Immunotherapy Innovations

When it comes to mesothelioma, “good news” is a phrase that most people do not associate with the disease. However, looking back over the past year, there have actually been quite a few stories highlighting positive developments in the realm of mesothelioma treatments, diagnosis, and other medical aspects of the disease.

With that in mind, here are some of the steps forward that mesothelioma research took this year.

Genetic Research Breakthroughs

Way back in February, Dr. Raphael Bueno wrote about the results of a study conducted by the International Mesothelioma Program (IMP) to develop a comprehensive gene-sequencing of mesothelioma tumors. Long story short, this groundbreaking research has given researchers new potential to develop individualized therapies based on specific factors within the tumor’s genetic structure. Considering the team found more than 2,500 alterations among the cancer’s genetic makeup, this astounding breakthrough gives an entirely new meaning to personalized medicine!

A different study published in September took another approach in genetic research related to mesothelioma. A study conducted in Sweden looked at how some families can be more at risk of developing the cancer through a gene known as BAP1. While the gene itself does not necessarily determine whether a person will develop mesothelioma, the study showed a definite correlation to the likelihood that someone exposed to asbestos would contract the disease. While a link BAP1 had been made previously, this study provided further understanding of the relationship, which could ultimately lead to better detection and treatment in the future.

In October, yet another study related to mesothelioma and genetics was published. This study showed that DNA screening could help doctors identify the best chemotherapy treatments for patients, based on the specific type of mesothelioma cells are present in the tumor. While pemetrexed (Alimta) and cisplatin are the most common chemotherapy drugs used to treat mesothelioma, they do not always work, and other chemotherapy drugs may be better for treating certain types of the cancer. Being able to determine how the cancer will react to the drugs beforehand will improve the effectiveness of the treatment significantly.

Top Mesothelioma Doctors in the Country
David Sugarbaker, M.D.

David Sugarbaker, M.D.

Professor of Surgery, Chief of General Thoracic Surgery, Director of the Lung Institute Map Marker Baylor College of Medicine
Raphael Bueno, M.D.

Raphael Bueno, M.D.

Chief, Division of Thoracic Surgery; Vice Chair of Surgery for Cancer and Translational Research Map Marker Brigham and Women's Hospital

More Mesothelioma Diagnostic Tools

It has long been known that the best way to improve mesothelioma prognosis is to detect it earlier; however, the disease often disguises its symptoms to make it look like other diseases or conditions, which can delay diagnosis and treatment. One way to detect mesothelioma early is through the use of blood tests (known as “assays”) that can identify biomarkers – substances in the bloodstream – linked to mesothelioma. Unfortunately, most biomarkers are insufficient to provide a diagnosis on their own, and searches for better biomarkers are ongoing.

In 2016, we’ve seen two studies showing promising results for new biomarkers. The first of these, published in August, looked at a protein known as high mobility group box protein 1 (HMGB1). In this study, scientists were not only able to distinguish between those with mesothelioma and those without the disease, but they also were able to identify those who had been exposed to asbestos but had not yet developed the deadly cancer. The sensitivity of this test makes it possible to monitor those who have high risk of developing mesothelioma, but who have not yet done so.

Earlier this month, a second study introducing a potential new biomarker was presented at the World Conference on Lung Cancer in Vienna, Austria. This new biomarker relies on detection of a protein known as fibroblast growth factor 18 (FGF18), which is present in much higher quantities in those who have mesothelioma than those who do not. This particular biomarker may also be a mesothelioma prognostic indicator, based on levels of the substance in the bloodstream.

While not a blood-based biomarker, yet another mesothelioma diagnostic procedure was introduced in 2016: a breath test that could detect the presence of pleural mesothelioma, which forms on the linings of the lungs. A group of Belgian researchers were able to successfully identify those who had mesothelioma through multicapillary column/ion mobility spectrometry (MCC/IMS), which has previously been used to detect exposure to various toxic substances that are inhaled. The test was recorded as having a nearly 90% accuracy rate, which makes it extremely effective at detecting the disease at a stage when it can be successfully treated.

New and Enhanced Mesothelioma Treatments

This past year has also seen advances in the way that mesothelioma is treated. Some of these are simply improvements on existing methods, while others employ new drugs to either enhance the effectiveness of existing therapies or which attack the disease in an entirely new way completely.

In August, we shared the news that the National Comprehensive Cancer Network (NCCN) – a group of dozens of the largest cancer centers and clinics – updated their recommendations for treating mesothelioma. Specifically, for first-line treatment of pleural mesothelioma that is unresectable (usually indicating it is in a late stage) the NCCN now recommends the use of bevacizumab (Avastin) in combination with the standard chemotherapy combination of pemetrexed and cisplatin. This recommendation is based off a study that was published earlier in the year which showed that bevacizumab was able to improve the effectiveness of traditional chemotherapy by preventing tumors from forming new blood vessels.

On the radiation side of treatment, a study describing a new lung-sparing technique known as IMPRINT was published over the summer. This new technique uses a narrower beam with higher intensity than traditional radiation treatments, making it easier to target the radiation at the tumors while avoiding healthy cells. Combined with a surgery known as pleurectomy-decortication (P/D) – which removes the lining of the lungs – the technique appears to be more effective than existing methods.

In addition, there are a number of studies currently underway that are showing significant promise in treating mesothelioma:

Meanwhile, in September Baylor University researchers announced a first-of-its-kind trial to use immunotherapy as a neoadjuvant therapy (i.e., given to patients before surgery). While multimodal therapy is already in use to treat some mesothelioma patients, and immunotherapy has been used as a second-line treatment, this particular combination of immunotherapy as part of a multimodal approach is novel.

Looking Forward to 2017

These are just some of the most notable improvements in mesothelioma treatment and research that has taken place over the last year. While there is still a long way to go, the research and techniques developed this year have brought us that much closer to developing an effective treatment for mesothelioma. In 2017, there will undoubtedly be even more progress made – we look forward to announcing it here at the Mesothelioma Cancer Alliance when it happens.