• Dandan Zhang, Jianping Liang, Yanhua Lv, Xikun Huang, and Weihong Guo.
• Zhongshan City People's Hostipial, Zhongshan, China.
• Medicine (Baltimore). 2022 Dec 30; 101 (52): e32459e32459.

RationaleMalignant pleural mesothelioma (MPM) is a malevolent tumor originated from pleura and often leads to poor prognosis. Chemotherapy of pemetrexed and cisplatin combined with antiangiogenic therapy of bevacizumab is recommended as the first-line regimen by guidelines. However, there are few sustainable second-line anti-tumor theraies that bring distinct survival benefit after the occurrence of drug resistance as the reported mPFS (median progression-free survival) scarcely exceeds 6 months. Immune checkpoint inhibitors are extensively investigated in pan-cancer, and dual immunotherapy has been listed in the first-line recommendation of MPM in several guidelines, while MPM patients benefit modestly from immune checkpoint inhibitors combination or monotherapy in second-line practice.Patient Concerns And DiagnosisWe report a 59-year-old male patient who was diagnosed with unresectable MPM in April 2021.InterventionsHe received firstly pemetrexed combined with platinum and bevacizumab, which barely curbed disease progression; When the first line treatment failed, he was switched to tislelizumab combined with anlotinib.OutcomesTislelizumab combined with anlotinib significantly relieved his clinical symptoms, and imaging examination further validated the improvement. Until present, the second-line treatment PFS is more than 10 months.LessonsThe case firstly demonstrated the efficacy of tislelizumab combined with anlotinib in the second-line management of MPM. Thus, immunotherapy combined with small-molecule multi-target anti-angiogenic medication may be alternative for the second-line schemes of MPM.Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

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