**6. Vaccine**

*Advances in Precision Medicine Oncology*

**68**

**Agent** **Anti-CTLA4**

Tremelimumab

Tremelimumab

Tremelimumab

**Anti-PD-L1**

Avelumab **Anti-PD-1**

Pembrolizumab

Pembrolizumab

Nivolumab Nivolumab **Combination therapy**

Tremelimumab/Durvalumab

Nivolumab/Ipilimumab

Nivolumab Nivolumab/Ipilimumab

Nivolumab/Ipilimumab

*programmed cell death protein 1.*

**Table 1.**

*Overview of clinical trials that tested immunocheckpoint inhibitors for malignant pleural mesothelioma.*

2019 2020

303

40 *ORR: objective response rate; mPFS: median progression free survival; mo: months; mOS: median overall survival; CTLA: cytotoxic T-lymphocyte antigen; PD-L1: programmed death ligand 1; PD-1:* 

6.8

18.1

3

34

29

6.2

NR

2

Disselhorst et al. [27]

Baas et al. [28]

2018 2019

62 63

19

4

11.9

28

5.6

15.9

2

40

28

5.7

16.6

2

Calabro et al. [25]

Scherpereel et al. [26]

2017 2018 2018 2018

34

29

6.1

17.3

2

34

24

2.6

11.8

2

65

19

4.5

11.5

2

25

20

5.4

18

1b

Alley et al. [19]

Desai et al. [20]

Quispel-Janssen et al. [23]

Okada et al. [24]

2013 2015 2017 2019

53

9

4.1

10.7

1b

Hassen et al. [17]

571

5

2.8

7.7

2b

20

3

6.2

11.3

2

29

7

6.2

10.7

2

Calabro et al. [11]

Calabro et al. [12]

Maio et al. [13]

**Year**

**N**

**ORR (%)**

**mPFS (mo)**

**mOS (mo)**

**Study type**

**Reference**

Cancer vaccines have been tested for various cancer types. These vaccines have included tumor lysate, attenuated bacteria, and single or multiple peptides. Wilms tumor 1 (WT-1) is one of the most well investigated cancer antigens. WT-1 was expressed in tumors in 97% of patients with MPM [29]. Galinpepimut-S, a multivalent vaccine against the WT 1 peptide, can activate both CD4+ and CD8+ T-cells [30]. The efficacy and safety of galinpepimut-S was investigated in a phase II trial. The pilot study demonstrated that the median PFS was 7.4 months in the placebo group and 10.1 months in the vaccine group. The median OS was 18.3 months in the placebo group and 22.8 months in the vaccine group. Based on th0se findings, a clinical trial is currently ongoing to investigate a combination treatment of galinpepimut-S plus nivolumab in patients with MPM (with WT-1-positive tumors). Combining cancer vaccines with ICIs might improve the clinical outcome and open a new avenue of therapeutic strategies for MPM.
