Conclusions

In conclusion, this study demonstrates that first-line systemic administration of combined nivolumab and ipilimumab is a safe and good viable chemotherapy-sparing regimen option for patients presenting with metastatic or inoperable epithelioid MPM. The regimen achieved substantial objective structural responses and encouraging one-year overall survival outcomes that closely align with established global benchmark data, such as the landmark CheckMate 743 trial. Furthermore, the safety profile underscores the feasibility of this dual immunotherapy approach, as observed immune-mediated adverse events (imAEs) were entirely manageable through standard, guideline-driven immunosuppressive protocols without compromising therapeutic continuity.

These real-world findings complement the findings from randomized clinical trials and suggest transitioning away from traditional platinum-based doublets toward frontline dual immune checkpoint inhibition in patients with epithelioid histology. However, to definitively establish these outcomes within diverse demographics, large-scale, multi-center prospective randomized controlled trials are urgently warranted across the Indian subcontinent. Future research must focus on identifying predictive biomarkers to refine patient selection, exploring cost-effective dosing strategies to optimize economic delivery in resource-constrained settings, and capturing mature, long-term survival data to confirm the durability of this therapeutic approach.