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Experimental Treatments

Conventional mesothelioma treatments include surgery, chemotherapy and radiation therapy. However, experimental treatments may be an option for patients not responding to standard options, if they are eligible.

Treatment techniques begin in the experimental stage as they are being tested and improved through clinical trials. If they show enough success, they may be offered as a standard treatment option after being approved by the U.S. Food and Drug Administration (FDA). Experimental treatments are constantly emerging as researchers look for more effective treatment options and a cure for mesothelioma cancer. Patients interested in undergoing experimental treatments must meet individual clinical trial criteria and should discuss with a mesothelioma specialist to determine the best treatment option.

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Immunotherapy

Immunotherapy is a mesothelioma treatment that boosts the immune system as a way to fight mesothelioma. Currently, there are two main immunotherapy techniques, including active immunotherapy and passive immunotherapy.

Active Immunotherapy

Passive Immunotherapy

There are different types of active and passive immunotherapies, including adoptive cell transfer, cancer vaccines, immune checkpoint inhibitors and monoclonal antibodies. Each of the four main types has its own benefits and risks, which patients should discuss with their doctor prior to consideration.

Immunotherapy drugs as part of a multimodal treatment plan have shown promising success, particularly in combination with chemotherapy. In some clinical trials, researchers have seen patient’s life expectancies extend to two or more years. Some immunotherapy drugs are currently available to mesothelioma patients as standard options after front-line chemotherapy, as they have been added to the National Comprehensive Cancer Network (NCCN) guidelines for the treatment of pleural mesothelioma. Other promising immunotherapy drugs and combinations are available through clinical trials, for which patients must meet certain criteria to participate.

Gene Therapy

When a patient has malignant mesothelioma, their healthy cells have mutated into cancer cells. Gene therapy works to treat cancer by introducing new DNA into the patient in an attempt to replace missing or defective genes caused by cancerous mutations, or to create a beneficial protein. In some cases, a replica of the normal gene is introduced to restore its original function.

Researchers continue to develop new ways of introducing gene therapy to patients, but currently, there are two main types used to treat mesothelioma.

Epigenetic Therapy

Epigenetic therapy is similar to gene therapy, as it targets changes in DNA. The main difference between gene therapy and epigenetic therapy is that epigenetic therapy focuses on changing DNA expression instead of altering the DNA sequence itself. This type of treatment uses drugs to target epigenetic changes, reverse any damage and return natural and normal DNA gene expression. Currently, epigenetic therapy is being tested on a variety of cancers, including mesothelioma, metastatic breast cancer, lymphoma and lung cancer with some drugs gaining FDA approval.

Researchers have noted that there are epigenetic changes in mesothelioma patients, focusing particularly on pleural mesothelioma. Malignant mesothelioma research suggests that certain changes in DNA expression can contribute to the growth and development of cancer, and some studies have shown epigenetic alterations in malignant pleural mesothelioma patients who are not responding to chemotherapy drugs. Studies have also found a connection between epigenetic changes and the presence of asbestos fibers within the lungs, as well as with epigenetic changes and survival rates of pleural mesothelioma patients.

Photodynamic Therapy

Photodynamic therapy (PDT) is an emerging mesothelioma cancer treatment that has shown early success. Mesothelioma photodynamic therapy uses light and drugs known as photosensitizing agents to kill cancer cells and stop the cancer from spreading.

This treatment technique has been of particular interest to researchers because of the lack of side effects, which could help improve quality of life for patients. With added success, photodynamic therapy may emerge from its experimental stages into a conventional treatment option. One recent study noted that intraoperative photodynamic therapy combined with lung-sparing surgery greatly extended life expectancies for malignant pleural mesothelioma patients.

Cryotherapy

Mesothelioma specialists have studied the use of cryotherapy in treating mesothelioma. Cryotherapy, otherwise known as cryosurgery and cryoablation, kills cancerous mesothelioma cells by exposing them to extremely cold temperatures.

Cryotherapy goals may include shrinking or eliminating a tumor, reducing mesothelioma symptoms and/or preventing recurrence. Some studies have seen success, but its effectiveness is still being tested.

Patients interested in undergoing an experimental treatment option should discuss the possibility with their medical care team. Clinical trials have certain criteria that a patient must meet to participate, such as the type of mesothelioma and stage of their cancer. Patients should also discuss whether or not experimental techniques are the best option for their individual case.

Multimodal Therapy

A multimodal treatment approach is very common for mesothelioma patients. Multimodal treatments often combine surgery, chemotherapy and/or radiation therapy, using different techniques based on the individual case. Ideally, patients are able to undergo surgical resection to remove as much of the cancer as possible, followed by chemotherapy or radiation therapy to kill any remaining cancer cells and help prevent recurrence.

Though this traditional multimodal treatment is readily available to most mesothelioma patients, researchers are still testing the effectiveness of different treatment techniques and the order that they are administered. For example, hyperthermic intraperitoneal chemotherapy is a relatively new treatment that has shown much success in treating peritoneal mesothelioma, combining surgery with a warm chemotherapy wash. The success of this treatment offers hope for other combinations and innovative techniques that may effectively treat mesothelioma cancer and extend patient survival.

Author: Linda Molinari

Editor in Chief, Mesothelioma Cancer Alliance

Linda Molinari

Reviewer: Dr. James Stevenson

Medical Reviewer and Thoracic Medical Oncologist

Dr. James Stevenson
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Sources

Cramer G, Shin M, et al. Modeling Epidermal Growth Factor Inhibitor-mediated Enhancement of Photodynamic Therapy Efficacy Using 3D Mesothelioma Cell Culture. Photochemistry and Photobiology. November 2018. doi: 10.1111/php.13067

Porpodis K, Zarogoulidis P, et al. Malignant pleural mesothelioma: current and future perspectives. Journal of Thoracic Disease. September 2013;5(4):S397-S406. doi: 10.3978/j.issn.2072-1439.2013.08.08

Suveg K, Putora PM, et al. Current efforts in research of pleural mesothelioma–An analysis of the ClinicalTrials.gov registry. Lung Cancer. October 2018;124:12-18. doi: 10.1016/j.lungcan.2018.07.007

Vachani A, Moon E, et al. Gene Therapy for Mesothelioma and Lung Cancer. American Journal of Respiratory Cell and Molecular Biology. April 2010;42(4). doi: 10.1165/rcmb.2010-0026RT

Vandermeers F, Sriramareddy SN, et al. The role of epigenetics in malignant pleural mesothelioma. Lung Cancer. September 2013;81(3):311-318. doi: 10.1016/j.lungcan.2013.05.014

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