Immunotherapy is the artificial stimulation of the body's immune system to treat cancer, improving the system's natural ability to fight cancer. Many experts and researchers believe that immunotherapy is the future of mesothelioma treatment.
Cancer vaccines help the immune system locate and kill cancer cells. Several vaccines are in development to prevent and treat pleural mesothelioma.
A preventative vaccine called HIvax is under development at the University of Hawaii. It remains in the animal testing phase.
A therapeutic stem cell vaccine called iPSC also remains in the animal testing phase at Stanford University School of Medicine.
A phase II trial of a therapeutic vaccine called WT1 reported an overall survival of 22.8 months among pleural patients receiving the vaccine, while placebo patients survived 18.3 months. A phase III trial is waiting on funding.
The Society for Immunotherapy of Cancer explains how immunotherapy uses the body’s immune system to fight cancer.
Immune Checkpoint Inhibitors
Immune checkpoint inhibitors help the immune system identify and attack cancerous cells. Several inhibitors are in development for pleural mesothelioma:
Clinical trials are combining these drugs with each other and with chemotherapy drugs. While no immune checkpoint inhibitor has been proven to cure pleural mesothelioma, they have helped many patients live longer with the cancer.
Monoclonal antibody therapy activates cancer-killing pathways in the immune system. A few monoclonal antibodies have been tested on pleural mesothelioma patients.
Tremelimumab is an immune checkpoint inhibitor and a monoclonal antibody. Clinical trials are combining it with other inhibitors and chemotherapy drugs. Preliminary results suggest the drug works for some pleural patients, but not all.
Amatuximab made it to a phase II clinical trial in pleural mesothelioma patients. One patient responded well for years on the drug, but others only survived for 14.8 months.
Adoptive Cell Transfer
Adoptive cell transfer uses live immune cells to boost the immune system. A patient’s immune cells are extracted from a blood sample and multiplied or modified in a lab. Then the cells are transferred back into the patient, this time in much higher quantity to give the immune system a natural boost.
CAR T-cell therapy is in the early phases of being tested on pleural mesothelioma patients. These trials are investigating how to safely apply the therapy in pleural patients.
Dendritic cell therapy has been studied in pleural patients with mixed results. Most of these studies are taking place in Europe and Asia. The only dendritic cell therapy trial in the U.S. for mesothelioma is for the peritoneal type and is not open to pleural patients.
Side Effects of Immunotherapy
The side effects of immunotherapy on pleural mesothelioma patients include:
Skin reactions near needle site
Skin rash or blisters
Nausea or vomiting
Loss of appetite
Shortness of breath
High or low blood pressure
Inflammation of the digestive tract
Vision loss or retinal detachment
Patients who experience shortness of breath, yellowing of skin, blood in stool or urine, severe headache or vision problems should consult their oncologist immediately.
Future of Immunotherapy for Mesothelioma
Immunotherapy will soon become part of standard care for pleural mesothelioma rather than an experimental therapy. The extensive research underway now will eventually lead to effective immunotherapies approved by the U.S. Food and Drug Administration.
Immune checkpoint inhibitors are currently producing the best survival rates among pleural patients. Other types of immunotherapy are showing promise as well, especially when combined with other therapies.
Pleural patients with specific qualifications can access these therapies with the help of their oncologist.
The future of pleural mesothelioma treatment will involve immunotherapy and likely several different types to control mesothelioma in diverse ways.
Snehal Smart is the Pleural Mesothelioma Center’s in-house medical doctor, serving as both an experienced Patient Advocate and an expert medical writer for the website. When she is not providing one-on-one assistance to patients, Dr. Snehal stays current on the latest medical research, reading peer-reviewed studies and interviewing oncologists to learn about advancements in diagnostic tools and cancer treatments.
Maio, M. et al. (2017). Tremelimumab as second-line or third-line treatment in relapsed malignant mesothelioma (DETERMINE): a multicentre, international, randomised, double-blind, placebo-controlled phase 2b trial. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/28729154
ClinicalTrials.gov. (2018, March 13). Study of Nivolumab Combined With Ipilimumab Versus Pemetrexed and Cisplatin or Carboplatin as First Line Therapy in Unresectable Pleural Mesothelioma Patients (CheckMate743). Retrieved from https://clinicaltrials.gov/ct2/show/study/NCT02899299