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Purpose: The NIPU-trial investigates the effect of adding the telomerase vaccine UV1 to treatment with ipilimumab and nivolumab for patients with pleural mesothelioma (PM)., Methods: In this phase 2 open-label trial, patients with PM progressing after first-line chemotherapy were randomised to receive ipilimumab and nivolumab alone (arm B) or combined with UV1 (arm A). The primary endpoint was progression-free survival (PFS) as determined by BICR. It was estimated that 69 PFS events were needed to detect a hazard ratio (HR) of 0.60 with 80% power and a one-sided alpha level of 0.10., Results: 118 patients were randomised. The median PFS determined by blinded independent central review (BICR) was 4.2 months (95%CI 2.9-9.8) in arm A and 4.7 months (95%CI 3.9-7.0) in arm B (HR 1.01, 80%CI 0.75-1.36 P = 0.979), after a median follow-up of 12.5 months (95%CI 9.7-15.6). The investigator-determined median PFS was 4.3 months (95%CI 3.0-6.8) in arm A and 2.9 months (95%CI 2.4-5.5) in arm B (HR 0.60, 80%CI 0.45-0.81 P = 0.025). Confirmed objective response rate (ORR) by BICR was 31% in arm A and 16% in arm B (odds ratio 2.44 80%CI 1.35-4.49 P = 0.056). After a median follow-up time of 17.3 months (95%CI 15.8-22.9), the OS was 15.4 months (95%CI 11.1-22.6) in arm A and 11.1 months (95%CI 8.8-18.1) in arm B, (HR 0.73, 80%CI 0.53-1.0, P = 0.197)., Conclusion: The primary endpoint was not met. Predefined analyses of response rates are in favour of adding the vaccine., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Vilde Drageset Haakensen - Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events: AstraZeneca, Roche, Takeda, Pfizer, BMS, MSD, Janssen. Participation on a Data Safety Monitoring Board or Advisory Board: Novartis, Astra Zeneca, BMS. Leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid: Board member of lung cancer patient organization from 2022. Support from the South-Eastern Norway Regional Health Authorities, grant number 2021083. Maria Bjaanæs - Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events: AstraZeneca, Pfizer, BMS. Weronika Maria Szejniuk – none declared. Solfrid Thunold - Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events: BMS. Susana Cedres - Participation on a Data Safety Monitoring Board or Advisory Board: F. Hoffmann La Roche AG, MSD Oncology, Pfizer, Amphera, Boehringer Ingelheim, BMS Wee L Chin – none declared. Tonje Sofie Dalen – none declared. Saima Farooqi - Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events: Merck. Oscar Grundberg – none declared. Åslaug Helland - All support for the present manuscript (e.g., funding, provision of study materials, medical writing, article processing charges, etc.): South-Eastern Norway Regional Health Authorities, grant number 202007 and 2016056, Ultimovacs, BMS. Grants or contracts from any entity: Roche, InCyte, Astra Zeneca, Merck, Novartis, Eli Lilly, GSK, Illumina, Nanopore. Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events: AstraZeneca, Janssen, Medicovver, Bayer, Eli Lilly, MSD, BMS, Merck, Sanofi, Abbvie, Pfizer, Takeda, Novartis, Roche. Participation on a Data Safety Monitoring Board or Advisory Board: AMGEN (DSMC), AdBoard: Roche, AstraZeneca, Pfizer, Janssen, BMS, EliLilly, Abbvie, Bayer, Sanofi, Merck, Takeda. Leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid: Board member of lung cancer patient organization until 2022 Marius Lund Iversen – none declared. Anna K Nowak - Grants or contracts from any entity: Astra Zeneca. Participation on a Data Safety Monitoring Board or Advisory Board: AstraZeneca, BMS, Douglas Pharmaceuticals Åsa Kristina Öjlert – none declared. Jens Benn Sørensen - Participation on a Data Safety Monitoring Board or Advisory Board: BMS, Merck, Astra Zeneca., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)