There were several notable advancements in mesothelioma treatment in 2019. Continued research and clinical trials led to various promising new treatments and treatment combinations, including the first FDA-approved treatment in more than a decade.
Traditional treatments like chemotherapy, radiation and surgery are common methods for treating mesothelioma. Newer treatments, such as immunotherapy, are also beginning to be more widely available as first- and second-line treatments. Although there is no cure for mesothelioma and the prognosis is often poor, continued research has found promising treatments that have extended survival for some mesothelioma patients. Novel treatments, such as CAR-T cell therapy, the NovoTTF-100L System and other targeted therapies, showed success in clinical trials throughout 2019 and will continue to be studied throughout the new year.
Clinical Trials Continue to Explore Effectiveness of Nivolumab
Several mesothelioma clinical trials have been exploring the efficacy of immunotherapy drug nivolumab, sometimes known as Opdivo®. The treatment has been tested as both a first-line and second-line treatment for mesothelioma.
One ongoing clinical trial at the Baylor College of Medicine is testing nivolumab with an adenovirus called MTG201. The combination therapy is applied as a second-line treatment in pleural mesothelioma patients who have previously been treated with chemotherapy. The clinical trial began in September 2019 and is expected to continue over at least the next year.
In November 2019, Memorial Sloan Kettering Cancer Center opened a nivolumab clinical trial for pleural mesothelioma patients. The treatment approach consists of nivolumab and standard chemotherapy before surgery. Researchers suggest incorporating nivolumab intravenously before surgery may increase the immune system’s ability to identify and kill cancerous cells.
Patients enrolled in this study will be administered two rounds of nivolumab and chemotherapy prior to undergoing pleurectomy/decortication surgery, which involves removal of the lung lining, affected tissue and tumors. Researchers will examine the ability for patients to progress to this surgery following immunotherapy and chemotherapy in a 30-day time frame.
Eligible patients for this study include individuals who have been diagnosed with pleural mesothelioma and have not received prior treatment. They must also be able to do routine activities for more than half of their day. The study is expected to be completed in 2022, and researchers will then have more insight into if this treatment combination is effective in improving life expectancy and quality of life for patients.
CAR-T Cell Therapy and PD-1 Immunotherapy Shows Promise in Clinical Trials
CAR-T therapy combined with PD-1 immunotherapy has also shown promise in phase 1 clinical trials. CAR-T cell therapy works by genetically modifying T cells, or white blood cells, to better recognize cancer cells in the body and fight them accordingly. PD-1 inhibitors block signals within mesothelioma cells in order to make them more susceptible to treatment.
The early-phase clinical trial tested the treatment combination in pleural mesothelioma patients. In their multimodal treatment plans, patients also received chemotherapy prior to CAR-T cell therapy. Following chemotherapy and CAR-T cell therapy, patients were administered PD-1 immunotherapy directly into the pleural cavity. When examining 14 patients who received combination treatment, researchers found five patients achieved partial responses and four achieved stable disease.
While the study is in early stages, it could prove to be a promising treatment as it continues to become available to eligible patients. With this emerging treatment already showing promise in the first phase of clinical trials, researchers hope it can impact more patients if it continues to show positive results in future study.
NovoTTF-100L Approved by FDA for Mesothelioma Treatment
A new treatment called NovoTTF-100L was approved by the FDA as a malignant pleural mesothelioma treatment method in May 2019. The system uses tumor treating fields (TTF), which are low-intensity electrical fields that disrupt cancer cell growth.
The treatment system is used in combination with chemotherapy as a first-line therapy. Given that this noninvasive treatment is the first mesothelioma treatment to be approved in more than a decade, it may be a promising option for patients in 2020 as it becomes more readily available.
NovoTTF-100L combined with chemotherapy was tested in a clinical trial known as the STELLAR study. The trial included 80 pleural mesothelioma patients.
Participants treated with TTF experienced a median overall survival of 18.2 months. Mesothelioma patients treated with chemotherapy alone have an average life expectancy of about one year.
One of the leading researchers behind tumor treating fields, Dr. Uri Weinberg, stated further testing would be needed to determine the efficacy of TTF with other treatments.
“We think that our results suggest a stronger immune response against the cancer, so there’s the opportunity to see a greater efficacy when the two treatments are combined. But to draw definitive conclusions regarding the effects of TTFields with immune checkpoint inhibitors in patients, we will need to see results of clinical studies.” said Dr. Weinberg in an interview with Mesothelioma.com.
Since the treatment is noninvasive, it can be viable even for late-stage mesothelioma patients. Patients with advanced-stage mesothelioma are often limited in their treatment options and commonly receive palliative treatment to minimize the severity of symptoms. TTF may provide alternative treatment that can improve the patients’ quality of life and survival.
The Future of Mesothelioma Treatment
Researchers are continually examining effective treatment methods for patients diagnosed with mesothelioma. With numerous clinical trials underway and even a new FDA-approved treatment, more options are available for patients in 2020. Ongoing research and new clinical trials will continue to explore treatments and treatment combinations in the new year. This can ultimately extend life expectancy and improve patients’ quality of life.