Mesothelioma Research, COVID Findings Featured at IASLC Conference

Research & Clinical Trials

Researchers from around the world presented their insights into serious lung health issues, including mesothelioma, during the International Association for the Study of Lung Cancer 2021 World Conference on Lung Cancer. The conference was held virtually, Sept. 8-14.

One clinical data analysis presented at the conference found that five of seven patients with COVID-19, who were also treated for malignant pleural mesothelioma at Vall d’Hebron Hospital in Barcelona, Spain, died during the first wave of the pandemic. It demonstrated the extreme vulnerability of those with this rare cancer.

The hospital treated 38 patients with pleural mesothelioma from March 2020 to March 2021, including the seven who were diagnosed with COVID. Four of the five deaths were directly COVID-related.

“This study, performed during the pre-vaccine period of the pandemic, once again demonstrates the importance of vaccination against COVID-19,” said Dr. Susana Cedres, a medical oncologist with Vall d’Hebron Hospital. “Malignant pleural mesothelioma patients are particularly vulnerable to COVID-19.”

Cedres said since the subsequent rollout of the COVID-19 vaccines, no positive cases have been attributed to pleural mesothelioma patients at the hospital.

The average age of the seven patients was 62. All had the epithelioid histology of mesothelioma and two were receiving oncologic treatment at the time of diagnosis.

Median overall survival of the seven was 17.8 months from the time of their cancer diagnosis, but less than two weeks from the COVID diagnosis.

“If a patient with this particular disease is diagnosed with the virus, he or she is at increased risk of mortality,” Cedres said. “Infection must therefore be prevented, and we know that the vaccine works.”

Second-Line Mesothelioma Treatment Has Potential

The virtual World Conference on Lung Cancer included other mesothelioma presentations, particularly on treatment advances.

In one phase II multicenter study in Europe, heavily pretreated mesothelioma patients found promise with the drug lurbinectedin. Both lung cancer and mesothelioma cancer patients showed clear clinical benefits from the anti-tumor, synthetically produced agent.

The 55 mesothelioma patients in the study received lurbinectedin after at least two previous failed lines of therapy. The disease control rate was a surprising 32%. Median progression-free survival was 2.8 months with an overall survival rate of 7.2 months, which was longer than typical second-line treatments with pleural mesothelioma.

There currently is no standard second-line treatment for pleural mesothelioma.

“Lurbinectedin appears to be a clinically meaningful option in heavily pretreated patients,” presenter Dr. Daphne Dumoulin, of the Erasmus MC Cancer Institute in Rotterdam, Netherlands, said.

MD Anderson Reports Immunotherapy Progress

The University of Texas MD Anderson Cancer Center also presented on the safety and efficacy of the immunotherapy drug atezolizumab as part of neoadjuvant treatment and maintenance therapy for resectable pleural mesothelioma.

Thoracic surgeon Dr. Boris Sepesi, who made the presentation, concluded that when used in combination with chemotherapy, atezolizumab enhances the T-cell activation against tumor cells and extends post-surgery survival.

Patients at MD Anderson underwent either pleurectomy and decortication or extrapleural pneumonectomy surgery.

The study also met the established safety criteria, showing no signs of any added, adverse side effects.

“I think this is a step forward in terms of treatment,” Sepesi said.

Accessing Mesothelioma Care Is Key

Dr. Estelamari Rodriguez at the University of Miami Sylvester Comprehensive Cancer Center presented on the significant difference in mesothelioma survival outcomes, the importance of access to care, income levels and positive association with multimodal therapy.

Rodriguez used the National Cancer Database and 2,804 cases within a 13-year period to make her assessment. She found that patients who underwent surgery often traveled significantly further for treatment, and that a better understanding of disparities in access to multidisciplinary treatment could help ensure equity of care.

“Among patients with operable malignant pleural mesothelioma, there is significant variability in access to care regarding the distance to facility, facility type and volume,” she said. “In a multivariable analysis, receipt of chemotherapy or multimodality treatment – chemotherapy and radiotherapy – predicted better outcomes, despite a patient’s race, socioeconomic status and tumor characteristics.”

More Research Supports Approved Immunotherapy

In other news, recently updated three-year survival data has strengthened the growing belief that the immunotherapy drug combination of Opdivo and Yervoy has become optimal first-line treatment for unresectable pleural mesothelioma.

A presentation this week at the European Society for Medical Oncology virtual conference includes study data showing a three-year survival rate of 23%, compared to just 15% for those receiving standard chemotherapy.

Bristol Myers Squibb, sponsor of the international CheckMate 743 study that led to U.S. Food and Drug Administration approval in 2020, also details the immunotherapy combination’s three-year duration of response at 28%, compared to 0% for those receiving chemotherapy.

The Opdivo/Yervoy combination has been approved now in 14 different regulatory zones around the world. It was the first systemic approval by the FDA since 2004.

“Earlier results from the study changed the first-line standard of care in several countries,” said Dr. Alessandra Curioni-Fontecedro, University Hospital of Zurich, Switzerland. “These updated data further reinforce the previously published findings and support the benefit of giving patients immunotherapy instead of chemotherapy.”

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