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Promising New Mesothelioma Treatments

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New treatment discussion

Three promising new mesothelioma treatments have recently been approved by the FDA or are in clinical trials. Approximately 2,500 Americans are diagnosed with mesothelioma each year. Mesothelioma is almost always caused by exposure to asbestos. Common exposures occurred in mines, construction, ships, industrial settings, refineries and chemical plants.  Household exposures, hobbies and even home remodeling can also be sufficient exposures to cause mesothelioma.  There is currently no cure for the disease.

An FDA-approved treatment was last approved in 2004. Now, however, there are some newly approved and others in clinical trials. The following shows three treatments that are extending lives.

Optune Lua

No new treatments were available for almost 16 years until Optune Lua was approved by the FDA in 2019. (FDA approval under the Humanitarian Device Exemption [HDE] pathway.) Optune Lua was developed by Novocure.

Since this was approved as a humanitarian device, it is only authorized by Federal Law for treatment of adult patients 22 years of age or older. They must need it for unresectable, locally advanced or metastatic, malignant pleural mesothelioma. It must be used in tandem with pemetrexed and platinum-based chemotherapy.

The device is worn on the body and produces electric fields – tumor treatment fields. These fields interrupt the division of cancer cells. The therapy is worn where the cancer resides.

Nivolumab and ipilimumab

These two drugs are also known as Opdivo and Yervoy. This combination is now approved by the FDA as a first-line treatment of adults with malignant pleural mesothelioma unable to be removed by surgery. These are monoclonal antibodies which decrease the growth of tumors by enhancing T-cell function. In a randomized trial with patients, those who received the antibodies lived a median of 18.1 months versus the patients who had the standard chemotherapy and lived 4 months less. This is a beginning for improved overall survival rates and the first FDA approved treatment since 2004.

Atezolizumab plus bevacizumab

This combination of atezolizumab (Tecentriq) and bevacizumab (Avastin) have garnered interest as they have shown marked responses in patients with advanced malignant peritoneal mesothelioma. Study author, Kanwal P.S. Raghav, MBBS, MD from the University of Texas MD Anderson Cancer Center wrote, “This study establishes a promising treatment option for our patients who suffer from this morbid cancer and represents an unprecedented effort to bridge the gap of dedicated research in this orphan disease.”

Raghav also said that this combination had an objective response rate of 40% in patients though they were resistant to previous chemotherapy of platinum-pemetrexed. “There is absolutely no other therapy approved for use in this setting. The only treatments we use are cytotoxic chemotherapies . . . all of which have response rates of less than 10%.”

Good news

After almost 16 years without an FDA approved treatment for mesothelioma, progress is being made. Researchers throughout the world work to bring new, creative ways to irradicate the world of this horrible disease. For too long, a diagnosis of mesothelioma has been a death sentence. We are moving forward and one day, hopefully soon, that sentence will be lifted and victims of this disease will return to health.

How Does COVID-19 Affect Lung Cancer Patients?

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The novel coronavirus, commonly called COVID-19, primarily affects breathing as it is a respiratory disease. But specifically, how does COVID-19 affect lung cancer patients?

Since there is currently no vaccine or treatment directly targeted for COVID-19, people with lung cancer need to be particularly aware of guidelines for protection strategies against the disease by following CDC directions. There are many causes of lung cancer, but exposure to asbestos is a major cause. Asbestos can also lead to the fatal lung disease, malignant mesothelioma.

How does COVID-19 affect lung cancer patients?

Since people with lung cancer are in one of the more high-risk groups for acquiring COVID-19, know the basics of prevention:

• Practice social distancing – Stay home as much as possible. If outside your home, wear masks and gloves, wash your hands with soap and water before and after any encounter with others or with in-store products for at least 20 seconds, and maintain a minimum of six feet between yourself and others. This includes during doctor visits and other medical appointments.

• Get tested – Since lung cancer classifies as high-risk, get tested if there are new symptoms beyond normal. Others who fall into this category are adults over 65, adults with other serious diseases, and those who are taking chemotherapy drugs or have other immunity issues. Symptoms include a dry cough, trouble breathing, and a temperature of 100.4 or over.

• Speak with a doctor – In all cases, if you or a loved one has lung disease, it is highly recommended to speak with their doctors to determine any guidelines the doctor may suggest for your specific situation. Here you can also access and print an informative handout produced by the Lung Cancer Research Foundation.

Should I really be concerned?

In a word, yes. Currently, the United States leads the world in the number of confirmed COVID-19 cases and deaths. However, the number may be much greater as many people experience COVID-19 with no symptoms. That doesn’t mean they can’t pass the virus on to others, so social distancing is extremely important – especially for high-risk individuals.

Remember, there is no treatment geared specifically for COVID-19 and there is no preventative vaccine. The only protection is squarely on each individual to do their best to follow all CDC guidelines.

What drugs are being used?

Some medications have shown promise but there are currently no COVID-19 specific drugs approved through a completed study.

Vaccines virtually eliminated smallpox and polio in past decades. Scientists are currently working toward developing vaccines that could end, or lessen the effects of, coronaviruses as well. In this month, there are almost 80 vaccine development initiatives ongoing. Best case timeline for vaccine development is 18 months.

Are lung cancer patients more susceptible to COVID-19?

While patients with lung cancer do not appear to be more likely to get COVID-19, if they do acquire the disease, complications are more likely. If a patient is undergoing immunosuppressive treatment, such as chemotherapy, their immune system may not be able to fight it off, however. Cancer patients, overall, should be more vigilant about all the precautions. Following all guidelines provides the best chance of avoiding contraction of COVID-19.

First New Mesothelioma Therapy Approved by FDA in Over 15 Years

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The first new mesothelioma therapy approved by the FDA is based on a trial. In this single-arm STELLAR trial, the median overall survival rate was 18.2 months with patients with unresectable, locally advanced or metastatic malignant pleural mesothelioma who received TTF plus chemotherapy. This combination of treatments comprises the NovoTTF-100L System along with pemetrexed and platinum-based chemotherapy for front-line treatment.

History of new mesothelioma therapy

Bill Doyle, executive chairman of Novocure, the developer of NovoTTF-100L stated, “Since 2000, we have been developing and commercializing Tumor Treating Fields (TTF) to extend survivals in some of the most aggressive forms of cancer. FDA approval of NovoTTF-100L provides patients with the first FDA-approved treatment for MPM in more than 15 years and, as our first FDA-approved torso cancer indication, marks a major milestone for Novocure. We are thankful for the patients, caregivers and health care providers who partnered with us to make this possible.”

What is malignant pleural mesothelioma (MPM)?

Strongly linked to asbestos exposure, MPM is a rare malignancy. Approximately 3,000 people are diagnosed with MPM each year in the US. This new therapy is welcome news as there was only one FDA-approved therapy prior to the NovoTTF-100L approval. That treatment consisted of pemetrexed plus cisplatin.

In addition to extending life, this new mesothelioma therapy approved by the FDA, is noninvasive, delivering TTF directly to the region of the tumor. No increase in serious systemic wide effects were noted with this new therapy.

Results showed patient overall survival at:
• 21.2 months for epithelioid malignant pleural mesothelioma (53 patients)
• 12.1 month for non-epithelioid malignant pleural mesothelioma (21 patients)
• 62% of those in the STELLAR study were alive at one year.
• Disease control when at least one CT scan was given as a follow-up was 97% (72 patients).

Mary Hesdorffer, NP, executive director of the Mesothelioma Applied Research Foundation, said “MPM is a devastating disease, with only 10 to 20 percent of patients being candidates for surgery to remove the tumor. Typically, mesothelioma patients who cannot have surgery receive palliative care to mitigate their symptoms. NovoTTF-100L provides unresectable MPM patients with a treatment option that may improve survival. We are encouraged by the FDA approval and hope it is just the beginning of innovation in the treatment of this aggressive disease.”

Studies Continue in Search of a Mesothelioma Cure

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Mesothelioma is a disease primarily caused by asbestos exposure and is usually fatal within a short period of time, however studies continue in search of a mesothelioma cure. This is not a simple task, as researchers are still not sure of the reason asbestos fibers encourage cancer in some individuals. With the long latency period between exposure and diagnosis, people will be fighting this disease for many decades to come. That means that new treatments to defeat the disease are urgently needed.

In the past, and currently, treatments often consisted of chemotherapy, radiation therapy, or surgery. These have extended the lives of many patients and they still do. However, as noted by the American Cancer Society, there are new studies and treatments that carry the promise that they may do more than extend life for a few months and actually bring about a cure.

What are the latest treatments?

While there are treatments currently in use, they are often limited in their effect and generally extend life a little longer rather than cure the disease. New ideas and studies take place all the time. Some of the newest treatments still under testing are listed below.

Immunotherapy

Clinical trials are underway using a patient’s own immune cells to attack their cancer. These cells are removed from the blood, taken to the lab where they are manipulated to react to tumor cells. They are then put back into the patient’s body through a blood transfusion. The presumption is these transformed immune cells will encourage the patient’s immune system to kill the cancer cells.

One other immunotherapy in trials uses tremelimumab, a drug that encourages the immune system to attack full force as it targets specific immune cells.

Gene therapy

This innovative treatment uses modified viruses and injects them into the cancer cells. Once an infection is created, the virus introduces new selected genes into the cells, which makes the cells easier to destroy. In some tests, the gene present in the virus assists in turning on the immune system to attack the cancer cells.

Virus therapies

Still in the early stages of testing, a specially created virus is put into the pleural space of the cancer cell. In the desired outcome, the virus would directly infect and then kill the cancer cells, or indirectly, the immune system would be encouraged to kill the cancer cells.

Targeted drugs

While chemotherapy has been used for some time but with limited success, there are newer chemotherapy drugs in tests that may do much more. These drugs are targeted to a specific type of cell or protein instead of standard chemotherapy that affects the whole body. This means there are usually fewer side effects.

Photodynamic therapy

While it sounds futuristic, there are a number of clinical trials in process that study the use of photodynamic therapy (PDT). Veins are injected with a light-activated drug. Once in the body, it spreads into cancer cells throughout the body. After a few days, a tube with a special red light on the tip is placed into the chest, usually after a surgery. The drug is activated by the light producing a chemical change that kills the cancer cells. Because all this happens only within the cancer cells, there may be fewer side effects.

Encouraging progress

The knowledge that studies continue in search of a mesothelioma cure should be an encouragement to anyone diagnosed with the disease or who have a experienced extended exposure to asbestos. Contact your doctor or this link to view current trials and, perhaps, find a new trial that interests you. There is hope, and we need to support those who are researching for ways to combat and kill mesothelioma before it continues its deadly toll.

Innovative Study that Inhibits Cancer Metastases

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Researchers at Case Western Reserve University School of Medicine, the National Cancer Institute, and Cleveland Clinic, as well as four other institutions, conducted an innovative study that inhibits cancer metastases through the use of epigenetics.

Epigenetics is the key

Epigenetics is the “study of biological mechanisms that will switch genes on and off.” That is an extremely simplified explanation, but that is the method used by these researchers. In the study, bone cancer (osteosarcoma) cells were halted in their spread to the lungs of mice. This is a major triumph as there is presently no widespread, approved and targeted anti-metastatic therapy for the disease. If metastases is prevented, fatalities from cancers can be reduced significantly.

Peter Scacheri, professor of genetics and genome sciences at Case Western Reserve University School of Medicine and member of the Case Comprehensive Cancer Center stated, “More than 90 percent of all cancer deaths are the result of tumor metastasis, not primary-site tumors. While many of the genes responsible for metastasis have been identified, the mechanisms that control these genes are not well defined. Our findings demonstrate that altered gene-enhancer activity is fundamental to a cancer cell’s ability to metastasize.”

These gene-enhancers, actually short segments of DNA, act like switches to activate genes. This is a necessary process for normal development. There are tens of thousands of these in a single cell! Sometimes, however, the process goes awry and contributes to the formation and spreading of tumor cells. This study showed that the on-off switches of metastasized cancer cells are in different positions than those in the primary tumor.

The experiment to inhibit cancer metastases

The researchers consistently noticed certain bunched groups of enhancers (metastatic variant enhancer loci – Met-VELs) were close to cancer genes in the lung metastases of patients with osteosarcoma. This indicated that were crucial to the metastatic process. They then saw that osteosarcoma cell growth in the lung can be diminished with BET inhibitors (current anti-cancer drugs in clinical trials). These interrupt the Met-VELs function in influencing gene expression. They also found that a certain Met-VEL-linked gene, Tissue Factor (F3), must be present for metastatic colonization. This interruption of signaling and the blood clotting factors of F3 prevented metastasis.

“Our experiments show that removing a single enhancer of the F3 gene in tumor cells virtually eliminates their ability to metastasize in mice,” said Scacheri. “Collectively, our findings establish that enhancer elements endow tumor cells with metastatic capacity and that targeted inhibition of genes associated with enhancer alterations, or deleting altered enhancers themselves is sufficient to block metastatic colonization and proliferation. While our work focused on lung metastasis in osteosarcoma, the findings have implications for other types of metastatic cancer as well.”

The benefits

This experiment changes the way researchers look at stopping cancer metastasis. Most research focused on gene mutation, not how – or even if – specific genes could be turned off or on. Studies in how tumors are formed and the differences in cancer cells versus normal cells has also been a primary area of study – usually in the early stages of a disease. At that point, treatment generally targets primary tumors, not those cancer cells that have traveled elsewhere in the body.

With this study, an entirely new treatment possibility may exist. This may not only affect osteosarcoma metastasizing to the lungs, but may mean the primary tumors of other cancers will be stopped before invading secondary areas of the body. This could be a new way to tackle the spread of mesothelioma and give hope to those diagnosed with this fatal disease.

The knowledge and creativity of scientists and researchers worldwide must be applauded as they continue to develop new and more effective treatments for cancers and other devastating diseases.