trametinib, achieving ongoing clinical and imaging response in all sites of the disease, including bones. This case supports the use of next-generation sequencing profiling in MPM, particularly in circumstances in which novel discordant response patterns are observed.http://www.sciencedirect.com/science/article/pii/S2666364325000360Case reportMalignant pleural mesotheliomaBRAF V600EDabrafenibTrametinib |
| spellingShingle | Olivia Wilkins, DO Adedamola Omogbehin, MD Peter J. Bergquist, MD Chul Kim, MD, MPH Stephen V. Liu, MD Joshua E. Reuss, MD Discordant Response to Nivolumab Plus Ipilimumab and Identification of BRAF V600E Mutation in Biphasic Malignant Pleural Mesothelioma: Case Report JTO Clinical and Research Reports Case report Malignant pleural mesothelioma BRAF V600E Dabrafenib Trametinib |
| title | Discordant Response to Nivolumab Plus Ipilimumab and Identification of BRAF V600E Mutation in Biphasic Malignant Pleural Mesothelioma: Case Report |
| title_full | Discordant Response to Nivolumab Plus Ipilimumab and Identification of BRAF V600E Mutation in Biphasic Malignant Pleural Mesothelioma: Case Report |
| title_fullStr | Discordant Response to Nivolumab Plus Ipilimumab and Identification of BRAF V600E Mutation in Biphasic Malignant Pleural Mesothelioma: Case Report |
| title_full_unstemmed | Discordant Response to Nivolumab Plus Ipilimumab and Identification of BRAF V600E Mutation in Biphasic Malignant Pleural Mesothelioma: Case Report |
| title_short | Discordant Response to Nivolumab Plus Ipilimumab and Identification of BRAF V600E Mutation in Biphasic Malignant Pleural Mesothelioma: Case Report |
| title_sort | discordant response to nivolumab plus ipilimumab and identification of braf v600e mutation in biphasic malignant pleural mesothelioma case report |
| topic | Case report Malignant pleural mesothelioma BRAF V600E Dabrafenib Trametinib |
| url | http://www.sciencedirect.com/science/article/pii/S2666364325000360 |
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