Dramatic Morphometabolic Response to Bevacizumab-Based Chemotherapy After Immunotherapy Failure in Malignant Pleural Mesothelioma on FDG PET

Malignant mesothelioma is a rare but highly aggressive malignancy associated with a poor prognosis. Similar to many other solid tumors, cytotoxic chemotherapy has traditionally been the standard treatment for patients with locally advanced or metastatic malignant pleural mesothelioma (MPM). However, with increasing recognition of immune dysregulation, immune-directed therapies have assumed a growing role in the management of mesothelioma. Here, we report a case of epithelioid-type malignant pleural mesothelioma that demonstrated primary resistance to ipilimumab plus nivolumab, followed by a marked metabolic response on 18F-FDG PET/CT after switching to bevacizumab plus pemetrexed plus carboplatin.