Second-Line Systemic Therapy for Pleural Mesothelioma

Relapsed-Setting Treatment Profile
Systemic Therapy After First-Line Failure
Setting	Relapsed / refractory pleural mesothelioma
Strongest Evidence	CONFIRM (Phase 3, positive) — see Immunotherapy_for_Mesothelioma
Positive Phase 2 (Chemo-Antiangiogenic)	RAMES — gemcitabine + ramucirumab
Key Negative Trial	Anetumab ravtansine vs. vinorelbine (ARCS-M)
Terminated Trial	NCT03502746 (nivolumab + ramucirumab)
Guidelines	ASCO 2025 Update; ESMO 2021/2022
Cause	Asbestos exposure (occupational/secondary)

Executive Summary

Second-line systemic therapy for pleural mesothelioma refers to the treatment options available once a patient's cancer progresses after first-line platinum plus pemetrexed chemotherapy (with or without bevacizumab) or after first-line immunotherapy such as nivolumab plus ipilimumab. Relapse after an initial response is the expected course of malignant pleural mesothelioma (MPM), and unlike the first-line setting — where two immunotherapy regimens now carry FDA approval — the relapsed setting has only one positive phase 3 trial, several informative phase 2 studies, and one formally negative randomized trial defining what does not work.

The strongest evidence in the relapsed setting is the CONFIRM trial, a phase 3 randomized comparison of nivolumab against placebo that met both of its co-primary endpoints. Beyond that single positive phase 3 result, the evidence base is built from smaller randomized and single-arm phase 2 trials — gemcitabine plus ramucirumab (RAMES), nivolumab plus ramucirumab, and nivolumab with or without ipilimumab (MAPS2) — alongside a phase 2 trial of the mesothelin-targeting antibody-drug conjugate anetumab ravtansine that failed to beat vinorelbine. Professional society guidelines from ASCO (2025) and ESMO synthesize this evidence into practical recommendations for oncologists managing relapsed disease.

This page focuses on the relapsed-setting evidence beyond first-line immunotherapy trial data, which is covered in depth on Immunotherapy_for_Mesothelioma. It also distinguishes proven, reported regimens from investigational trials still enrolling patients, which are catalogued on Clinical_Trials_Mesothelioma. Throughout, this page flags evidence strength honestly — phase 2 versus phase 3, abstract-only versus full-text-confirmed data, and positive versus negative trial results — because relapsed mesothelioma treatment decisions depend on understanding exactly how strong (or limited) the supporting data are.

Malignant pleural mesothelioma is caused by asbestos exposure, typically decades earlier through occupational or secondary (household/take-home) contact with asbestos fibers. Patients diagnosed with relapsed MPM, and their families, may be entitled to compensation from asbestos trust funds or through litigation regardless of which systemic therapy line they are currently receiving.

At-a-Glance

Second-line systemic therapy for pleural mesothelioma at a glance:

• CONFIRM is the only positive phase 3 trial in relapsed mesothelioma — nivolumab improved median overall survival to 10.2 months versus 6.9 months for placebo (adjusted HR 0.69, 95% CI 0.52–0.91, p=0.0090); full trial detail lives on Immunotherapy_for_Mesothelioma
• RAMES nearly doubled median survival with gemcitabine plus ramucirumab — 13.8 versus 7.5 months (HR 0.71) — but the trial reported 70% confidence intervals (0.59–0.85), not the standard 95%, and its published figures are abstract-only pending full-text confirmation
• Anetumab ravtansine was NOT superior to vinorelbine in a randomized phase 2 trial of 248 mesothelin-overexpressing patients — PFS hazard ratio 1.22 (95% CI 0.85–1.74), log-rank p=0.86 — a key negative trial defining what does not work in this setting
• The HCRN nivolumab-ramucirumab trial (NCT03502746) was formally TERMINATED after enrolling only 34 of its planned patients, though the single-arm data that was collected showed a 22.6% objective response rate and 12.5-month median overall survival
• MAPS2 established that checkpoint inhibition is feasible in relapsed MPM — nivolumab alone and nivolumab plus ipilimumab both cleared the trial's 40% disease-control threshold (44% and 50% respectively at 12 weeks in the primary analysis population)
• ASCO's 2025 guideline update reviewed 110 studies published from 2016–2024 to issue evidence-based recommendations spanning surgery, immunotherapy, chemotherapy, pathology, and germline testing
• A cross-trial network meta-analysis found dual checkpoint blockade outperformed monotherapy in relapsed disease — 15.9 versus 11.9 months median OS — though this is an indirect, non-head-to-head comparison
• A retrospective series of post-surgical recurrence patients reported a 43.9% objective response rate to nivolumab plus ipilimumab, with 74.2% alive at 12 months, though the underlying data are abstract-only
• Salvage chemotherapy predates the immunotherapy era but remains relevant — vinorelbine and pemetrexed rechallenge are documented options in narrative reviews covering the pre- and peri-immunotherapy treatment landscape
• No regimen in the relapsed setting carries FDA approval specifically for second-line mesothelioma — treatment selection depends on what was used first-line, trial eligibility, and shared decision-making between patient and oncologist

Key Facts

Regimen / Source	Finding
Nivolumab vs. placebo (CONFIRM)	Phase 3 RCT, positive. Median OS 10.2 vs. 6.9 months; HR 0.69 (95% CI 0.52–0.91), p=0.0090. Full detail: Immunotherapy_for_Mesothelioma
Gemcitabine + ramucirumab (RAMES)	Phase 2 RCT, positive. Median OS 13.8 vs. 7.5 months; HR 0.71 (70% CI 0.59–0.85), p=0.028. Abstract-only.
Nivolumab + ramucirumab (HCRN-LUN15-299)	Single-arm phase 2, n=34. ORR 22.6% (43% non-epithelioid); median OS 12.5 months. NCT03502746 status: TERMINATED.
Anetumab ravtansine vs. vinorelbine (ARCS-M)	Phase 2 RCT, n=248, formally negative. PFS HR 1.22 (95% CI 0.85–1.74), log-rank p=0.86. Not superior to vinorelbine.
Nivolumab ± ipilimumab (MAPS2)	Randomized non-comparative phase 2, n=125. 12-week disease control 44% (nivo) and 50% (nivo+ipi) in primary analysis population, both meeting the 40% threshold.
ASCO Guideline Update (2025)	110 studies (2016–2024) reviewed; evidence-based recommendations for surgery, immunotherapy, chemotherapy, pathology, and germline testing.
ESMO Clinical Practice Guidelines	European standard-of-care reference for diagnosis, treatment, and follow-up, including relapsed-setting systemic options. No PubMed abstract; cited as a guideline document.
Salvage therapy network meta-analysis (Tsai et al.)	Cross-trial comparison: dual immunotherapy vs. monotherapy OS 15.9 vs. 11.9 months (indirect, non-head-to-head).
Nivolumab + ipilimumab, post-surgical recurrence (Nakamura et al.)	Retrospective, n=41. ORR 43.9%, disease control 75.6%, 12-month survival 74.2%, median PFS 7.3 months. Abstract-only.
Narrative reviews (Cui; de Gooijer; Petrini)	Document vinorelbine, pemetrexed rechallenge, and other salvage chemotherapy options predating and paralleling the immunotherapy era.

What Happens When First-Line Mesothelioma Treatment Stops Working?

Nearly every patient with malignant pleural mesothelioma who responds to first-line treatment eventually experiences disease progression. First-line therapy today generally means one of three approaches: platinum-based chemotherapy plus pemetrexed (with or without the addition of bevacizumab), or one of the two FDA-approved first-line immunotherapy regimens — nivolumab plus ipilimumab or pembrolizumab plus chemotherapy — detailed on Immunotherapy_for_Mesothelioma. Once any of these approaches fails, oncologists must choose a second-line (or later) systemic therapy, and the strength of the supporting evidence varies dramatically by regimen.

This matters because the relapsed-therapy landscape shifted meaningfully once immunotherapy became the first-line standard for many patients. Trials conducted before that shift — including several discussed on this page — enrolled patients whose first-line treatment was chemotherapy alone, since immunotherapy was not yet approved. That means second-line sequencing today increasingly depends on what a given patient received first: a patient relapsing after first-line chemotherapy has different second-line chemotherapy and immunotherapy options available than a patient relapsing after first-line nivolumab plus ipilimumab, who may be more likely to receive salvage chemotherapy next.

No single regimen in the relapsed setting carries FDA approval specific to second-line mesothelioma. Consequently, oncology guidelines from ASCO and ESMO play an outsized role in standardizing relapsed-setting care, and clinical trial enrollment is frequently recommended as a preferred option at progression. The sections below cover the relapsed-setting evidence in order of evidentiary strength: the one positive phase 3 trial (briefly, since it is detailed elsewhere), the phase 2 combination regimens, the key negative trial, the governing guidelines, and the broader salvage-chemotherapy literature.

What Is the Strongest Evidence for Second-Line Immunotherapy?

The strongest relapsed-setting evidence is the positive phase 3 CONFIRM trial (nivolumab vs. placebo) — see Immunotherapy_for_Mesothelioma for full trial detail, including the complete progression-free and overall survival data, safety profile, and PD-L1 biomarker findings.

In brief: CONFIRM randomized 332 patients with relapsed pleural or peritoneal mesothelioma (2:1) to nivolumab or placebo after progression on first-line platinum-based chemotherapy. It was the first phase 3 trial to demonstrate improved overall survival in the relapsed setting, meeting both co-primary endpoints — progression-free survival (HR 0.67, 95% CI 0.53–0.85, p=0.0012) and overall survival (HR 0.69, 95% CI 0.52–0.91, p=0.0090). This page focuses on the rest of the relapsed-setting systemic therapy landscape — the regimens, negative trials, and guideline positioning that CONFIRM does not cover.

What Phase 2 Combination Regimens Have Shown Promise in Relapsed Mesothelioma?

RAMES: Gemcitabine Plus Ramucirumab

The RAMES trial tested whether adding the anti-VEGFR-2 antibody ramucirumab to gemcitabine could improve outcomes in patients whose mesothelioma had progressed during or after first-line pemetrexed plus platinum chemotherapy. This double-blind, placebo-controlled phase 2 trial enrolled 161 patients across 26 Italian hospitals and randomized them 1:1 to gemcitabine plus ramucirumab or gemcitabine plus placebo.

The results were positive: median overall survival was 13.8 months in the ramucirumab arm versus 7.5 months in the placebo arm (HR 0.71, p=0.028). Two caveats are essential to interpreting this result correctly. First, RAMES reported 70% confidence intervals (0.59–0.85) rather than the conventional 95% confidence intervals used in most phase 3 trials — a narrower confidence level that should not be mistaken for the same statistical certainty a 95% CI would represent. Second, the specific survival figures cited here come from the published PubMed abstract; while the trial itself was peer-reviewed and published in Lancet Oncology, the numeric detail on this page has not been independently cross-checked against the full-text manuscript's tables and figures, and should be treated as abstract-level confirmation rather than full-text-verified. Grade 3–4 treatment-related adverse events were more common with ramucirumab (44% vs. 30%), with neutropenia and hypertension the most frequent.

Nivolumab Plus Ramucirumab (HCRN-LUN15-299)

A separate trial tested the combination of nivolumab (an anti-PD-1 checkpoint inhibitor) with ramucirumab, hypothesizing that adding antiangiogenic therapy could improve on the roughly 11% objective response rate previously reported for single-agent nivolumab in the second-line setting. This was a single-arm, cooperative-group phase 2 trial (Hoosier Cancer Research Network, HCRN-LUN15-299) that enrolled 34 patients with unresectable mesothelioma who had progressed on at least one pemetrexed-containing regimen.

The combination achieved an objective response rate of 22.6% overall (43% in patients with non-epithelioid histology), a median progression-free survival of 4.2 months, and a median overall survival of 12.5 months. The trial's primary endpoint — a 40% objective response rate — was not reached. The registered trial, NCT03502746, is documented on ClinicalTrials.gov with a status of TERMINATED and a final enrollment of 34 patients, short of its original target. The termination and the missed primary endpoint do not mean the combination was ineffective — the response and survival figures compare reasonably with historical single-agent nivolumab data — but they mean this remains low-to-moderate-strength, single-arm evidence rather than a confirmed standard of care.

MAPS2: Nivolumab With or Without Ipilimumab

The MAPS2 trial (IFCT-1501) was designed to establish whether checkpoint inhibition had meaningful activity in relapsed MPM at all, at a time when no second-line therapy had been formally validated. This randomized, non-comparative, open-label phase 2 trial enrolled 125 patients across 21 French hospitals and randomly assigned them to nivolumab alone or nivolumab plus ipilimumab after progression on first- or second-line pemetrexed-platinum chemotherapy.

The trial's primary endpoint — 12-week disease control in at least 40% of patients — was met in both arms: 44% for nivolumab alone and 50% for nivolumab plus ipilimumab in the primary analysis population of 108 patients (40% and 52% respectively in the full intention-to-treat population of 125). Grade 3–4 toxicity was more frequent with the combination (26% vs. 14%). MAPS2 did not compare its regimens against a chemotherapy or placebo control, so it cannot establish a survival benefit on its own — its contribution was demonstrating that checkpoint inhibition has real activity in relapsed MPM, providing the rationale for the larger phase 3 trials that followed, including CONFIRM. The specific numeric findings summarized here reflect the published abstract.

What Trial Showed a Negative Result — and Why Does That Matter?

Not every relapsed-setting trial has been positive, and negative trials are just as important to document as positive ones — they tell oncologists and patients what does not work, preventing wasted time on ineffective therapy. The clearest example in relapsed pleural mesothelioma is anetumab ravtansine, an antibody-drug conjugate that delivers a cytotoxic payload (a maytansinoid microtubule inhibitor) specifically to tumor cells that overexpress mesothelin, a cell-surface protein found on the majority of epithelioid mesothelioma tumors.

The ARCS-M trial tested anetumab ravtansine against vinorelbine — an established, low-cost salvage chemotherapy — in patients with relapsed, mesothelin-positive malignant pleural mesothelioma who had progressed on first-line platinum-pemetrexed chemotherapy with or without bevacizumab. This open-label, randomized phase 2 trial screened 589 patients for mesothelin overexpression and randomized 248 who qualified (2:1) to anetumab ravtansine (166 patients) or vinorelbine (82 patients) across 76 hospitals in 14 countries.

The result was formally negative. Median progression-free survival was 4.3 months with anetumab ravtansine versus 4.5 months with vinorelbine — essentially identical — with a hazard ratio of 1.22 (95% CI 0.85–1.74) and a log-rank p-value of 0.86, indicating no statistically significant difference and, if anything, a trend favoring the older, cheaper drug. The trial's own investigators concluded that anetumab ravtansine "was not superior to vinorelbine" despite a manageable safety profile. This result is a genuine data point: it demonstrates that targeting mesothelin with this particular antibody-drug conjugate, in this trial design, did not translate into a clinical benefit over standard salvage chemotherapy — a finding that should inform, not be omitted from, any honest accounting of the relapsed-treatment landscape.

What Do the ASCO and ESMO Guidelines Recommend for Relapsed Disease?

Because no single relapsed-setting regimen carries a dedicated FDA approval, professional society guidelines play a central role in standardizing how oncologists approach second-line and later therapy for pleural mesothelioma.

The American Society of Clinical Oncology (ASCO) published an updated guideline in 2025 that convened an expert panel spanning medical oncology, thoracic surgery, radiation oncology, pathology, cancer genetics, and patient advocacy. The panel reviewed the literature published from 2016 through 2024, identifying 110 additional relevant studies, and issued evidence-based recommendations across five domains: surgical cytoreduction, immunotherapy, chemotherapy, pathology, and germline testing. The germline-testing recommendation is a biomarker/testing guideline scoped strictly to clinical management — identifying patients who may carry hereditary cancer-predisposition mutations relevant to treatment planning and family counseling. It is not a claim about what causes mesothelioma: malignant pleural mesothelioma remains a cancer caused by asbestos exposure, and germline findings do not change that causal relationship for any individual patient's diagnosis.

The European Society for Medical Oncology (ESMO) Clinical Practice Guidelines serve as the parallel European standard-of-care reference, covering diagnosis, treatment, and follow-up for malignant pleural mesothelioma, including systemic therapy options in the relapsed setting. The ESMO guideline document does not carry a PubMed abstract and is cited here as a guideline document rather than a primary research study — a distinction worth making explicit, since guideline documents synthesize and interpret trial evidence rather than generating new randomized data themselves.

Both guidelines converge on a similar practical message for relapsed disease: treatment selection should account for what was used first-line, the patient's performance status and histology, and — where available and appropriate — enrollment in a clinical trial. For a catalogue of currently enrolling investigational trials in mesothelioma (as distinct from the completed, reported regimens on this page), see Clinical_Trials_Mesothelioma.

What Does the Broader Salvage-Chemotherapy Literature Show?

Before checkpoint inhibitors entered the relapsed-mesothelioma treatment landscape, and continuing in parallel with them today, a body of narrative and systematic review literature has documented the salvage chemotherapy options available to patients whose disease has progressed after first-line pemetrexed-platinum therapy.

A systematic review and network meta-analysis by Tsai and colleagues synthesized randomized controlled trial data across chemotherapy, antiangiogenic, and immunotherapy second-line regimens in relapsed MPM, using indirect statistical comparison (network meta-analysis) to rank treatments where head-to-head trials do not exist. Among its findings: cross-trial data suggested dual immunotherapy (nivolumab plus ipilimumab) achieved a median overall survival of 15.9 months versus 11.9 months for nivolumab monotherapy. Because this is an indirect, cross-trial comparison rather than a randomized head-to-head trial, it should be read as hypothesis-generating rather than definitive proof that dual therapy outperforms monotherapy in every patient population.

A 2021 review by Cui and Popat in Cancer Treatment Reviews covers the broader status of systemic therapy for pleural mesothelioma, including the evolution from upfront platinum-antifolate chemotherapy through the emerging relapsed-setting immunotherapy data, noting that the role of maintenance chemotherapy remains unclear and that antiangiogenic agents added to chemotherapy have produced only modest survival improvements. A companion 2018 review by de Gooijer, Baas, and Burgers in Translational Lung Cancer Research focuses specifically on chemotherapy strategies, noting that platinum-pemetrexed remains the only registered chemotherapy regimen for MPM and that among antiangiogenic agents, only bevacizumab and nintedanib have shown activity when added to that doublet. A third review, by Petrini and colleagues in the Journal of Thoracic Disease, focuses specifically on relapse management in the pre-immunotherapy treatment framing: it documents that pemetrexed rechallenge may benefit selected patients based on retrospective analyses, and that single-agent vinorelbine produces modest response rates (0–18%) with a tolerable toxicity profile, while combination chemotherapy regimens increase toxicity without demonstrating improved efficacy. Together, these reviews frame vinorelbine and pemetrexed rechallenge as the accessible, lower-cost salvage chemotherapy options that predate — and continue to sit alongside — the immunotherapy-based regimens discussed above.

What Does Post-Surgical Recurrence Data Show?

A distinct population worth noting separately is patients who recur after primary curative-intent surgery rather than after first-line systemic therapy alone. A retrospective study by Nakamura and colleagues examined the efficacy, tolerability, and safety of nivolumab plus ipilimumab specifically in this post-surgical recurrence setting, treating 41 patients with 360 mg nivolumab every three weeks and 1 mg/kg ipilimumab every six weeks.

The reported results were notable: an objective response rate of 43.9%, a disease control rate of 75.6%, a 12-month post-treatment survival rate of 74.2%, and a median progression-free survival of 7.3 months. Grade 3–4 adverse events occurred in 34.1% of the 29 patients (70.7% of the cohort) who experienced any adverse event. As with RAMES and MAPS2, these figures are drawn from the published abstract rather than independently cross-checked against full-text tables, and the retrospective, non-randomized design (versus a prospective randomized trial) means selection bias cannot be excluded. The study nonetheless adds to the case that checkpoint inhibition retains activity in mesothelioma patients who progress after surgery, a population that overlaps with but is not identical to the broader relapsed-after-chemotherapy population most other trials on this page enrolled.

How Should Patients Think About These Options?

For a patient and oncologist facing relapsed pleural mesothelioma, the practical takeaway from this evidence landscape is that treatment selection is genuinely individualized rather than protocol-driven. What was used first-line, histologic subtype, performance status, mesothelin expression (relevant to some antibody-drug conjugate trials), and access to a clinical trial all factor into the decision. Enrollment in a clinical trial is frequently the preferred option at progression per current guideline positioning, and investigational approaches — including TEAD inhibitors, mesothelin-targeted CAR-T cell therapy, and next-generation checkpoint combinations — are tracked separately on Clinical_Trials_Mesothelioma, which covers what is currently enrolling as opposed to the completed, reported regimens documented on this page. Readers seeking the full first-line and relapsed-setting immunotherapy trial detail, including CONFIRM and the negative PROMISE-meso pembrolizumab trial, should see Immunotherapy_for_Mesothelioma.

Patients and families navigating a relapsed mesothelioma diagnosis may also be facing decisions about legal compensation alongside treatment planning. Because malignant pleural mesothelioma is caused by asbestos exposure, patients — regardless of which treatment line they are currently on — may be eligible for compensation through asbestos trust funds or litigation. More on treatment planning and legal options is available through Danziger & De Llano's mesothelioma treatment resources.

Frequently Asked Questions

What is second-line therapy for pleural mesothelioma?

Second-line therapy is the treatment given after a patient's mesothelioma progresses following first-line platinum-pemetrexed chemotherapy (with or without bevacizumab) or first-line immunotherapy. Unlike first-line treatment, no regimen carries an FDA approval specific to the relapsed setting; options include the phase 3-validated nivolumab (CONFIRM trial), phase 2 combinations like gemcitabine plus ramucirumab (RAMES) or nivolumab plus ramucirumab, and salvage chemotherapy such as vinorelbine or pemetrexed rechallenge.

Is there an FDA-approved treatment specifically for relapsed mesothelioma?

No regimen currently carries an FDA approval specific to second-line or relapsed pleural mesothelioma. Nivolumab and pembrolizumab-based combinations are FDA-approved as first-line therapy, and the CONFIRM trial provides the strongest relapsed-setting evidence for nivolumab, but that approval is for first-line use. Relapsed-setting treatment selection is guided by ASCO and ESMO clinical practice guidelines rather than a dedicated approval.

How strong is the evidence for the RAMES trial's survival benefit?

RAMES showed a genuine survival benefit for gemcitabine plus ramucirumab — median overall survival of 13.8 versus 7.5 months — but two caveats matter. First, it reported 70% confidence intervals rather than the standard 95%, a narrower statistical window that should not be read as offering the same certainty as a typical phase 3 result. Second, the published figures come from the trial's PubMed abstract and have not been independently confirmed against the full-text manuscript on this page.

Why did anetumab ravtansine fail in relapsed mesothelioma?

Anetumab ravtansine, an antibody-drug conjugate targeting mesothelin, was tested against vinorelbine in the randomized phase 2 ARCS-M trial and was not superior — progression-free survival was essentially identical between arms (4.3 vs. 4.5 months, HR 1.22, p=0.86). The trial's own investigators described it as "not superior to vinorelbine," making it a clear negative result rather than an inconclusive one.

What happened to the nivolumab-ramucirumab HCRN trial?

The HCRN-LUN15-299 trial testing nivolumab plus ramucirumab is registered as NCT03502746 and its ClinicalTrials.gov status is TERMINATED, with a final enrollment of 34 patients. The single-arm data collected before termination showed a 22.6% objective response rate and 12.5-month median overall survival, but the trial's primary endpoint (40% ORR) was not met.

What do ASCO and ESMO guidelines say about relapsed mesothelioma?

ASCO's 2025 guideline update, based on a review of 110 studies from 2016–2024, issued evidence-based recommendations spanning surgery, immunotherapy, chemotherapy, pathology, and germline testing. ESMO's Clinical Practice Guidelines serve as the parallel European reference for diagnosis, treatment, and follow-up, including relapsed-setting systemic options. Both frame treatment selection as individualized based on prior therapy, histology, and trial availability.

Should mesothelioma patients get germline testing?

ASCO's 2025 guideline includes a recommendation on germline testing as part of biomarker-driven clinical management — helping identify hereditary cancer-predisposition mutations relevant to treatment planning and family counseling. This is a testing recommendation, not a claim about the cause of the patient's mesothelioma. Malignant pleural mesothelioma is caused by asbestos exposure; germline findings do not change that causal relationship.

Where can I find currently enrolling clinical trials for relapsed mesothelioma?

Investigational trials still enrolling patients — as distinct from the completed, reported regimens on this page — are catalogued on Clinical_Trials_Mesothelioma, which covers approaches including TEAD inhibitors, mesothelin-targeted CAR-T cell therapy, and next-generation checkpoint combinations.

Quick Statistics

• 10.2 vs. 6.9 months — median overall survival with nivolumab vs. placebo in the positive phase 3 CONFIRM trial (HR 0.69, 95% CI 0.52–0.91)
• 13.8 vs. 7.5 months — median overall survival with gemcitabine plus ramucirumab vs. gemcitabine alone in RAMES (HR 0.71, 70% CI 0.59–0.85; abstract-only)
• 22.6% — objective response rate for nivolumab plus ramucirumab in the terminated HCRN-LUN15-299 trial (NCT03502746)
• 4.3 vs. 4.5 months — progression-free survival with anetumab ravtansine vs. vinorelbine, a statistically non-significant, formally negative result (HR 1.22, p=0.86)
• 44% and 50% — 12-week disease control rates for nivolumab alone and nivolumab plus ipilimumab in MAPS2, both exceeding the trial's 40% threshold
• 110 studies — number of additional publications (2016–2024) reviewed to inform ASCO's 2025 guideline update
• 15.9 vs. 11.9 months — cross-trial network meta-analysis comparison of dual vs. single-agent immunotherapy overall survival (indirect comparison, not head-to-head)
• 43.9% — objective response rate to nivolumab plus ipilimumab in a retrospective post-surgical recurrence cohort (abstract-only)
• 0–18% — response rate range for single-agent vinorelbine salvage chemotherapy reported across relapse-management reviews
• 34 patients — final enrollment of the terminated NCT03502746 trial, short of its original target

External Links

• Danziger & De Llano — Mesothelioma Treatment — overview of treatment approaches and how they intersect with legal compensation options
• Mesothelioma Lawyer Center — Treatment — patient-facing resources on mesothelioma treatment options
• Mesothelioma.net — Treatment — additional patient and caregiver resources on systemic therapy and clinical trials

Related Pages

• Pleural_Mesothelioma — Full disease overview, including first-line treatment, staging, and prognosis
• Immunotherapy_for_Mesothelioma — Full detail on CONFIRM, PROMISE-meso, CheckMate 743, KEYNOTE-483, and CAR-T
• Clinical_Trials_Mesothelioma — Currently enrolling investigational trials, distinct from the completed regimens covered here
• Mesothelioma_Immunotherapy — Additional immunotherapy background and mechanism-of-action coverage