Immunotherapy with Durvalumab: Record Survival in Inoperable Mesothelioma

There is new evidence that the immunotherapy drug durvalumab may make chemotherapy more effective for people with inoperable pleural mesothelioma. Researchers recently achieved record mesothelioma survival times with this combination.

Mesothelioma is a rare cancer with a poor prognosis. Surgery can sometimes help if it is caught early. But only a small percentage of patients are candidates for mesothelioma surgery. Most have chemotherapy, which is only moderately effective. 

But new research presented to the nation’s largest gathering of cancer doctors shows the immunotherapy drug durvalumab may help. 

Doctors at Johns Hopkins combined durvalumab with standard mesothelioma chemotherapy. Study participants lived an average of 8 months longer than is typical with this disease. 

If further studies confirm the benefit, it could change the outlook for mesothelioma patients with few other options.  

What is Durvalumab?

The immunotherapy drug durvalumab (IMFINZI) is an immune checkpoint inhibitor. Keytruda (pembrolizumab) is another example of an immune checkpoint inhibitor. 

These drugs work by blocking the protein PD-L1. Mesothelioma cells use PD-L1 to protect themselves from immune system attack. When durvalumab inactivates this protection, cancer cells are more vulnerable. 

The Johns Hopkins researchers hoped this would make them more responsive to chemotherapy. Alimta is the main chemotherapy drug for mesothelioma. But fewer than half of patients respond to it. 

Patient Response to Immunotherapy with Durvalumab

The new study was presented last month at the virtual annual meeting of the American Society of Clinical Oncology. 

The Johns Hopkins study included 55 mesothelioma patients from 15 US cancer centers. These patients had not received any treatment yet. 

In the study, patients got six treatments with Alimta, cisplatin and the immunotherapy drug durvalumab. The treatments happened every three weeks. After three weeks, patients received durvalumab by itself for up to a year. 

“The chemo-immunotherapy combination improved overall survival to 20.4 months from the historically expected survival of 12 months with chemotherapy alone,” writes lead author Patrick Forde. Dr. Forde is an associate professor of oncology at Johns Hopkins. “This is the first study to show survival times exceeding 20 months for patients with inoperable mesothelioma,” he writes.

Patients did not have any side effects serious enough to make them stop treatment. These promising results prompted the Hopkins team to start a Phase 3 study. They will start recruiting mesothelioma patients for this study later this year.

Researchers say they are hopeful that the immunotherapy drug durvalumab and standard chemotherapy could become a new first-line treatment for mesothelioma. 

Source:

Forde, P, et al, “PrE0505: Phase II multicenter study of anti-PD-L1, durvalumab, in combination with cisplatin and pemetrexed for the first-line treatment of unresectable malignant pleural mesothelioma (MPM)—A PrECOG LLC study”, ASCO Meeting Library, May 2020, https://meetinglibrary.asco.org/record/184552/abstract

“Research Story Tip: Chemotherapy/Immunotherapy Combo Shows Promise for First-Line Treatment of Mesothelioma”, Johns Hopskins new release, June 11, 2020, https://www.hopkinsmedicine.org/news/newsroom/news-releases/research-story-tip-chemotherapyimmunotherapy-combo-shows-promise-for-first-line-treatment-of-mesothelioma