Mesothelioma Immunotherapy Trial Involves Targeted Radiation

Memorial Sloan Kettering Cancer Center in New York City has opened a clinical trial for mesothelioma involving a combination of targeted radiation and the novel immunotherapy drug avelumab.

Hopes are high for the first-of-its kind study.

The trial will be conducted at Memorial Sloan Kettering’s main campus and regional sites. It is open to pleural and peritoneal mesothelioma patients.

Radiation oncologist Dr. Andreas Rimner and medical oncologist Dr. Marjorie Zauderer are the lead investigators of the trial, which is expected to run through 2020.

Avelumab is designed to block a specific protein (PD-L1) found on the surface of most mesothelioma tumor cells.

The immunotherapy drug will be given through an IV every two weeks, along with stereotactic body radiation therapy (SBRT).

Individually, both treatments have shown success with mesothelioma and other cancers in previous studies.

The hope is for a synergistic effect in combination. The doctors will be measuring an overall response rate.

“The combination of radiation treatment and immunotherapy may be more effective against cancer than either radiation or immunotherapy alone,” reads the trial description on ClinicalTrials.gov. “It is thought that radiation treatment may create a form of ‘vaccine’ against cancer inside the body.”

Previous Studies Show Effectiveness

Dr. Raffit Hassan of the National Cancer Institute detailed the most recent study of avelumab’s effectiveness in treating mesothelioma.

He found a median progression-free survival — the time before it begins to worsen after taking the drug — of 17.1 weeks.

Hassan also reported the drug reduced tumor size in 10 percent of patients.

The PD-L1 protein has become a popular target for several immunotherapy drugs being tested on a wide variety of cancers.

The theory behind targeting the protein, according to doctors at Memorial Sloan Kettering (MSK), is avelumab can improve the ability of a patient’s own immune system to destroy the cancer. Tumor cells produce the PD-L1 protein to evade detection by the immune system.

“We are making meaningful advances for a broad range of patients with cancer. These data add to the growing body of evidence for avelumab, indicating efficacy and a favorable safety profile in multiple cancers,” said Chris Boshoff, vice president and head of early development for Pfizer Oncology, the pharmaceutical giant sponsoring the trial at MSK.

Avelumab Tested with Many Cancers

There are 64 avelumab clinical trials around the world, on various levels, recruiting patients for a variety of cancers.

MSK’s is the only involving mesothelioma and radiation.

Participants in the trial will receive up to five sessions of SBRT. The high-dose, high-accuracy radiation has shown effectiveness with mesothelioma in recent testing.

SBRT has shown an ability to boost the power of the immune system to help a patient fight off the cancer, which could make avelumab more effective.

Mesothelioma specialists have been pushing different immunotherapy agents in an ongoing search for a reliable second-line treatment for the rare cancer.

There currently is no FDA-approved second-line treatment.

Mesothelioma specialty centers started using the targeted radiation more frequently in combination with chemotherapy after lung-sparing pleurectomy and decortication surgery.

Targeted Radiation Use Growing

In one previous study, patients receiving only chemotherapy and targeted radiation had a one-year survival rate of 74 percent.

“We know that giving radiation after surgery makes it less likely for the tumor to come back,” radiation oncologist Dr. Kenneth Rosenzweig at New York’s Mount Sinai Health System said in 2016. “We’ve been working on this [radiation] technique over the last 10 to 12 years. This is very encouraging.”

Among the criteria to be eligible for the study:

• No prior immunotherapy
• Patients must have recovered from any serious side effect of prior therapies
• Patients must have had at least one prior treatment of chemotherapy and are experiencing disease recurrence

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