Meta-analysis finds immunotherapy improves survival in mesothelioma

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Journal of chemotherapy (Florence, Italy) Published May 8, 2026 Medically reviewed May 8, 2026 Study authors: Skelin Marko, Matić Kaja, Anić-Matić Andrea, Krečak Ivan, Perkov-Stipičin Bruna, Grubor Mirko PubMed ↗ DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

Key Takeaway

Consider immunotherapy for mesothelioma, especially in non-epithelioid subtypes, given significant OS benefit.

This meta-analysis pooled data from 2549 patients with mesothelioma to evaluate the efficacy of immunotherapy. The primary outcome was overall survival (OS), with secondary outcomes including progression-free survival (PFS) and objective response rate (ORR).

Immunotherapy significantly improved OS compared to control (HR 0.78, p=0.0005). The benefit was similar regardless of line of therapy (first-line vs second/later-line, p=0.25) or ECOG performance status (p=0.32). However, a greater OS benefit was observed in non-epithelioid histologic subtypes compared to epithelioid (p=0.002).

A strong correlation between OS and PFS was noted (r=0.86, p=0.01), supporting PFS as a surrogate endpoint in mesothelioma trials. Safety data were not reported in this meta-analysis.

The authors did not explicitly list limitations, but as a meta-analysis, heterogeneity across trials and potential publication bias are inherent concerns. The results emphasize the importance of immunotherapy in mesothelioma and suggest that PFS may serve as a valid surrogate for OS in future trials.

Study Details

Study typeMeta analysis

Sample sizen = 2,549

EvidenceLevel 1

Follow-up60.0 mo

PublishedMay 2026

PMID40264298

View Original Abstract ↓

Mesothelioma has a poor prognosis, with a 5-year overall survival (OS) rate less than 5%. Immunotherapy has been proven as a promising alternative to platinum-based therapies in first-line treatment. Our systematic literature search included 7 randomized clinical trials involving 2,549 patients to evaluate the impact of immunotherapy on OS across different lines of therapy, histologic subtypes, and ECOG performance status, and to assess the correlation between OS, progression-free survival (PFS), and objective response rate (ORR). Immunotherapy significantly improved OS (HR 0.78, = 0.0005) with a similar benefit observed in first-line and second/later-line treatment ( = 0.25) as well as in all ECOG statuses ( = 0.32). A significantly greater benefit was observed in non-epithelioid compared to epithelioid mesothelioma ( = 0.002). Additionally, a strong correlation was shown only between OS and PFS ( = 0.86, = 0.01). Our results emphasize the importance of immunotherapy in mesothelioma and further support PFS as a surrogate endpoint.