According to a new study presented at the American Society of Clinical Oncology (ASCO) 2015 annual meeting, there is a promising new mesothelioma treatment regimen that could replace the standard of care that has been in place since 2003. Chemotherapy combinations pemetrexed and cisplatin or pemetrexed and carboplatin have been the preferred treatment combinations, but the addition of a new drug called bevacizumab could make for the newest and best treatment option out there.
As an overview, pemetrexed, also known as Alimta®, was the very first mesothelioma chemotherapy drug to be approved by the Food and Drug Administration (FDA). Cisplatin is another drug used when surgery is not an option. And carboplatin is primarily used for when the cancer is located in the ovaries, lungs, head, and neck.
Bevacizumab, also known as Avastin®, is an anti-angiogenic or tumor-starving treatment designed to prevent the growth of new blood vessels, including the ones that feed tumors. So far, it’s approved for treatment of types of colon, lung, ovarian, cervical, kidney and brain cancers.
This data from the French Cooperative Thoracic Intergroup (IFCT) MAPS study, reported at the ASCO 2015 annual meeting, showed that when bevacizumab is used with the current standard of care combination of pemetrexed and cisplatin, it provides a significantly higher median overall survival versus the standard of care used alone for first-line in patients with pleural mesothelioma.
Median progression-free survival (PFS) also followed a similar trend, showing significantly higher in patients receiving the triplet treatment of bevacizumab, pemetrexed, and cisplatin as well.
Natasha Leighl, MD, of Princess Margaret Cancer Centre in Toronto said this data was “practice changing” for mesothelioma cancer patients.
Other medical professionals are cautiously optimistic. Anna Nowak, PhD, of the Sir Charles Gairdner Hospital in Western Australia, is one of them. She is not endorsing it as the new standard of care, mostly because it needs to be studied further.
“We cannot know if efficacy will translate into effectiveness,” said Dr. Nowak. “Regimens and doses vary from the label when introduced in the community setting particularly where carboplatin is more often used with pemetrexed.”
Plus, quality of life was the same across both sides of the study with little information regarding pain, weight loss, and other patient symptom improvements. She believes the data may vary with geography, especially in the context of health economics and effectiveness. The trial occurred in an academic setting so racial minorities were underrepresented as well as the elderly.
Cost will be a major concern, especially for countries that don’t provide much access to care. Dr. Nowak thinks “it may be a new standard of care for some and not others.” Obviously, there is still much more to learn about this potential treatment option.