A landmark trial from Johns Hopkins has demonstrated that giving immunotherapy drugs before and after mesothelioma surgery is both safe and effective—a finding that could reshape treatment for patients whose tumors can be surgically removed.
The phase 2 study, published in Nature Medicine and presented at the World Conference on Lung Cancer in September 2025, marks the first time this “perioperative” immunotherapy strategy has been rigorously tested in mesothelioma.
How the Trial Worked
Patients received nivolumab (Opdivo) alone or paired with ipilimumab (Yervoy) for six weeks before surgery, then continued nivolumab for up to a year afterward.
“This is the first published clinical trial to show that perioperative combination immune checkpoint blockade is not only feasible but potentially beneficial in resectable mesothelioma,” says Dr. Valsamo Anagnostou, the study’s senior author at Johns Hopkins.
Survival Results
Patients who received the combination therapy (nivolumab plus ipilimumab) lived a median of 28.6 months—significantly longer than the historical average of 18 months for mesothelioma.
Key findings:
- Nearly 36% of combination-treated patients remained alive and recurrence-free at follow-up
- Over 80% successfully underwent surgery within the planned window
- Side effects remained manageable with low rates of serious complications
A Blood Test That Sees What Imaging Misses
Perhaps equally important, the trial incorporated an innovative monitoring tool: an ultra-sensitive liquid biopsy that detects circulating tumor DNA (ctDNA) in the bloodstream.
Patients whose ctDNA became undetectable after pre-operative immunotherapy, or whose levels dropped 95% or more, experienced significantly longer survival and longer periods without cancer recurrence.
“Imaging doesn’t always capture what’s happening with mesothelioma, especially during treatment,” Dr. Anagnostou explains. “By using an ultra-sensitive genome-wide ctDNA sequencing method, we were able to detect microscopic signs of cancer that imaging missed.”
What This Means for Patients
These preliminary findings provide a foundation for larger confirmatory trials. If the benefits hold up in broader populations, the combination approach could become standard care for mesothelioma patients eligible for surgery.
For mesothelioma patients and families, this trial offers a rare bright spot in a disease that has resisted treatment advances for decades.