Mesothelioma is known for having a very poor prognosis. Caused by asbestos exposure, symptoms often don’t begin to show until 20 – 50 years later. Unfortunately, this long latency period means many patients aren’t diagnosed until the disease has progressed to a later stage.
Mesothelioma is difficult to treat, and in later stages it becomes even more grueling. In many instances, mesothelioma specialists will recommend a multimodal approach to treatment, meaning a combination of standard therapies like surgery with chemotherapy. Emerging therapies have also begun to give patients hope. Immunotherapy, a treatment that boosts the immune system to fight cancer, has shown promise as an effective treatment for mesothelioma.
Last September, a new mesothelioma clinical trial began at the Baylor College of Medicine Mesothelioma Treatment Center. The clinical trial is a new multimodal approach that looks at the effectiveness of immunotherapy applied before surgery for pleural mesothelioma patients. Though the trial is still in its early stages, researchers are encouraged by the results so far.
Promising Early Results
Typically, immunotherapy has been approached as a stand-alone treatment method or an adjuvant therapy after surgery. This clinical trial is one of the first to study the use of immunotherapy as a neoadjuvant therapy, or a so-called helper treatment used before the primary treatment method.
Researchers are studying and comparing two variants: MEDI4736 alone versus MEDI4736 combined with tremelimumab. The first has one checkpoint inhibitor, while the second consists of two types of checkpoint inhibitors. A checkpoint inhibitor blocks the negative signals tumors display, thus reactivating the immune system to target the tumor cells.
After receiving one of these therapies, patients will then undergo surgery to remove any visible tumors. Before the immunotherapy is administered and following surgery, researchers will study the immune response of these tumors.
When the trial was first announced in the fall, Dr. Bryan Burt, the lead investigator, explained how their data suggests pleural mesothelioma tumors could be more immunogenic (capable of producing an immune response) than previously believed. He predicted that immunotherapy could become a critical component for multimodal treatments in mesothelioma in the future.
Recently, Dr. Burt told the Mesothelioma Cancer Alliance (MCA) that the early results of the trial are very encouraging. “We have seen that our patients are tolerating checkpoint inhibitor immunotherapy very well in the preoperative setting, and we are now beginning to look at how these drugs are influencing the immunologic environment within the tumor, which we believe can favorably influence long-term clinical outcomes.”
What It Means for Mesothelioma and Other Cancers
Emerging treatments and clinical trials like this one have given mesothelioma patients hope. Mesothelioma is an aggressive cancer that is very difficult to treat, so in turn patients have a life expectancy of just 12 – 21 months. Only 9% of mesothelioma patients survive 5 years after diagnosis. Any new treatments that can possibly change their odds are understandably exciting.
“Our trial is designed to learn about the response of the tumor’s immune environment to checkpoint inhibitor immunotherapy, however, a multimodality strategy incorporating immunotherapy and surgery holds promise for favorable impact on life expectancy of mesothelioma patients,” Dr. Burt explained.
As the study progresses, Dr. Burt believes this trial could potentially prove to be beneficial for other kinds of cancer, as well. “Firstly, a multimodality attack on a tumor, such as combining immunotherapy with surgery, has realistic potential to improve patient survival,” Dr. Burt told MCA. “Trials such as this one can potentially set the stage for larger trials that are designed to study long term patient outcomes, such as overall survival and freedom from recurrence.”
For many patients, the cancer journey goes beyond the initial diagnosis and beating the disease. Some patients face recurrence or even a second kind of cancer. Though chance of recurrence varies widely based on the type of cancer and a patient’s individual case, researchers have found it to be fairly common in mesothelioma patients. Being able to monitor long-term outcomes and potentially reduce recurrence rates could provide these patients with a much higher quality of life.
Dr. Burt also believes this trial’s focus on biomarkers, which are molecular indicators of biological processes in the body, could possibly help identify effective treatments for other types of cancer. “The biomarker work that is being done in this trial could potentially lead to a marker, or set of markers, that correlate with favorable responses to therapy that can be refined in future studies,” he said.
The Future of Clinical Trials
Researchers and patients alike are weary of the Trump administration’s plans to reform healthcare and make significant budget cuts to medical and scientific research. Trump’s plan showed severe cuts to the National Institutes of Health (NIH), slashing almost $6 billion from their budget. This would greatly impair cancer research, as many cancer drugs–including immunotherapies–stem from clinical trials and studies with roots in the NIH.
With possible changes like this looming, Dr. Burt said, “I am hopeful that our new administration will see the value in biomedical research and clinical trials such as this one, and will continue to support physician investigators.”
Research efforts like this clinical trial and the ongoing research surge from the Cancer Moonshot are critical for patients today and patients in the future. Hopefully the important work from medical researchers like Dr. Burt and his team can continue without any setbacks.