Editing Treatment Options (section)

== How Does Immunotherapy Work for Mesothelioma? ==

[https://mesothelioma.net/immunotherapy/ Immunotherapy for mesothelioma] represents the most significant treatment advance since pemetrexed approval in 2003. These drugs work by removing the "brakes" on the immune system, allowing it to recognize and attack cancer cells.

=== What Are the FDA-Approved Immunotherapy Options? ===

Two immunotherapy combinations have received FDA approval for mesothelioma as of 2025:

'''1. Nivolumab Plus Ipilimumab (October 2020 Approval)'''

The [https://www.mesotheliomalawyercenter.org/blog/first-new-approved-treatment-for-mesothelioma-in-more-than-a-decade/ CheckMate 743 trial] established this combination as a breakthrough first-line option. Nivolumab blocks PD-1, while ipilimumab blocks CTLA-4, creating a two-pronged attack on cancer's immune evasion mechanisms.

{| class="wikitable" style="width:100%; border-collapse:collapse; margin:1em 0;"
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! style="background:#1a5276; color:white; padding:10px;" colspan="2" | CheckMate 743 Results
|-
| style="padding:10px; background:#f8f9fa; width:50%;" | Median Overall Survival
| style="padding:10px;" | 18.1 months (vs 14.1 months chemotherapy)
|-
| style="padding:10px; background:#ffffff;" | 3-Year Survival Rate
| style="padding:10px;" | 23% (vs 15% chemotherapy)
|-
| style="padding:10px; background:#f8f9fa;" | Response Rate
| style="padding:10px;" | 40%
|-
| style="padding:10px; background:#ffffff;" | Non-Epithelioid Response
| style="padding:10px;" | HR 0.46 (exceptional benefit)
|-
| style="padding:10px; background:#f8f9fa;" | Annual Cost
| style="padding:10px;" | $150,000-$256,000
|}

'''2. Pembrolizumab Plus Chemotherapy (September 2024 Approval)'''

The KEYNOTE-483 trial supported the newest approval, demonstrating 52% overall response rate versus 29% with chemotherapy alone, with median overall survival of 17.3 months.

{| style="width:100%; background:#cce5ff; border:1px solid #007bff; border-left:5px solid #007bff; border-radius:4px; margin:1em 0;"
|-
| style="padding:15px; color:#004085;" | '''ℹ️ Histology Matters:''' Non-epithelioid mesothelioma (sarcomatoid and biphasic subtypes) shows remarkable responses to nivolumab plus ipilimumab, while epithelioid cases may benefit more from pembrolizumab plus chemotherapy. Treatment selection should consider histologic subtype.
|}

=== What Are Immunotherapy Side Effects and Costs? ===

Immunotherapy activation of the immune system can cause it to attack normal tissues, creating unique immune-related adverse events:

'''Common events:''' Fatigue (35-40%), skin reactions (25-30%), diarrhea/colitis (20-25%), thyroid dysfunction (15-20%)

'''Severe events:''' 26% experience grade 3-4 events with combination therapy; 23% require treatment discontinuation

'''Fatal events:''' Approximately 1.3% of patients

'''Side effect management costs:''' $500-$1,000 monthly routine monitoring; $15,000-$30,000 for hospitalization if severe events occur

According to Michelle Whitman, Attorney at Danziger & De Llano, "We work closely with families to document all treatment-related expenses, including the substantial costs of managing immunotherapy side effects. These expenses are recoverable through [https://dandell.com/whats-your-case-worth/ legal compensation claims]."

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