Targeted Therapy for Mesothelioma

What Is Targeted Therapy?

Targeted therapy is a type of 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 certain proteins, enzymes and other molecules involved in cancer cell maintenance or growth. The aim is to kill cancer cells or prevent them from growing and spreading.

In general, targeted therapies may have fewer side effects compared to 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. Apoptosis inducers trigger cancer cell death.

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, which are immune cells that attack cancer cells. Opdivo targets the PD-L1 protein to block a cancer cell’s ability to hide from T cells. These therapies work together to enhance the immune system’s ability to find and kill mesothelioma cells.

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 known as 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.

Side Effects

Targeted therapy’s most 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 regularly can help manage side effects. Quitting smoking and reducing alcohol consumption may also help to minimize adverse reactions.  

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 administered as pills or capsules that you swallow, which means you can take them at home or while traveling. However, another type of targeted therapy known as 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 are delivered in cycles that involve a period of treatment and then a period of rest.

How to Prepare for Targeted Therapy

Preparing for targeted therapy varies depending on the type of drug administration. As noted previously, oral treatments can be taken 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 medicine 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 you’re 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.