In Search of a Second Line Option for Mesothelioma

The fact that cancer researchers are not focusing on one type of therapy in their efforts to develop a second line mesothelioma treatment may be hurting the chances of finding one that works.

That is the conclusion of a team of Greek researchers who recently performed a retrospective study of second line mesothelioma therapies currently in use.

What is a Second Line Mesothelioma Therapy?

Second line therapy means a mesothelioma treatment that can be used after first line therapy either fails to work or stops working.

The gold standard therapy for malignant pleural mesothelioma (the most common type of mesothelioma) is a combination of pemetrexed (Alimta) and a platinum-based drug like cisplatin. Unfortunately, because mesothelioma is extremely resistant to treatment, even these drugs work less than half the time to slow or reverse mesothelioma tumor growth.

Since first line treatments are far from 100 percent effective, scientists recognize the urgent need to find a viable second line treatment for mesothelioma..  

Evaluating Second Line Mesothelioma Treatments

To evaluate some of the possible second-line treatment options available to mesothelioma patients, researchers at the University of Athens School of Medicine did a retrospective analysis of 98 mesothelioma cases at their center.

The study involved closely examining each patient’s case, including all of the different treatments that were used during the course of their disease and how well they worked.

Too Many Options?

Researchers found that just over half of the mesothelioma patients in the study received second line treatment. For 48 percent of those patients, the second line treatment used was a combination of taxane and gemcitabine.

Although no one experienced a reversal of their tumor growth on that combination, it stabilized the growth in 22 percent of patients. It took about 3 months for their mesothelioma to start growing again after this treatment. Median overall survival was about 15 months.

Eighteen percent of those who had second line mesothelioma therapy received a drug called docetaxel. Although a third of these patients stopped taking the drug because they developed problems on it, the overall survival on this drug was slightly longer at 23 months.

The remaining eight patients had a third type of second line mesothelioma treatment. They got either a second round of pemetrexed-based chemotherapy or pemetrexed alone. Median overall survival among this small subset of patients was the longest at 29 months.

No Clear Second Line Winner for Mesothelioma Patients

But the Greek researchers say these results do not offer much useful information about second line mesothelioma treatment because they are all so different and the groups who took them so varied.

“The heterogeneity of the three distinctive second line chemotherapy groups has a negative impact on the reproducibility and interpretation of the result,” writes researcher Dimitris Vassos in the Journal of Thoracic Oncology. The team concludes that there is still “no satisfactory second line chemotherapy agent” for patients with mesothelioma.

The fact that no single second line therapy has been shown to be most effective does not mean that a particular therapy cannot help a particular mesothelioma patient. If you or a family member is battling mesothelioma and has failed at first line chemotherapy, your doctor will work with you to determine if a second line treatment could help.

Source:

Vassos, D, et al, “2nd line chemotherapy in malignant mesothelioma: A center’s experience”, Journal of Thoracic Oncology, April 2016, S148-149