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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.

A New Treatment Doubles Mesothelioma Survival Rates

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A study at the University Hospital of Udine, Italy found that radical hemithoracic radiology, a new treatment doubles mesothelioma survival rates. The patients studied had cancers that were unable to be totally removed with surgical procedures. Mesothelioma patients generally live a year or, more rarely, up to two years. In this study of 108 patients, half were randomly selected to receive the new treatment and half the more palliative radiotherapy. Of those receiving the new, 58% were still living at two years. Of patients who received the more palliative radiotherapy, only 28% were still living at two years.

Mesothelioma and asbestos

The relationship between asbestos and mesothelioma is well known. The fibers from asbestos – smaller than a human hair – can embed in the layers of tissue surrounding the lungs. Not everyone exposed to asbestos contracts the disease, but it’s always a possibility. It’s an aggressive and fatal cancer that can take up to 50 years for a diagnosis. Current treatments are limited, so all new strides deserve a celebration.

Radical hemithoracic radiology a hopeful improvement for survival

Marco Trovo, MD, leader of the study and Chief of the Radiation Oncology Department at the University Hospital said, “There is an urgent need for more effective treatments for mesothelioma. Surgery can be given to these patients, but it is often impossible to remove all of the tumor. Patients with mesothelioma are sometimes given radiotherapy to help control their symptoms. However, radiotherapy has evolved dramatically in the last few years, so we wanted to see if it could now be used to prevent the cancer from spreading to nearby tissue, hopefully bringing improvements in survival.”

About 20% of the new radical treatment patients did develop radiation pneumonitis as a side effect. Professor Umberto Ricardi, President of ESTRO and head of the Department of Oncology at the University of Turin, Italy stated, “This is an extremely positive result that brings good news to patients with this rare and difficult-to-treat cancer. To ensure these patients benefit from this type of treatment, it’s important that they are referred to a specialist cancer centre with the right expertise and equipment to carefully plan and deliver the most effective radiotherapy treatment and manage any side effects that occur.”

New treatment doubles mesothelioma survival

Dr. Trovo said, “This research shows a clear survival benefit in using this type of radiotherapy for [patients with] mesothelioma whose tumors can only partially be removed by surgery. We believe that this should be considered the new standard of care for these patients.”

He believes that even longer survival rates could be made by using the new radiation technique followed by an immunotherapy technique that uses the patient’s immune system to target and fight the cancer cells. Creative scientific studies continue throughout the world with the goal of curing the deadly disease.

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.”

Should a Mesothelioma Patient Receive the Flu Vaccine

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Since there are conflicting opinions on getting the flu vaccine, should a mesothelioma patient receive the flu vaccine? These patients in particular, along with the elderly, young children, and people living with some chronic health issues, should assess the pros and cons of receiving the vaccine.

What do the experts say?

According to the Centers for Disease Control and Prevention (CDC), flu vaccines given with a needle cannot cause the flu. Even the vaccine given through a nasal spray, though it has a live virus, has been weakened and cold-adapted so it cannot infect a person as it would not survive the body’s warmth. Because there are a number of vaccines available, anyone with health problems should confer with their doctor to receive the correct one.

The CDC strongly encourages everyone to get the vaccine since flu is a serious, and sometimes deadly, disease. The risk of not getting the vaccine is greater than receiving it.

Currently, that means a shot or nasal spray every year as the virus is seasonal. Fortunately, there is a new type of vaccine on the horizon that may mean a vaccine only every few years.

The Universal Flu Vaccine

For decades, scientists searched for a universal vaccine that could eliminate the yearly shot and cover a variety of flu viruses. This is important, not only for patient convenience, but seasonal vaccine development means scientists have to guess what virus may be prevalent in any one year. A universal vaccine could eliminate that problem.

Currently, there are numerous vaccines in various stages of development. The one currently closest to release is the M-001 by BiondVax Pharmaceuticals Ltd. The company has recently enrolled its final participant so it can begin a Phase 3 trial.

Tamar Ben-Yedidia, the chief scientific officer at BiondVax, stated, “A universal flu vaccine is often referred to as “’The Holy Grail’ of influenza research, and like the Holy Grail, it is challenging to achieve.” He also said in a press release, “This challenging trial aims to show the extent to which M-001 protects people against influenza illness, regardless of the flu strain.” The M-001 vaccine is free of all viruses, but instead contains nine viral epitopes – the antibody binding sites on an antigen – which are recognized by the immune system.

Though the M-001 is currently furthest along in trials, all the flu vaccines use similar strategies. They target the least variable parts of the flu virus to produce immunity.

Why Should a Mesothelioma Patient Receive the Flu Vaccine?

As expressed by the CDC, a person with already weakened systems, such as the lungs, is more at risk of harm by getting the flu rather than getting a vaccine. Not only should the mesothelioma victim be vaccinated, but all those people normally around them.

Since a universal vaccine will mean a more successful and targeted answer to various flu viruses, chances of actually contracting the flu will be less. Those with mesothelioma already fight a serious disease and anything they can do to stay healthy will assist in that fight. This universal flu vaccine is one more tool to prolong life and ease the pain and discomfort of this detestable disease.