People who have been diagnosed with pleural or peritoneal mesothelioma are facing aggressive cancer with a poor prognosis. This cancer, which is caused by asbestos exposure, invades the delicate tissues lining the lungs and abdominal organs.
But there have been innovations in treatment options for mesothelioma in the last several years. Below is a list of cutting edge mesothelioma treatment options that are showing real promise. Talk to your healthcare provider to find out if one of these treatments may be right for you.
In This Section
- Chemotherapy Hybrid
- Photodynamic Therapy
- Gene Therapy
- Radiation Therapy
- Cancer Vaccines
- Alternative Electric Fields
New Surgery Combined With Photodynamic Therapy and Chemotherapy
A new clinical study shows that patients with epithelial malignant pleural mesothelioma who have surgery to remove the tumors, combined with photodynamic therapy and chemotherapy, survived a median of three years. (mesotheliomagroup.com). The lung itself was not removed in this procedure.
Even better, if cancer did not spread to the lymph nodes, the median survival time was an impressive 7.3 years. Median survival is the rate at which half of the patients with cancer are still living.
Patients have an operation to remove all signs of cancer from the pleura around the lungs. The idea of this cutting edge surgery is not to remove the lung and other vital structures such as the diaphragm or pericardium.
Photodynamic therapy uses photosensitizing agents to kill cancer cells that were not visible during surgery. Chemotherapy is started after the operation.
Cisplatin and pemetrexed is the standard, first-line chemotherapy for mesothelioma patients. However, a recent phase III trial recruited 448 patients with mesothelioma who could not have surgery. When bevacizumab – anti-vascular endothelial growth factor antibodies – was added to chemotherapy, there was significantly longer median survival times of 18.8 months. (ERJ.ERSJournals.com). The drug helps to stop blood vessels from getting to the tumor, potentially starving the tumor of nutrients.
Keytruda is a new, cutting edge immunotherapy drug that is made to reveal cancer cells to the patient’s immune system so the body can fight cancer in a natural way.
Keytruda functions by blocking the interaction of PD-L1 proteins on mesothelioma cells with PD-1 proteins on immune system cells. Mesothelioma cancer cells frequently use PD-L1 proteins as a mask to hide from the immune system.
One of the advantages of immunotherapy is that it has fewer side effects than chemotherapy. Keytruda has been proven to extend survival time for some cancer patients. Mesothelioma clinical studies are testing the drug in patients. It also can be accessed through the FDA’s Expanded Access program. (mesotheliomaprognosis.com)
Using Keytruda as a second-line treatment for asbestos cancer patients whose cancer did not respond well to surgery, radiation, or chemotherapy. Using it as a second-line treatment has shown good results in several clinical studies.
For example, the KEYNOTE-028 clinical trial performed at 13 different sites in six different countries showed success in treating pleural mesothelioma in patients who were unsuccessfully treated with chemotherapy.
Clinical researchers found that 14 of 25 patients had a reduction in tumor size. Also, the average survival time with Keytruda was 18 months, and cancer patients in the trial averaged 180 days with no progression of cancer. (Researchgate.net)
Clinical researchers have been experimenting with combining Cediranib with standard chemotherapy drugs cisplatin and pemetrexed. Cediranib works by stopping the production of enzymes that mesothelioma cells need to grow. The drug also may reduce blood flow to tumors and make them shrink. Similar drugs in development also stop tumors from growing essential blood vessels that allow them to grow.
It is believed these drugs together can destroy cancer cells more effectively and prevent metastasis. (ASCOPubs.org). One study showed a ‘small survival benefit.’ It was found in the study that cediranib demonstrated therapeutic potential in the trial.
Also, a phase II trial was conducted with 92 mesothelioma patients. Some patients received chemotherapy and cediranib, and others received a placebo and chemotherapy. The median survival for the cediranib group was 10 months and 8.5 months for the placebo group.
Photodynamic Therapy (PDT) uses a drug activated by light to fight mesothelioma. Physicians inject the drug into the bloodstream, which spreads the drug all over the body.
During this process, it is absorbed by more mesothelioma cells than healthy cells. When the doctor shines a certain type of laser on various areas, it causes a chemical reaction to occur that kills cancer cells while leaving normal cells alone. Some clinical trials have tested PDT before the cancer surgery, where researchers put the drug in the body before surgery and activate it during the surgical procedure. (Cancer.gov)
Researchers are continuing to study ways to enhance the effectiveness of PDT on mesothelioma and other cancers. Other research on PDT is focused on developing photosensitizers that have more power that specifically targets cancer cells. Researchers also are studying ways to enhance PDT equipment and how the activating light is delivered.
Drugs that are FDA-approved for use in PDT are Photofrin and ALA or Levulan.
With gene therapy, cancer doctors modify your genes to treat or prevent mesothelioma. They may be able to replace or repair the mutated genes that were harmed by asbestos exposure. Doctors also may be able to change the genetic code of cancer cells to kill them more easily.
One gene therapy approach uses certain viruses that were modified in the laboratory. The virus is inserted into the pleural space and infects the cancer cells. As this infection occurs, the virus injects a specific gene into the cancer cells. In one type of this therapy, the virus has a gene that helps to engage the immune system to attack mesothelioma cells.
One clinical study for gene therapy modified the blood cells of the patient so they could better target cancer cells and even shrink tumors. Scientists think gene therapy used in this way could help patients with advanced mesothelioma who have responded poorly to chemotherapy or radiation. (NIH.gov)
Intensity Modulated Radiation Therapy (IMRT)
Researchers have seen impressive results in early tests of a new type of radiation therapy known as IMRT. This therapy allows physicians to deliver greater doses of radiation with higher accuracy, which can reduce damage to healthy tissues.
IMRT is safer to use on pleural mesothelioma than regular radiation therapy, as it is safer to administer near vital organs.
A clinical study at the MD Anderson Cancer Center in Houston concluded that IMRT is ‘promising and feasible.’ None of the 30 patients treated with IMRT had their cancer return after nine months. However, cancer still metastasized to other parts of the body. Scientists think combining IMRT with chemotherapy could address this problem. (asbestos.com)
Physicians are using IMRT for palliative treatment in some cases. This treatment is intended to reduce chest pain and enhance the quality of life. IMRT usually causes only mild side effects and can be safely combined with chemotherapy and immunotherapy.
There are two major types of IMRT that are being used:
- Helical Tomotherapy: The patient lies on a table that goes through a machine shaped like a donut. The machine has a linear accelerator that revolves around the patient. A 2014 study in the journal Lung Cancer noted that 20 pleural mesothelioma patients received lung-sparing surgery and then this type of IMRT. Median survival time was almost three years, which is much better than normal. (thoracic.org)
- Volumetric Modulated Arc Therapy (VMAT): VMAT also has a linear accelerator that rotates around the patient. It is faster than other types of IMRT and reduces the risk of the patient moving and disrupting the therapy. In 2012, physicians from the Memorial Sloan-Kettering Cancer Center reported on a pleural mesothelioma study for 36 patients. The median survival time for the patients was 26 months for those who got VMAT after surgery. It was 17 months for patients who could not have surgery. (ncbi.nlm.nih.gov)
Vaccines are typically given to healthy people to prevent infections such as measles. But there are now vaccines being worked on to treat mesothelioma and other cancers, too. The idea is to help treat cancer or prevent it from returning after other cancer treatments. There also some experimental vaccines that could help to prevent some cancers. (Cancer.gov)
So far, the FDA has approved only one therapeutic cancer vaccine – Sipuleucel-T (Provenge) that was approved to treat advanced prostate cancer. There are no preventative cancer vaccines approved to treat mesothelioma yet, but scientists are trying to develop them.
For example, scientists at the University of Hawaii are working on a mesothelioma vaccine called Hlvax. It works on Survivin, which is a protein in mesothelioma cells. A 2015 study published in Human Vaccines and Immunotherapeutics stated that the vaccine is in animal testing and has not been approved for human trials.
Also, a phase II clinical trial of the WT1 vaccine for mesothelioma patients had a median overall survival of 21.4 months in patients who got the vaccine. Those who got the placebo survived 16.5 months.
Stem Cell Vaccine
There also is a stem cell vaccine being worked on at Stanford University School of Medicine for mesothelioma patients. The vaccine has induced pluripotent stem cells, which are the patient’s own cells that are changed in a laboratory and then placed back in the bloodstream to stimulate the immune system. This study is still in animal trials and has not been tested in humans at this time. (Med.Stanford.edu)
Scientists have found that exposing some cancer cells to alternating electric fields, called tumor treating fields or TTF, can slow and even stop their growth. (Cancer.gov)
A portable medical device that generates these electric fields called NovoTTF-100L is now a possibility in conjunction with chemotherapy to treat pleural mesothelioma that cannot be treated with surgery.
For this therapy, the chest or back is shaved, and electrode sets are put on the skin. The electrodes are connected to a battery pack and are worn all day. They generate electric currents that are believed to reduce tumor cell growth.
Mesothelioma researchers have recently focused on using nanotechnology to deliver tumor-fighting drugs directly to mesothelioma cells while leaving healthy cells intact.
The tiny size of nanoparticles – just one-billionth of a meter – allows minute quantities of drugs to zero in on tumors while reducing side effects from excess medicine that is usually needed to attack cancer cells in conventional therapies. Usually, capsules are developed by scientists to deliver cancer-fighting drugs to the cancer cells. The FDA is still working to determine if current regulatory processes are enough to identify any possible risks with using nanotechnology on cancer and to reduce any risks that exist.
Still, nanotechnology holds promise for mesothelioma patients. Scientists at the Institute of Bioengineering and Nanotechnology in Singapore devised a miniaturized biochip that uses nanotechnology that can assess how effective anti-cancer drugs are on cancer stem cells. This is especially of significance so oncologists can offer personalized medicine to asbestos cancer patients. (Mesotheliomahelp.org)
Much advanced research is being conducted on cutting edge mesothelioma treatment options. If chemotherapy, radiation, and surgery are not providing the desired results for your cancer, talk to your doctor about some of these new therapies that are extending lifespans for some patients.