In a new year, it’s traditional to review recent achievements, then identify goals for the year that lies ahead.
In the December 2012 issue of the Journal of Thoracic Oncology, mesothelioma expert Anne Tsao analyzed the recent — and upcoming — directions in mesothelioma research. The article focused on three main areas of development: anti-angiogenic drugs, immunotherapy and biomarkers.
These treatments have been in development long before 2012 — but researchers did make several breakthroughs in each of the fields. Experts with the Southwest Oncology Group, the Memorial Sloan-Kettering Cancer Center and similar research organizations plan to take these findings to the next level, thanks to funds from the Department of Defense and national cancer research groups.
While summarizing the year’s clinical trial activity, Dr. Jessica Donington noted an emphasis on anti-angiogenic agents, or drugs that prevent tumors from creating new blood vessels (which allows the tumor to spread from its origin). Researchers are finding great promise in these drugs for mesothelioma patients who meet a very specific set of characteristics. These trials have produced positive responses for sunitinib, bevacizumab/gemcitabine/platinum-based chemotherapy regimens, and the tumor-specific peptide known as NGR-hTNF.
Researchers have already identified vorinostat as a potential treatment for mesothelioma. This lymphoma drug has produced median survival rates of up to four weeks longer than placebo drugs, but further developmental trials are currently on pause. Once researchers can provide further analysis on the biomarkers that indicate a positive response to vorinostat, they may be able to launch additional studies.
Donington also mentioned a clinical trial that is currently wrapping up at MD Anderson Cancer Center. The study is one of the first efforts to incorporate pre- and post-treatment biopsies, personalized treatment plans and a novel targeted agent.
Dr. Ibrahim discussed relevant developments in immunotherapy, many of which focused on the use of tremelimumab. This human antibody is proving especially useful in patients who do not respond to traditional chemotherapy drugs. In one study of 22 patients, tremelimumab produced two partial responses, stabilized four patients’ progression and yielded an overall survival of 17.5 months.
In light of the recently completed phase II immunotherapy studies, researchers hope to advance to the next stage in tremelimumab testing. If certain results are achieved, the drug may become an ideal “salvage therapy” for mesothelioma patients who do not respond to first-line treatment.
Dr. Anne Tsao concluded the article with an overview of biomarker research. In the last year, this research has included studies of genetic mutations, serum markers, blood-based markers and prognostic tumor markers. Most recently, researchers identified the biomarker, BAP1, which may contribute to patients’ genetic predisposition for non-asbestos-related mesothelioma.
The MD Anderson Cancer Center and the Memorial Sloan-Kettering Cancer Center will soon open enrollment for a WT-1 vaccine trial. This vaccine may prompt attacks on mesothelioma cells contaning the WT-1 biomarker.
Researchers also hope to identify a more accurate prognostic biomarker for mesothelioma. While one team in Boston has identified a four-gene ration test that has decent results, they must adapt the test to account for several limitations (including the lack of real-time results).
These advancements may certainly change the way doctors currently treat mesothelioma. Each trial brings us one step closer to an effective treatment, which the mesothelioma community will pursue this year, and each year that follows, until we find a cure.