Introduction

Malignant pleural mesothelioma (MPM) is an uncommon but exceptionally aggressive malignancy arising from the mesothelial linings of the pleural cavity, strongly associated with historical asbestos exposure. The global disease burden carries a dismal prognosis, with a median survival of approximately one year post-diagnosis and a five-year survival rate hovering below 10% [1]. In India, the recorded incidence is estimated at approximately one in a million cases per year, though underreporting and diagnostic challenges often mask the true clinical volume [2].

For nearly two decades, systemic frontline therapeutic choices remained constrained to platinum-plus-pemetrexed cytotoxic chemotherapy regimens. While these combinations offer modest palliative benefits, they fail to deliver sustained long-term survival or durable disease control.

The therapeutic landscape shifted fundamentally following the landmark phase III CheckMate 743 trial, which demonstrated a statistically significant and durable overall survival (OS) advantage using first-line dual checkpoint inhibition with nivolumab (anti-PD-1 antibody) and ipilimumab (anti-CTLA-4 antibody) compared to standard of care chemotherapy [3]. This regimen effectively blocks synergistic coinhibitory pathways, restoring T-cell-mediated anti-tumor immunity. While globally adopted as a standard first-line choice, real-world clinical data evaluating this immunotherapy combination within the Indian demographic remains very scarce. The primary objective of this study was to evaluate the real-world OS, including median OS and one-year OS, and safety profile. This study addresses the therapeutic efficacy, safety parameters, and demographic characteristics of Indian patients undergoing frontline treatment with nivolumab and ipilimumab for inoperable epithelioid MPM.

The abstract of this study was presented at ISMPOCON-2024 and was published as a conference proceeding abstract in the Indian Journal of Medical and Paediatric Oncology. The current manuscript represents an expanded full-length retrospective analysis detailing the finalized 12-month overall survival tracking, structured cross-trial discussion metrics, and institutional ethics review parameters [4].