Targeted Therapy for Mesothelioma

What Is Targeted Therapy?

Targeted therapy is a cancer treatment designed to attack cancer cells while sparing normal cells. Different targeted therapies use specific methods to single out cancer cells or block mechanisms that promote cancer growth.

Also known as precision medicine or personalized medicine, targeted therapies use specific proteins, enzymes and other molecules involved in cancer cell maintenance or growth to kill or prevent cancer cells from growing and spreading.

In general, targeted therapies may have fewer side effects than other cancer therapies, such as chemotherapy. Two targeted therapy drugs approved to treat mesothelioma are Yervoy (ipilimumab) and Opdivo (nivolumab). Though they’re approved, they are still considered emerging treatments. Several other drugs are under investigation to treat mesothelioma.  

Types of Targeted Therapy

Targeted therapies primarily fall into two types. These include monoclonal antibodies and small-molecule drugs.

Specific monoclonal antibodies help the immune system recognize cancer cells and attack them. Others stop them from growing or cause them to die.

Other targeted drugs include angiogenesis inhibitors and apoptosis inducers. Angiogenesis inhibitors limit the growth of new blood vessels required for tumor growth, while apoptosis inducers trigger cancer cell death.

Expert Take

Dr. Jacques Fontaine: Emerging Targeted Therapies for Mesothelioma

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In the last few years, I’m happy to say that we’ve made great advances in cancer care, not just for mesothelioma, but for lung cancer, esophagus cancer, and a multitude of cancers. The new treatment concept in cancer is that we need to better define each cancer, get more data on the cancer, get more personal information on that cancer. So that means that we need to do molecular testing, genomic testing. You may hear from your physician that they’re gonna send next gen sequencing.


Some people call it liquid biopsy. Some call it molecular molecular testing, genetic fingerprinting, molecular testing. All these things are trying to get more information about that specific cancer. Are there specific genetic mutations that are driving the growth of that tumor?


That’s called an oncogene, a driver mutation. And now we have medications that target specifically that driver mutation. So if your cancer has that specific medication, now we have an off the shelf medication specifically for that cancer. We also need to look, are there certain proteins that are overexpressed on that tumor?


Meaning is the tumor expressing a certain protein just on itself, but that is not found anywhere else. So that’s kind of like a very specific birthmark than a patient has. So do you have a specific birthmark on you that differentiates you from the million other patients out there that may look like you.


And now we have medications that try to target if you have that very specific birthmark, if you have that very specific protein.


So how does that work? Once we have identified a specific type of protein on the cancer, a protein that’s almost exclusively found on that cancer cell and nowhere else in that patient’s body, then we can target that protein.


How do we target that protein? Well, proteins are also called antigens and antigens bind to antibodies. So you could take an antibody, an antigen or like a key and lock. The antibody will only come and lock to that antigen.


So now on that antibody, you can place chemotherapy bound to it. That’s called an antibody drug conjugate, an ADC.


And this is the frontier in cancer care. So we’re gonna take that antibody that’s gonna lock to that specific antigen and we’re gonna attach to it chemotherapy so that the chemotherapy doesn’t float around the whole body, the whole system, it will come and be delivered specifically to that cancer cell.


But we can take that same antibody and instead of linking to it chemotherapy, we can link to it a radioactive molecule. So it’s basically a miniature smart nuclear bomb radioactive molecule attached to the antibody, and it’s gonna come attached to the antigen on the tumor cell and be able to deliver the payload or that nuclear substance to kill only the cancer cell and nowhere else in the body. So that’s the key, the antigen and the antibody interaction allows the payload to come, whether it’s chemotherapy or radioactive substance, to go only to that antigen, to that cancer cell.

How Do Targeted Therapies Treat Mesothelioma?

Several types of targeted therapies either help the immune system recognize cancer cells or block the growth of new blood vessels to fight mesothelioma. In the U.S., the two targeted therapy drugs approved to treat mesothelioma, Yervoy and Opdivo, target different cancer molecules. 

Yervoy targets the CTLA-4 protein to promote the growth of T cells, immune cells that attack cancer cells. Opdivo targets the PD-L1 protein to block a cancer cell’s hiding ability. These therapies work together to enhance the immune system’s ability to find and kill mesothelioma cells.

Expert Insight

Everyone’s DNA is different, and everyone seems to respond differently to treatment. I’ve been very fortunate with this. I just hope the good fortune continues.

Peter L. , mesothelioma survivor

Oncology groups in the U.S. and France recommended adding a monoclonal antibody known as Avastin (bevacizumab) to improve chemotherapy outcomes in 2016 and 2017. Avastin inhibits a protein called vascular endothelial growth factor (VEGF), which limits the growth of new blood vessels that tumors need to grow and spread.

Combining different therapies is known as multimodal therapy. Another type of experimental targeted therapy, kinase inhibitors, is under preliminary investigation for mesothelioma. Kinase inhibitors also block the growth of new blood vessels. Researchers are also considering combining targeted therapies with gene therapy in future research.

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Side Effects

Targeted therapy’s common side effects include diarrhea and liver issues. Some people may develop a skin rash. Side effects vary depending on the type of targeted therapy prescribed. 

Getting enough sleep, maintaining a healthy diet and exercising can help manage side effects. Quitting smoking and reducing alcohol consumption may also help to minimize adverse reactions.  

Target therapy works against cancer cells, saving the normal cells from any damage. Using the body’s immune system, targeted therapy can block further growth of cancer cells or cause apoptosis (cancer cell death). Ongoing research is striving to determine how targeted therapy can help mesothelioma patients.

Dr. Snehal Smart, Medical Doctor and Patient Advocate at The Mesothelioma Center

What to Expect When Getting Targeted Therapy

Your experience with targeted therapy depends on the type of therapy your mesothelioma doctor prescribes. Your body’s response to treatment also significantly shapes your experience with targeted therapy. 

Small-molecule drugs are pills or capsules that you swallow, which means you can take them at home or while traveling. However, another type of targeted therapy, monoclonal antibodies, is administered intravenously through a needle in a blood vein. This type of therapy must take place in a hospital or cancer center.

Treatment frequency also depends on the drug, how advanced your cancer is and how your body responds. In general, you may receive treatment daily, weekly or monthly. Some targeted therapies involve cycles that include time between treatments for rest.

How to Prepare for Targeted Therapy

Preparing for targeted therapy varies depending on the type of drug administered. You can take oral treatments at home, but IV therapy must occur in a hospital or other medical facility. 

Targeted therapies may interact with many common medicines and produce unwanted side effects. Tell your doctor about all the medicines you currently take, including prescriptions, supplements and over-the-counter pills. Ask if you should avoid certain vaccinations during targeted therapy.

You typically do not need to take precautions at home to protect loved ones while undergoing targeted therapy. Unlike chemotherapy, which may result in drug waste in bodily fluids, such as urine, vomit and sweat, targeted therapies don’t harm caregivers and household members.

Common Questions Associated With Targeted Therapies

How is targeted therapy different from chemotherapy and immunotherapy?

Chemotherapy drugs kill both cancer cells and normal cells, while targeted drugs only attack cancer cells. Certain forms of targeted therapy, such as monoclonal antibodies, are also considered immunotherapy. 

Is targeted therapy an FDA-approved treatment for mesothelioma?

Yes, the two targeted therapy drugs approved to treat mesothelioma include Yervoy (ipilimumab) and Opdivo (nivolumab). They’re in a class of immunotherapy medications known as monoclonal antibodies.

Is targeted therapy painful?

While administration of targeted therapy is generally not painful, targeted drugs may cause painful side effects including skin rashes and pain in the muscles, bones and joints.

Is targeted therapy expensive?

Yes, the average annual cost of targeted therapy treatment is expensive and may exceed $250,000 a year. For example, the annual cost of Yervoy and Opdivo in 2018 was $350,646, according to a 2019 study published in JAMA Oncology.