Efficacy of First-Line Nivolumab Plus Ipilimumab in Metastatic/Inoperable Malignant Pleural Mesothelioma

Aims and Objectives: To study efficacy of first-line nivolumab plus ipilimumab in metastatic/inoperable malignant pleural mesothelioma. Materials and Methods: We conducted a retrospective study at our institute on patients diagnosed as metastatic/inoperable malignant pleural mesothelioma from January 2021 to august 2023. We studied the epidemiological profile and the outcome of the treatment (first-line nivolumab plus ipilimumab) in terms of safety, response rates, and survival. Nivolumab dose given was 240 mg or 3 mg/kg every 2 weeks and the dose of Ipilimumab was 1 mg/kg every 6 weeks till progression. Overall survival analysis was done at the end of 6 months from the first dose. Results: Total 15 patients were diagnosed with metastatic pleural mesothelioma among which 8 (54%) were males and 7 (46%) were females. Median age at diagnosis was 65 years (range 40–76 years). Median number of nivolumab cycles given was 7 cycles (range 2–26 cycles) and the median number of ipilimumab cycles was 3 cycles (range 1–10 cycles). Out of 15, 9 patients (60%) showed a partial response after the first reassessment done at 3 months and these patients continued to show a good response at the end of 12 months follow-up. One patient lost to follow-up after 2 cycles of nivolumab. At the end of 12 months of follow-up, 9 patients (60%) were alive and were continuing immunotherapy. Grade 3 treatment-related adverse effects were seen in 4 (27%) patients which were hepatitis and hypothyroidism. Conclusion: We conclude that the combination of Nivolumab and Ipilimumab is safe and effective as first-line treatment in metastatic pleural mesothelioma and randomized trials from India are needed to evaluate the role of these agents in malignant mesothelioma. Publication History Article published online: 20 February 2026 © 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/) Thieme Medical and Scientific Publishers Pvt. Ltd. A-12, 2nd Floor, Sector 2, Noida-201301 UP, India