Second Line Mesothelioma Treatment Shot Down in New Study
Italian researchers say there is good news and bad news about a proposed second line mesothelioma treatment.
The good news is that the treatment did not cause major side effects in the patients who tried it. The bad news is that it also did not help them live any longer.
The treatment is a mixture of gemcitabine and imatinib. Animal studies suggested that the combination might improve mesothelioma survival.
The newly-published study shows the second line mesothelioma treatment did help control the disease in most patients. But the 23 patients who tried it only lived for a median of 5.7 months. That was not enough for doctors to recommend the combination.
Mesothelioma Chemotherapy and Survival
The most common first line treatment for mesothelioma is chemotherapy. Most patients have a combination of Alimta (pemetrexed) and cisplatin.
Unfortunately, this ‘gold standard’ mesothelioma therapy is only moderately effective. For most patients, their tumors start growing back within a few months. Previous studies suggest standard chemotherapy extends mesothelioma survival by about four months.
Doctors have tested a number of different second line mesothelioma treatments. One of the most recent studies focused on a drug called lurbinectedin. Lurbinectedin impacts cancer cells at the DNA level. But the 2019 Swiss study found it barely met the progression-free survival goal of three months.
Some other tested second line treatments include:
- Additional rounds of pemetrexed
- Taxane and gemcitabine
- Docetaxel
- Avelumab
- Tremelimumab
None of the drugs tested have improved mesothelioma survival by more than eight months.
Gemcitabine Combo as a Second Line Mesothelioma Treatment
The latest search for a second line mesothelioma treatment focuses on gemcitabine again, but in combination with a different drug. Imatinib mesylate sells under the brand name Gleevec. It is a protein tyrosine kinase inhibitor usually used for certain kinds of leukemia.
Italian doctors gave the combination to patients who already had at least one cycle of standard chemotherapy. Their tumors also had to shower elevated levels of the protein PDGFR-β and/or cKIT.
Patients received gemcitabine on days 3 and 10 and took oral imatinib daily for two different five-day stretches. The goal for this second line mesothelioma treatment was for at least three quarters of the patients to live for three months without their cancer coming back.
Twenty-three patients received the treatment combo. In four of them, their mesothelioma tumors actually shrank a little. Eleven others had stable disease. But only 39 percent of patients met the three-month progression-free survival goal.
“The combination of IM and GEM is well tolerated in platinum-pemetrexed-pretreated MPM patients…but it does not show a significant progression free survival benefit,” concludes study author Paolo Andrea Zucali.
The fact that this second-line therapy did not extend survival for these patients does not mean that no second mesothelioma treatment can help. If you have been through mesothelioma chemotherapy and your cancer has come back, discuss possible second line options with your doctor. In some cases, they may be available through a clinical trial.
Source:
Zucali, PA, et al, “A phase II study of the combination of gemcitabine and imatinib mesylate in pemetrexed-pretreated patients with malignant pleural mesothelioma”, February 12, 2020, Lung Cancer, Epub ahead of print, https://www.lungcancerjournal.info/article/S0169-5002(20)30301-9/fulltext
