| | | |

Chemotherapy Still Good First-Line Option for Unresectable Epithelioid Mesothelioma

ByAlex Strauss

unresectable epithelioid mesotheliomaA top mesothelioma expert says chemotherapy may still be the best first-line treatment for unresectable epithelioid mesothelioma, even though immunotherapy is an increasingly popular option.

Chemotherapy has been the primary way to treat mesothelioma since 2004. This is when the FDA approved the drug Alimta (pemetrexed). Alimta remained the only systemic treatment for asbestos cancer until 2020.

In 2020, the FDA approved a combination of the immunotherapy drugs ipilimumab (Yervoy) and nivolumab (Opdivo). But Dean Fennell, PhD, of the UK’s University of Leicester says chemotherapy is still a good choice for many unresectable epithelioid mesothelioma cases.

A Better Version of Chemotherapy?

Epithelioid mesothelioma is the most common subtype. It is also the most responsive to treatment.

For the healthiest patients, surgery and chemotherapy offer the best outcomes. People with unresectable epithelioid mesothelioma usually start with chemotherapy. The most common combination is Alimta and a platinum drug like cisplatin or carboplatin.

These drugs kill some of the mesothelioma cells, but usually not enough to eradicate tumors. Instead, they just slow down the growth. For some patients, chemotherapy does not work at all.

But there is a drug that helps chemotherapy work better. Avastin (bevacizumab) is a monoclonal antibody. It inhibits the growth of life-supporting blood vessels. Without an adequate blood supply, unresectable epithelioid mesothelioma tumors are more susceptible to chemotherapy drugs.

A 2016 French Avastin and chemotherapy study showed that it improved mesothelioma survival by 23 percent.

Dr. Fennell says this is one reason that chemotherapy – including the improved version – may be better than immunotherapy for some patients. He warns that immunotherapy should not be “a reflex replacement” for chemotherapy.

Weighing the Options for Unresectable Epithelioid Mesothelioma

The new article in the Journal of Thoracic Oncology is by Dr. Fennell and his colleague Sean Dulloo. They acknowledge what a breakthrough immunotherapy is for mesothelioma. Nivolumab and ipilimumab (ipi-nivo) harness the cancer-killing power of the patient’s own immune system to combat mesothelioma. One study shows patients live about four months longer.

But this action comes at a price. Immunotherapy can cause life-threatening side effects. Some side effects may be even more severe than side effects from chemotherapy. Also, doctors still have no reliable way to predict response to immunotherapy. Research showed people with non-epithelioid mesothelioma saw much greater benefit from ipi-nivo therapy. Using this form of therapy for unresectable epithelioid mesothelioma is more of a gamble.

On the other hand, chemotherapy with Avastin is already standard-of-care for mesothelioma in France, including for patients with unresectable epithelioid mesothelioma. And, chemotherapy offers about the same rate of disease control as ipi-nivo immunotherapy.

Until doctors have a better way to predict immunotherapy success, Drs. Fennell and Dulloo say they should still consider chemotherapy.

“Based on these arguments, it can reasonably be argued that chemotherapy with or without bevacizumab should continue to be considered an optimal first-line option in patients with E-MPM [unresectable epithelioid mesothelioma],” the article concludes.

Source:

Fennell, Dean & Dulloo, Sean, “Chemotherapy With or Without Bevacizumab Should Be the Standard of Care for First-Line Unresectable Epithelioid Mesothelioma”, January 1, 2022, Journal of Thoracic Oncology, Volume 17, Issue 1, pp. 34 – 37, https://www.jto.org/article/S1556-0864(21)02395-9/fulltext#relatedArticles

Similar Posts

  • | |

    Doctors Describe "Concrete Therapeutic Approach" for Mesothelioma

    ByAlex Strauss

    A team of medical researchers in Italy have achieved what they are calling “excellent” tumor control and survival results in malignant pleural mesothelioma patients using a combination of surgery, chemotherapy, and radiotherapy. Caused by exposure to asbestos, mesothelioma typically spreads quickly across the lung-encasing membrane called the pleura. There is no known cure but treatments are improving. In the current prospective study, 20 malignant pleural mesothelioma patients underwent radical pleurectomy/decortication followed by high doses of radiation. After surgeons removed as much of the visible mesothelioma tumor and surrounding tissue as possible, patients received 50Gy of radiation to the effected side of their chest, delivered in 25 fractions. Regions of particular concern for mesothelioma regrowth got an extra radiation “boost” to…

  • |

    Mesothelioma Still Rising Despite Ban in Ireland

    ByAlex Strauss

    A study in Ireland confirms that it can take many years for a ban on asbestos to have a measurable impact on a country’s rates of malignant mesothelioma. Mesothelioma is the most serious of a list of diseases – including lung cancer, pleural plaques, asbestosis, and others – linked with exposure to asbestos dust. Affecting the linings around the lungs and other organs, mesothelioma is often resistant to most cancer treatments and may be fatal within a year of diagnosis. According to the International Ban Asbestos Secretariat, Ireland is one of 55 countries that have enacted some type of asbestos ban. However, although Ireland banned asbestos in 2000, a new study published in Cancer Epidemiology shows that incidence of the…

  • | |

    Does Radiotherapy Reduce Mesothelioma Pain?

    ByAlex Strauss

    A new study says there is not enough evidence to support the use of radiotherapy for the treatment of pain associated with malignant pleural mesothelioma. Researchers at the University of Edinburgh in Scotland reviewed a range of past studies on mesothelioma pain and radiotherapy by searching databases that date back as far as 1974. To be eligible to be included in their review, the study had to focus on malignant pleural mesothelioma and radiotherapy given “with the intent of improving pain”. The study also had to report doses and fractionation of the radiotherapy and how the pain responded. In all, the researchers found eight studies on mesothelioma pain and radiotherapy that met the criteria. Two of the studies were prospective…

  • |

    Website Aims to Protect Homeowners from Mesothelioma

    ByAlex Strauss

    Australia’s Cancer Council is trying to educate home renovators about their risk for mesothelioma with a new e-learning course. Australia has one of the highest per capita rates of mesothelioma in the world, largely because of several asbestos mining operations that were once located there. Although asbestos has been banned from building products in Australia since 1989, asbestos-linked diseases like mesothelioma, lung cancer, and asbestosis continue to pose a serious health concern. While mesothelioma has traditionally occurred among people exposed to asbestos on the job, Australia is now bracing for another “wave” of mesothelioma victims among homeowners who encounter asbestos while doing their own renovation projects. Cancer Council Australia has launched “kNOw asbestos in your home” in an effort to…

  • | |

    Radiotherapy for Mesothelioma: Better But Still Limited

    ByAlex Strauss

    A form of highly-targeted radiation therapy for mesothelioma is better than it used to be, but is still risky. That is the message of a recent article on intensity-modulated radiation therapy (IMRT) in Seminars in Thoracic and Cardiovascular Surgery. Author Kenneth E. Rosenzweig, MD, a Radiation Oncologist with Mount Sinai Hospital in New York, reviewed recent studies on IMRT and mesothelioma. He concludes that, while the “troubling toxicity” associated with IMRT when it was first introduced has not been entirely eliminated, the fact that clinicians now have more experience with it is making a positive difference for mesothelioma patients. Before targeted therapies like IMRT were available, high-dose radiation was not usually a feasible option for mesothelioma since the irregular shape…

  • | | |

    Mesothelioma Nurses Ready for New Cases in Australia

    ByAlex Strauss

    Australia is bracing for an expected new wave of mesothelioma cases in the next decade and the Lung Foundation of Australia is taking action now to get ready. The Foundation has paid for ten nurses from around the country to receive specialized training in helping patients and families cope with mesothelioma. The nurses, who have recently completed the training, are now equipped to lead treatment planning for these complex cancer patients and to help other nurses do the same. Pleural mesothelioma is an aggressive cancer that occurs in the lining around the lungs. It is caused by exposure to asbestos dust, a toxin that was once alarmingly prevalent in Australia where it was mined and heavily used in construction. Because…