While many patients with mesothelioma — a type of rare cancer that most commonly occurs in the membrane between the lungs and the chest wall — may not be eligible to undergo surgery, drug advancements in recent years have improved outcomes for patients with the disease, while new therapies continue to be studied, explained Dr. Aaron Mansfield.
Mansfield, who is a professor of oncology at the Mayo Clinic in Rochester, Minnesota, recently discussed mesothelioma at CURE®’s Educated Patient® Lung Cancer Summit.
“The primary treatments for mesothelioma, as they stand, are surgery (with or without radiation) and systemic therapy, which most patients are offered,” Mansfield said in his presentation.
However, patients with a subtype of the disease called sarcomatoid mesothelioma (which make up about 10% to 20% of all mesothelioma cases) cannot undergo surgery, nor can patients whose disease has moved to certain areas. These patients must rely on systemic therapies, which are drugs that move throughout the entire body via the bloodstream.
Immunotherapy for Mesothelioma
“We often have to look in the center of the chest in the belly to make sure it hasn’t spread to those sites, as surgery would then likely become futile,” Mansfield explained. “If we’re not going to do surgery, we then consider the IV therapies and in 2022, that would be a combination of immunotherapies … or chemotherapy with the platinum drug and pemetrexed.”
In October 2020, the Food and Drug Administration (FDA) approved the immunotherapy combination Opdivo (nivolumab) plus Yervoy (ipilimumab) for the frontline treatment of patients with pleural mesothelioma that is not eligible to be surgically removed.
Since then, immunotherapy has become the “dominant frontline therapy for pleural mesothelioma,” according to Mansfield, who explained that mesothelioma is also frequently treated with platinum-based chemotherapy and pemetrexed.
The Future of Mesothelioma Treatment
Radiation may also be used for mesothelioma, though it is primarily used to relieve symptoms in patients whose disease has spread to the ribs. Radiation’s larger role in the disease is still yet to be determined, and is currently being investigated in clinical trials, Mansfield said.
Also being investigated for mesothelioma is CAR-T cell therapy, dendritic cell vaccines and different types of immunotherapy drugs that target different checkpoints, other than PD-1 and CTLA-4, which Opdivo and Yervoy, respectively, inhibit.
“Mesothelioma has the highest expression of a different immune checkpoint called VISTA,” Mansfield explained. “So there’s going to be more to come in this space, and we’ll see if other immunotherapies might be beneficial for the disease.”
Ultimately, Mansfield said that there is more research to be done when it comes to treating mesothelioma.
“We’re still trying to develop new treatments,” he said. “We’re not giving up here. There’s a lot more to do, and more to come in the very near future.”
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