A new study from Georgetown University and Johns Hopkins researchers suggests that patients with operable diffuse pleural mesothelioma may benefit from immunotherapy before and after surgery. The findings, presented at the 2025 World Conference on Lung Cancer and published in Nature Medicine, also highlight a groundbreaking blood test that detects cancer undetectable by scans.
“Mesothelioma is a difficult tumor to treat,” explained lead author Joshua Reuss, MD, a thoracic oncologist at Georgetown Lombardi Cancer Center. “Our study demonstrated the feasibility and safety of using immunotherapy before surgery for patients who have tumors that can potentially be removed.”
Mesothelioma, often linked to asbestos exposure, typically spreads diffusely across the lung lining, making it hard to measure or track using standard imaging. To overcome this, scientists applied an ultra-sensitive circulating tumor DNA (ctDNA) sequencing method. Tumors shed small fragments of DNA into the bloodstream, and this test detected microscopic cancer signals that scans missed.
“Imaging doesn’t always capture what’s happening with mesothelioma,” said senior author Valsamo Anagnostou, MD, PhD of Johns Hopkins. “By using genome-wide ctDNA analysis, we could predict which patients were likely to benefit from treatment or relapse.”
The phase II trial tested neoadjuvant immunotherapy using nivolumab alone or combined with ipilimumab. Both strategies delayed tumor progression and extended survival times compared to expectations, though the study was not designed to measure long-term efficacy. Researchers caution that larger trials are needed, but the signals are encouraging.
Reuss noted that ctDNA could provide a powerful tool to monitor treatment response in real time, guiding when to adjust therapy. While further validation is necessary, this approach may soon reshape how doctors determine surgery eligibility and track outcomes for mesothelioma patients.
New Trial: Immunotherapy Plus Blood Testing May Transform Mesothelioma Care
