Emerging Mesothelioma Treatments
Traditional treatments such as surgery, chemotherapy and radiation have helped patients with mesothelioma cancer live longer with a better quality of life. However, there is still much room for improvement. Recent research has led to several emerging treatments for mesothelioma.
For patients who don’t respond to standard therapies, experimental new treatment options may provide a source of hope. While we don’t yet have a cure for mesothelioma, doctors, researchers and scientists are developing promising new treatments for mesothelioma to extend patients’ lives.
Emerging mesothelioma treatments such as immunotherapy, vaccine therapy and gene therapy have identified new targets against mesothelioma cancer. Many of these new treatments also work best when paired with traditional options.
The body’s immune system recognizes and attacks foreign invaders called pathogens to protect healthy cells from infections such as the flu. Immunotherapy for mesothelioma influences immune cells to identify and destroy cancer cells in the same way. Mesothelioma immunotherapy is an intravenous medication and is available for pleural and peritoneal mesothelioma patients.
Immunotherapy provides several benefits over chemotherapy because it uses your natural immune cells to fight cancer. It often involves fewer and less severe side effects, such as rash, cough or intestinal issues. Checkpoint inhibitors such as pembrolizumab (Keytruda) are some of the latest developments in the treatment of mesothelioma.
Cancer uses unique proteins to hide behind immune system checkpoints and tricks the body into believing mesothelioma cells are healthy, normal cells. Checkpoint inhibitors unmask cancer cells, allowing the immune system to “see” them and create an inflammatory response that kills cancer and prevents new tumors from forming.
In addition to Keytruda, the U.S. Food and Drug Administration has also approved the immunotherapy combination nivolumab (Opdivo) and ipilimumab (Yervoy) for mesothelioma. Doctors often prescribe immunotherapy alongside chemotherapy as part of a multimodal treatment plan. Newer immunotherapies are available through clinical trials.
Vaccine therapy is a new mesothelioma treatment option that involves immunotherapy. A cancer vaccine instructs your immune system to make antibodies against cancer cells, similar to how the flu vaccine prepares your body to identify and attack the influenza virus. Mesothelioma vaccines are still in clinical trials where scientists are testing them for safety and effectiveness.
In a phase II mesothelioma clinical trial, patients who received the WT1 vaccine had a median overall survival of 21.4 months compared to 16.6 months for those who received a placebo. Doctors are also testing the benefits of combining mesothelioma vaccines with immunotherapy drugs such as Opdivo.
Preventive vaccines for illnesses such as HPV and hepatitis are especially effective at preventing cancers associated with those diseases, such as cervical or liver cancer. Eventually, researchers may develop a preventive vaccine for anyone with asbestos exposure to help prevent mesothelioma.
Photodynamic therapy is an emerging mesothelioma treatment that uses photosensitizing drugs that react to a particular light. When stimulated, these drugs kill cancer cells and prevent metastasis. Doctors can administer a photodynamic medication vaccine that promotes an immune response and delays tumor growth when activated with radiation therapy.
Another example is low-dose photodynamic therapy (L-PDT) combined with an anti-CTLA4 immune checkpoint inhibitor. In a mesothelioma mouse model, this combination significantly increased the level of immune cell activity around the tumor. The results showed a complete mesothelioma regression in 37.5% of animal test subjects.
Photodynamic therapy has significant potential for increasing immune activity against mesothelioma cells, especially in combination with other treatments such as surgery. This treatment also lacks substantial side effects, which could help improve a patient’s quality of life.
Cancer cells carry DNA like all healthy cells in the body. However, mutations or defects in DNA cause normal cells to transform into cancerous tumors. Gene therapy for mesothelioma attempts to repair or replace genes in the DNA that lead to cancer.
One of the latest developments in the treatment of mesothelioma with gene therapy is gene transfer. For example, replacing the BAP1 gene leads to tumor suppression. Transferring “suicide genes” into cancer cells could allow certain chemotherapies to activate the gene and self-destruct, leaving healthy cells intact.
Gene therapy is a broad category for any method that genetically modifies cancer cells, viruses or immune cells. The FDA approved the first gene-based cancer therapy in 2017, and mesothelioma gene therapies are still undergoing clinical trials. Researchers are working to overcome issues such as targeting specificity and the side effects of gene manipulation.
While gene therapy specifically targets genes within DNA, epigenetic therapy for mesothelioma focuses on how DNA expressions translate to changes in the body. For example, age, environment and lifestyle cause our DNA to express genes differently. Current emerging mesothelioma treatments include epigenetic targets UHRF1 and inflammation biomarkers.
Asbestos fibers and other toxic substances also contribute to an epigenetic effect, causing inflammation and DNA damage that leads to cancer formation. Some studies have shown that epigenetic alterations may be responsible for pleural mesothelioma patients not responding to chemotherapy drugs.
Epigenetic therapies can potentially reverse asbestos damage and promote regular DNA gene expression. A 2021 study demonstrated that epigenetic changes affect pleural mesothelioma survival rates, aligning with recent studies. Phase II clinical trials are ongoing for tazemetostat, a drug that targets the BAP1 enzyme involved in epigenetic regulation.
Anti-angiogenic drugs are an emerging mesothelioma treatment that targets blood vessel growth in tumors. Angiogenesis is the process of growing new blood vessels, which can supply tumors with the oxygen and nutrients that allow cancer to grow and spread. By stopping this process, anti-angiogenic drugs can prevent tumor development and metastasis.
One new mesothelioma treatment option is bevacizumab (Avastin). Some of Avastin’s side effects are potentially severe, such as blood clots, hemorrhaging or low white blood cell counts. Scientists are still working to decrease these effects by limiting the impact of anti-angiogenic drugs on healthy blood vessels. Cediranib is another new mesothelioma treatment that targets tumor angiogenesis
Not every patient responds well to anti-angiogenic drugs. A multimodal combination with chemotherapy or other treatments may be the key to improving mesothelioma prognosis and life expectancy.
Cryotherapy is a new treatment option for mesothelioma that uses freezing temperatures to kill cancerous cells. Also known as cryoablation or cryosurgery, this targeted therapy has proven effective at reducing tumor sizes and improving mesothelioma symptoms.
Because cryotherapy targets a specific location, it’s less invasive than systemic therapies such as chemotherapy and produces fewer side effects. In a 2020 study, researchers used cryotherapy to successfully provide chest pain relief for a median of five weeks.
Although it is a new treatment for mesothelioma, virotherapy has existed as a cancer treatment since the 1950s. Viral immunotherapy and viral vector therapy use viruses to infect and destroy cancer cells alongside an immune response. Oncolytic viruses destroy cancer cells through aggressive replication.
Viral vectors are modified viruses that deliver immunotherapy drugs or gene therapy, such as the p53 gene, directly into tumor cells. The viral activity also triggers the immune system to respond and attack the cancer site. Recent successful virotherapy studies for mesothelioma have demonstrated improved disease response and overall survival.
Multimodal Therapy: The Latest Developments in Mesothelioma Treatment
Multimodal therapy is the term for combining multiple treatments, such as mesothelioma surgery and radiation, into a single treatment plan. As researchers develop new treatments for mesothelioma, combining traditional and emerging therapies will become the new gold standard.
Combining therapies benefits the patient by controlling tumor growth and cancer spread with numerous techniques. For example, post-surgical radiation for mesothelioma can kill cancer cells left behind from surgery. However, patients are also subject to side effects from multiple treatments in a multimodal plan.
Emerging cancer treatments give physicians more options for developing a patient’s multimodal treatment plan. For years, Tumor Treating Fields has helped cancer patients control tumor growth as a noninvasive at-home treatment in clinical trials. The FDA approved TTFields for mesothelioma in 2019, and it is now part of a standard multimodal plan with chemotherapy.
Emerging Multimodal Therapies
One of the gold standard treatments for peritoneal mesothelioma is hyperthermic intraperitoneal chemotherapy, or HIPEC. The process involves heated chemotherapy circulated through the abdomen during surgery. A similar emerging technique, called HITHOC, could prolong pleural mesothelioma survival by killing cancer cells throughout the thoracic cavity.
Another emerging treatment option is surgery for mesothelioma after radiation, also known as the SMART protocol. SMART is a multimodal therapy that involves radiation therapy before extrapleural pneumonectomy surgery. A 2021 report stated that patients with epithelial cell type and no lymph node involvement had a median survival of 5.5 years after SMART.
How to Access the Newest Mesothelioma Treatments
Patients primarily gain access to new and emerging mesothelioma treatment options through clinical research trials. Unfortunately, clinical trials are limited to specialized treatment centers, and patients must also pass an eligibility checklist to ensure their safety.
Examples of eligibility requirements for a clinical trial include cancer stage, cell type, tumor location, overall health and previous treatment history. Patient Advocates at The Mesothelioma Center can help patients interested in emerging therapies find eligible clinical trials and treatment centers in their area.
One of the first steps in participating in a clinical trial is speaking with your provider or mesothelioma specialist about potential studies appropriate for your diagnosis. If you’re unsure how to enroll in clinical trials in your area, The Mesothelioma Center Patient Advocate team can match you with local studies.
Many patients benefit from a clinical trial when other options have failed. In a research study you’ll have access to the newest medications, and study sponsors will often cover the entire cost of the experimental treatment. If at any point during the study you wish to drop out, or you aren’t receiving a benefit, your doctor will switch you to a standard-of-care treatment.
In addition to providing access to mesothelioma clinical trials, specialists offer the newest treatment options available. Mesothelioma specialists have the knowledge and experience to diagnose asbestos-related illnesses quickly and accurately. They also know the best multimodal treatment plans for each patient’s diagnosis.
Finding a mesothelioma specialist can be challenging but getting a second opinion or referral can make a significant difference. Specialists are involved in the latest mesothelioma research using cutting-edge technology and resources at the nation’s top treatment centers.
Cancer Centers with a Meso Team
Emerging mesothelioma therapies and clinical trials, including gene therapy and immunotherapy, are typically only available at specialized cancer centers. These facilities offer new mesothelioma treatment options that aren’t available at other facilities.
The teams at top mesothelioma centers include world-renowned thoracic and radiation oncologists, immunologists, pathologists, surgeons and other experts in a multidisciplinary team. At most centers, these experts regularly meet at tumor discussion boards to deliberate the best mesothelioma treatment options for each patient.
How Does the FDA Approve Emerging Mesothelioma Treatments?
The U.S. Food and Drug Administration’s approval process for new medications and medical devices involves several checks to ensure safety and effectiveness for all patients. Many drugs, such as Keytruda, had successfully treated other cancers for several years before the FDA approved their use for mesothelioma.
Pharmaceutical companies must adequately prove that their drug’s benefits outweigh its risks in animal testing and subsequent human trials. The five-step FDA approval process for a new drug involves the discovery phase, preclinical research, clinical testing, FDA review and post-market monitoring for safety.
The time from the discovery phase to marketing approval varies widely depending on the success and efficiency of clinical trials. After successful testing, the FDA aims to complete a standard review within 10 months or a priority review within six months for significant advances in treatment.
The FDA can apply a priority review or accelerated approval to promising therapies that treat life-threatening conditions or emerging treatments where no previous option existed. Similar processes include breakthrough therapy and priority review, which fall under the Fast Track designation, as in the case of the COVID-19 vaccine.
Criteria for drug quality, safety and effectiveness is set by the FDA’s Center for Drug Evaluation and Research. The CDER oversees these standards for prescription and over-the-counter drugs. Other FDA centers evaluate safety across medical devices, food, cosmetics, veterinary drugs and tobacco products.