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Immunotherapy for Mesothelioma
Table Of Contents
Mesothelioma immunotherapy works by helping the body’s immune system to better recognize and kill cancer cells. The main benefit of using immunotherapy to treat mesothelioma is prolonged survival rate and improved symptoms.
Written by Sean Marchese, MS, RN | Medically Reviewed By Dr. Estelamari Rodriguez | Edited By Walter Pacheco | Last Update: July 24, 2024
Written by Sean Marchese, MS, RN | Medically Reviewed By Dr. Estelamari Rodriguez | Edited By Walter Pacheco | Last Update: July 24, 2024
What Is Immunotherapy for Mesothelioma?
Immunotherapy for mesothelioma is a treatment that uses cells from a patient’s own immune system to fight cancer. This treatment for mesothelioma has become a standard therapy option for many patients.
Unlike traditional treatments such as chemotherapy and radiation, which directly target cancer cells, immunotherapy boosts the immune system’s ability to recognize and destroy these cells. This approach can be particularly effective for pleural mesothelioma patients, offering new hope for those with aggressive or treatment-resistant forms of the disease.
Immunotherapy has revolutionized survival for patients with cancers that were historically very difficult to treat, like mesothelioma.
Dr. Andrea Wolf, director of the New York Mesothelioma Program at Mount Sinai
There are several types of immunotherapy for mesothelioma treatment. Checkpoint inhibitors, such as pembrolizumab (Keytruda) and nivolumab (Opdivo), block proteins that prevent immune cells from attacking cancer. Another approach involves using drugs called monoclonal antibodies, which can target specific antigens on cancer cells.
Research has proven these drugs extend survival for mesothelioma patients with fewer and more manageable side effects than other options. Doctors also combine immunotherapy with other treatments for mesothelioma, such as chemotherapy and surgery.
How Does Immunotherapy for Mesothelioma Work?
Mesothelioma immunotherapy modifies and improves the immune system. It enhances the ability to recognize and kill cancer cells. This process is similar to how the body fights foreign pathogens, such as viruses and bacteria that cause disease. Immune cells also help remove other damaged or dead cells.
Immune cells locate and destroy mesothelioma cancer cells.
Checkpoint inhibitors, such as Keytruda (pembrolizumab), Opdivo (nivolumab), and Tecentriq (Atezolizumab) get around the defenses of a cancer cell. Cancer cells display proteins that deactivate immune system T cells, allowing the cancer to hide from the body’s defenses. Keytruda blocks this interaction and reveals tumor cells to the immune system, exposing them to cytokines that destroy tumors.
Key Facts About Immunotherapy for Mesothelioma
- Immunotherapy is one of the newest gold-standard treatments for mesothelioma.
- Some immunotherapy trials have shown an increase in survival by over a year.
- Many patients respond better to chemoimmunotherapy than to chemotherapy alone.
Types of Immunotherapy for Mesothelioma
Immunotherapy for mesothelioma can be broadly classified into several types, each using different ways to enhance the body’s own immune response against cancer cells. The main types of immunotherapy are: Mesothelioma cancer vaccines, monoclonal antibodies, immune checkpoint inhibitors and CAR T-cell therapy.
Immunotherapy can either be active or passive. Active immunotherapy, such as CAR T-cell therapy and the UV1 cancer vaccine, stimulates the body’s creation of cancer-fighting antibodies. Passive immunotherapy, such as Keytruda, Opdivo and Yervoy, involves artificial immune cells that provide protection, but the anti-cancer effects fade over time after treatment.
Related Videos:
Clinical trials examine the safety and effectiveness of new types of mesothelioma immunotherapy. Success rates for immunotherapy treatments vary for each patient. Your cancer type, stage, previous treatments and overall health will determine which therapy is best for you.
Cancer Vaccines
There are two types of cancer vaccines: Preventative and therapeutic. Preventative vaccines decrease the chance of recurrent cancer, and therapeutic vaccines attempt to treat active diseases. Cancer vaccines help prevent specific diseases from coming back like vaccines for the flu and other illnesses.
One preventative mesothelioma vaccine targets the OX40 receptor. It has decreased tumor growth and increased survival in mice carrying mesothelioma tumors. Researchers are studying whether this vaccine could prevent mesothelioma recurrence.
Two therapeutic vaccines for mesothelioma, the listeria-based cancer vaccine CRS-207 and galinpepimut-S (WT1), have shown promise in clinical trials. A phase 2 trial of the WT1 vaccine reported more prolonged survival and better tumor control.
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FDA Fast Tracks UV1 Vaccine Combo for Mesothelioma
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Monoclonal Antibodies
Monoclonal antibodies (MABs) are a type of immunotherapy that create many copies of anti-cancer antibodies that your body uses to fight cancer. While it’s the most common immunotherapy for many cancers, it’s rarely used to treat mesothelioma. However, there are studies looking at ways to effectively use it to help mesothelioma patients.
Tremelimumab is a monoclonal antibody and an immune checkpoint inhibitor under investigation for mesothelioma that works against CTLA-4. Amatuximab (MORAb-009), another monoclonal antibody, progressed to a phase 2 clinical trial. Overall survival was almost 25% longer than average mesothelioma survival.
Cell and Protein Therapies
Cell therapies, such as adoptive cell transfer, involve transferring whole immune cells into patients. This therapy has been successful for advanced melanoma and renal cell carcinoma and is under study for patients with mesothelioma. Another type of adoptive cell transfer, CAR T-cell therapy, modifies immune system T cells to make them cancer-specific.
A phase 1 clinical trial injected immune system dendritic cells following chemotherapy. Ten mesothelioma patients treated with cisplatin and pemetrexed tolerated the therapy, and the study’s participants showed strong immune responses.
Cytokines are proteins made by T cells. They coordinate immune responses against cancer and foreign pathogens. Cytokines work independently or as a coordinated attack to kill cancer cells or stop the birth of new cells. Examples include tumor necrosis factor, interferon and interleukin-2.
What Are the Best Immunotherapy Treatments for Mesothelioma?
The best immunotherapy treatment will differ for each mesothelioma patient based on their needs. Some of the most frequently used immunotherapy drugs include Opdivo, Yervoy and Keytruda.
The FDA has approved Opdivo and Yervoy combination immunotherapy as an option for nonsurgical pleural mesothelioma patients. Newer experimental treatments include immune checkpoint inhibitors for peritoneal mesothelioma and targeted therapies such as the WT1 vaccine. Keytruda is effective against mesothelioma when cancer recurs after first-line treatment. It led to an average overall patient survival of 18 months.
Mesothelioma survivor Barbara Lappala told us, “Keytruda has worked like a charm for me, although I’m not exactly sure why. There have been absolutely no side effects. For me, it’s the magic bullet.”
A 2021 clinical trial found patients treated with Opdivo and Yervoy had a median overall survival of 18.1 months. Chemotherapy patients survived 14.1 months. The 2-year survival rate was 41% for patients treated with the immunotherapy combination. It was only 27% for the chemotherapy group.
Survivor Story
Survivor Story
Michael Cole
Pleural Mesothelioma
Immunotherapy Has a Positive Effect on My Mesothelioma
The combination of targeted radiation and immunotherapy had an effect. My tumors didn’t go away, but growth slowed to a comparatively glacial pace. We fell into a rhythm of immunotherapy monthly and radiation yearly. A couple of years later, I had a new type of radiation done. Some tumors shrank around 50% with no growth or new tumors since. I continue to have immunotherapy monthly.
Common Side Effects of Immunotherapy for Mesothelioma Patients
Side effects of immunotherapy for mesothelioma patients involve a heightened immune response. Examples include fevers or body aches. Some side effects, such as coughing or fatigue, can be more uncomfortable for mesothelioma patients.
Common Immunotherapy Side Effects
- Constipation
- Coughing
- Diarrhea
- Fatigue
- Fever
- Mouth sores
- Muscle or joint pain
- Nausea
- Skin irritation
- Weight loss
Most mesothelioma patients experience only mild side effects with immunotherapy. Doctors monitor whether there is a need to slow or stop treatment. Almost all immunotherapy side effects are reversible with rest or medication. In rare cases, more severe reactions can damage sensitive tissue or organs.
Severe Adverse Reactions to Immunotherapy for Mesothelioma
Serious side effects can occur when the immune system overproduces antibodies that accumulate in delicate organs such as the lungs or kidneys. Generally, these conditions are associated with inflammation, which can cause scarring or organ damage after long periods.
Severe Immunotherapy Side Effects
- Pneumonia: Chest pain, shortness of breath and persistent cough
- Colitis: Inflammation of the colon that causes bloody stools, abdominal pain and intestinal tearing
- Hepatitis: Liver inflammation characterized by eye and skin discoloration, changes in urine and right-side abdominal pain
- Hormone Gland Problems: Hormonal side effects such as muscle aches, increased heart rate, headaches and weight loss
- Kidney Problems: Nephritis, or inflammation of the kidneys, leading to changes in urine, back pain, hormone imbalance and potential kidney failure
Early treatment of immunotherapy side effects can help prevent long-term damage. In every patient’s case, discussing the potential benefits versus risks of treatment with a mesothelioma specialist is essential. Lifestyle changes and habits, such as a mesothelioma diet, can improve energy and reduce the severity of some side effects.
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Get a RecordingBenefits of Immunotherapy for Mesothelioma
The primary benefit of immunotherapy for mesothelioma is more prolonged survival and improved symptoms. This targeted treatment aims to only affect cancer cells. It avoids damaging healthy tissue, unlike chemotherapy or radiation.
Immunotherapy and other targeted therapies are widely considered the future of cancer treatment for mesothelioma patients. Immunotherapy can utilize the immune system’s natural processes to create long-lasting protection against mesothelioma for many years.
Advantages
- Fewer side effects and more manageable than conventional mesothelioma treatment.
- Targeted immunotherapy reduces damage to healthy tissues.
- Treatment uses the immune system and the body’s cells to fight cancer.
- When a patient enrolls in a clinical trial, the research sponsor covers the cost of experimental immunotherapy.
Other benefits of immunotherapy for mesothelioma include personalized treatment and financial support. Some types of immunotherapies are specific to the cancer DNA of individual patients. The study sponsor pays for immunotherapy available through clinical trials.
40%
Percentage of respondents to The Mesothelioma Center’s 2023 survey who tried immunotherapy.
Cost of Immunotherapy
Immunotherapy for mesothelioma can often cost more than $10,000 per month. Additional medical support and associated care can drive the total costs even higher. According to a recent Reuters report, Yervoy and Opdivo combination therapy can cost more than $250,000 annually while other immune checkpoint inhibitors can cost up to $150,000 annually.
We do our best to explain patients’ financial options. Our job as Patient Advocates is to educate and guide them, so when it comes time to make those decisions, they’re making very informed decisions.
Karen Selby, RN, and Patient Advocate at The Mesothelioma Center
Medicare and many insurance plans cover cancer immunotherapy, but out-of-pocket expenses and lost wages can significantly impact personal finances. VA benefits cover immunotherapy with limited to no out-of-pocket fees, but the veteran’s claims system can be complicated.
Patient Advocates can help patients and their families identify financial assistance opportunities for medical care, such as clinical trials or legal compensation. The Veterans Outreach team at The Mesothelioma Center can also help patients file VA claims.
Future of Immunotherapy for Mesothelioma
Immunotherapy researchers will likely continue to combine the treatment with other cancer therapies for mesothelioma in the future. For example, in May 2024 the U.S. Food and Drug Administration approved a priority review to seek approval for the use of a combination treatment of Keytruda (pembrolizumab) with chemotherapy as a first-line treatment for pleural mesothelioma.
The FDA based its decision to fast track its review on the significant benefits shown in clinical trials. The combined treatment shows promise for patients with mesothelioma that can’t be removed with surgery or metastatic malignant pleural mesothelioma.
Future immunotherapy options for mesothelioma could include tumor-infiltrating lymphocytes, a type of white blood cell that invades tumors. This therapy signals a broader immune response alongside other treatments and may improve mesothelioma prognosis. Advanced preventative vaccines could disrupt the ability of asbestos to cause cancer, reducing risk after exposure.
Common Questions About Immunotherapy for Mesothelioma
- Can immunotherapy be used to treat mesothelioma?
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Immunotherapy has become a standard mesothelioma treatment option. Clinical research trials have proven this therapy’s safety and effectiveness. Immunotherapy boosts a patient’s immune system to help treat cancer and works in conjunction with chemotherapy, surgery and other treatments.
- What is the success rate of immunotherapy?
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Immunotherapy success varies for each patient based on the type and stage of cancer and the patient’s immune system. Keytruda is one of the most promising immunotherapy options for malignant pleural mesothelioma. The KEYNOTE-483 trial has shown that Keytruda combined with chemotherapy reduced the risk of death by 21% compared to chemo alone. In many cases, Keytruda has extended the life expectancy of patients by almost a year.
- Is immunotherapy equally effective for men and women?
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A 2018 systematic review and meta-analysis of 20 studies published in Lancet Oncology included 11,351 people with various types of metastatic cancer. Researchers reported men receiving checkpoint inhibitors had a 28% reduced risk of dying during the study period vs. a 14% reduced risk for women.
However, a July 2020 report in Biomedicines found that immunotherapy had an overall survival benefit for men and women. Neither gender showed statistically significant differences in their responses to immunotherapy.
- What are the disadvantages of immunotherapy?
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Immunotherapy results vary because treatment predominantly depends on the activity of the patient’s immune system and biomarkers on the tumor’s surface. Based on the intensity of the immune reaction, mesothelioma cancer symptoms and treatment side effects may also be more severe in some patients.
- Is immunotherapy better than chemotherapy?
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Each treatment has advantages and disadvantages. Some patients might have fewer side effects with immunotherapy, while chemotherapy for mesothelioma may better control their tumor growth. Many oncologists use a combination approach that employs both therapies for optimal impact.
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