If you have been diagnosed with mesothelioma, you’re likely considering treatment options.
These might include surgery, radiation therapy or chemotherapy with pemetrexed plus cisplatin or carboplatin. In some cases, bevacizumab may be added to that chemotherapy regimen.
These therapies are standard of care. They are accepted by medical experts as appropriate treatment for mesothelioma and are used by oncology professionals.
If you’ve already received standard of care and related treatments or you’re considering clinical trials, you may be interested in learning more about immunotherapy.
A free immunotherapy teleconference is a great place to start. CancerCare recently hosted a one-hour education workshop featuring three immunotherapy experts. The teleconference is available online for free.
For mesothelioma patients, immunotherapy is mostly available through clinical trials at this time.
Along with many important topics, the experts discussed clinical trials and shared important considerations for anyone thinking of participating in a clinical trial.
Exploring Future of Immunotherapy
Medical oncologist Dr. Mark Kris of Memorial Sloan Kettering Cancer Center (MSK), who served on the panel, discussed the early days of immunotherapy and its future.
“A better understanding of the immune system in recent years has allowed us to capitalize on that early work and develop new immune-based therapies,” Kris said. “Just a short time ago, we didn’t understand the on-off switches of the immune system. Now we understand them better. This has allowed development of drugs that don’t kill cancer directly but enable the immune system to do so.”
Kris explained there are several approved drugs that work this way, and more are on the horizon. None of these are approved for mesothelioma as standard of care, although they may be available through a clinical trial.
“These drugs can improve outcomes for many people,” Kris said. “But the key is working with your health care team to find out if immunotherapy is right for you. I cannot stress enough the importance of clear communication with your team about immunotherapy and whether it should be added to your cancer care plan.”
Consider a Clinical Trial
Clinical trials often are the only way a person with mesothelioma can access immunotherapy treatment options.
“We really need to acknowledge the many decades of patients who have participated in clinical trials over the years,” said panelist and medical oncologist Dr. Gregory Daniels of Moores Cancer Center in California. “We owe them a huge debt of gratitude, because it’s gotten us to where we are now.”
Daniels said clinical trial participation is always voluntary and helps patients gain access to otherwise unavailable treatments while advancing medical science.
“Ask questions so you fully understand, ‘How is this trial helpful to me? How could this trial harm me?’” he added.
To keep patient interests front and center, clinical trials are well regulated. Doctors and nurses familiar with giving experimental treatments conduct these trials.
If a patient is interested in a clinical trial, the medical provider will determine eligibility. That means finding out if they meet the right criteria to safely participate in the study.
For example, this might include undergoing scans or other tests to ensure your heart function is good enough for this particular treatment. Researchers always want to match someone to the right clinical trial for them.
“Clinical trials also allow for stopping the trial early if there is a clear benefit or harm of a newer therapy being tested,” Daniels said. “Most importantly, the patient must be comfortable with getting either treatment.”
Daniels explained trials are randomized, so patients — and often doctors — do not know who is receiving which treatment. The patient and doctor do not have a choice about which treatment will be administered.
“However, most clinical trials do not use a true placebo, meaning no treatment at all. Instead, you might be comparing standard of care against standard of care plus a new drug,” Daniels said. “Either way, you’ll be getting good treatment. No one receives no treatment.”
For mesothelioma patients, clinical trials may be the only way to receive a new drug not yet approved to treat mesothelioma, even if it already is approved for other cancers.
‘Environment Around Cancer’ Matters
Dr. Michael Postow, panel member and assistant attending physician in the melanoma and immunotherapy department at MSK agreed with Kris: Medical science advancements have allowed for a better understanding of the immune system.
“Immunotherapy is often called a ‘fourth modality’ of treatment after chemotherapy, radiation therapy and surgery, but it’s really more than that. It interacts with the immune system, which affects how other therapies work, to give even better outcomes,” said Postow.
Postow stressed that “immunotherapy is about the environment around the cancer. We used to focus only on the cancer cell, and now we know it is important to consider what is happening around the cancer cell that allowed it to grow and reproduce.”
“We now take a more holistic view on how the body interacts with cancer, and what we learn gives us even more targets for future immunotherapy approaches,” Postow said. “This informs how we approach cancer prevention, too.”
Postow explained that, surprisingly, not smoking is actually a form of immunotherapy “because smoking interferes with how the immune system functions.”
“Tobacco and alcohol cause cancerous mutations in cells and chronic inflammation that allow cancer to grow,” he said. “We now know avoiding things that harm the body works against cancer.”
The holistic approach also extends to cancer prevention vaccines.
For example, the HPV vaccine that prevents cervical and head and neck cancers caused by the HPV virus is a form of immunotherapy. For this approach, timing matters.
People are exposed to HPV through sexual activity, so the vaccine is recommended for children before they become sexually active. Getting vaccinated before viral exposure is critical for cancer prevention.
Postow also noted the important role of clinical trials in immunotherapy advances: “While immunotherapy allows for complete elimination of cancer from the body for a few people, a substantial number of patients do not have the response we want.”
A final takeaway from the experts is the importance of cancer survivorship care.
“These therapies are very complicated,” Postow said. “If you receive immunotherapy, you need experienced cancer centers and experienced doctors for appropriate treatment and long-term follow up.”