Yearly Recap: 2021 Mesothelioma Treatment Advances

Mesothelioma Research in Laboratory with Microscope

The year 2021 brought a mixture of challenges and hope for mesothelioma patients. The ongoing COVID-19 pandemic created some difficulties. For instance, mesothelioma patients may have switched some of their healthcare to telehealth. The pandemic also affected some mesothelioma research efforts.

Along with these challenges, there were also several mesothelioma treatment advances. New 2021 research studies revealed important progress in many areas of mesothelioma treatment. Some of these new treatments have already helped extend survival for some mesothelioma patients. These advances may help improve the lives of mesothelioma patients around the world.

Immunotherapy Advances for Mesothelioma Treatment

Immunotherapy drugs are relatively new to the mesothelioma treatment toolbox. These drugs help the immune system recognize and destroy cancer cells. There have been multiple immunotherapy advances for mesothelioma treatment in 2021.

Opdivo® and Yervoy® Improve Survival for Pleural Mesothelioma

In 2020, the United States Food and Drug Administration (FDA) approved a new treatment for pleural mesothelioma. It was the first new drug approval for mesothelioma in 16 years.

The new treatment combines two immunotherapy drugs: nivolumab (Opdivo®) and ipilimumab (Yervoy®). Early clinical study results for Opdivo® and Yervoy® were encouraging. The combination improved survival for inoperable pleural mesothelioma patients.

Understanding Checkpoint Inhibitors

Immune checkpoints are a safeguard within the immune system. These checkpoints prevent immune cells from attacking healthy cells. Cancer cells can use these checkpoints to avoid being attacked by the immune system.

Checkpoint inhibitors are a form of immunotherapy. They block cancer cells from exploiting immune checkpoints. This can allow the body’s immune cells to attack and kill cancer cells. Opdivo® and Yervoy® are checkpoint inhibitors.

The immunotherapy combination resulted in a median survival of 18.1 months. Patients undergoing chemotherapy treatment had a median survival of 14.1 months.

This means patients receiving Opdivo® and Yervoy® lived about five months longer than those receiving chemotherapy.

However, additional follow-up of this study revealed even more promising results. In late 2021, researchers reported patient survival based on mesothelioma cell type. Immunotherapy gave patients with non-epithelial cell types a survival advantage. These patients survived more than twice as long as those treated with chemotherapy. This treatment is one of the first to ever achieve such success in non-epithelial mesothelioma.

Immunotherapy and Chemotherapy Before Mesothelioma Surgery

In September 2021, researchers published promising results for a combination pleural mesothelioma treatment. Prior to surgery, participants received atezolizumab, an immunotherapy drug, in combination with chemotherapy. Atezolizumab (Tecentriq®) is a checkpoint inhibitor. Checkpoint inhibitors help the immune system find and fight cancer cells.

Study findings showed treatment kept tumors from progressing for about 19 months. This may be heartening for some patients, as tumors sometimes progress during chemotherapy. That progression may impact patients’ eligibility for mesothelioma surgery. A lead researcher from the study described the results as “rather encouraging.”

More studies may take place to review the efficacy and other factors. Pleural mesothelioma patients may qualify to join a clinical trial for this treatment. If interested, patients should discuss this possibility with their doctor.

CAR T-Cell Therapy and Pembrolizumab as Second-Line Treatment

Researchers have also been studying CAR T-cell therapy for mesothelioma. CAR T-cell therapy has been successful in treating some cancers. But it fell short in early studies using CAR T cells to treat solid tumors, such as pleural mesothelioma.

Understanding CAR T-Cell Therapy

CAR T-cell therapy uses a person’s T cells to combat cancer. The CAR T-cell therapy process starts with removing some cancer-fighting T cells from the patient. Scientists modify the T cells in a lab. Then a care provider administers the CAR T cells back to the patient.

A recent study combined CAR T-cell therapy with pembrolizumab (Keytruda®), a checkpoint inhibitor. The combination was used as a second-line treatment for pleural mesothelioma. Researchers combined these treatments in an effort to overcome perceived shortcomings of CAR T cells. Patients receiving this treatment had a median survival of two years. This is about one year longer than previous second-line treatments.

Given these positive results, researchers may continue performing studies of this combination. If the FDA approves it, it will be more accessible. Until then, eligible patients may access this treatment through clinical trials.

New Research on Surgery for Mesothelioma

For decades, surgery has been a prominent mesothelioma treatment. In 2021, researchers continued studying surgical options for peritoneal and pleural mesothelioma. Ongoing research led to notable advances in several surgery methods. These include Hyperthermic Intraperitoneal Chemotherapy (HIPEC), extrapleural pneumonectomy and pleurectomy/decortication.

Repeat CRS + HIPEC May Extend Peritoneal Mesothelioma Survival

There are promising studies for treating peritoneal mesothelioma with combination, or multimodal, treatments. One such study analyzed cytoreductive surgery (CRS) combined with HIPEC therapy. This study showed patient survival may improve with several rounds of CRS and HIPEC.

CRS and HIPEC treatment combines surgery with local, heated chemotherapy. Patients who received one round of this treatment had a median survival of 27.2 months. In comparison, those who received repeat rounds had a median survival of 80 months.

Improved median survival may increase interest in this treatment. There are many factors to consider before pursuing repeat CRS and/or HIPEC. Peritoneal mesothelioma patients should discuss treatment options with their doctor.

Pleurectomy/Decortication (P/D) vs. Extrapleural Pneumonectomy for Pleural Mesothelioma

A 2021 study reviewed 20 years’ worth of surgical procedures for pleural mesothelioma. All 282 surgeries used one of the two pleural mesothelioma surgery methods:

  • Pleurectomy and Decortication (P/D): a surgery that removes mesothelioma tumors
  • Extrapleural Pneumonectomy (EPP): a surgery that removes mesothelioma tumors and the affected lung

Researchers documented many details of disease, recovery and quality of life. Findings showed that with all factors considered, P/D was the more successful surgery.

Pleurectomy Decortication (P/D) Study Results

  • Median survival: 22 months
  • Perioperative mortality (death during or soon after surgery): 0%

Extrapleural Pneumonectomy (EPP) Study Results

  • Median survival: 13 months
  • Perioperative mortality (death during or soon after surgery): 11%

EPP may remove more cancer, but it is also more aggressive and may lead to greater complications. The patient’s quality of life may decrease. Patients may also experience more recovery challenges and have a higher chance of death. As a result, researchers concluded P/D is the better surgical option for many cases.

For years, mesothelioma doctors have studied the advantages of P/D and EPP surgical methods. This research has clarified the advantages of P/D and may lead to further developments on the subject.

Hope for Continued Advances in 2022

2021 brought several significant advances in mesothelioma research and treatment. There were developments in both longstanding and new fields of study. Many of these offer possibilities for further research and development of valuable treatments. This year, areas with notable progress included immunotherapy drugs, combination treatment and surgery.

In 2021, mesothelioma research continued to progress. This helps make traditional treatments and practices more effective. Ongoing research also helps pave the way for new, more powerful treatment methods. In 2022, these advances may improve many things, including survival and quality of life for mesothelioma patients.