Mesothelioma immunotherapy is a type of cancer treatment that uses the patient’s own immune system to fight mesothelioma cancer cells. On October 2, 2020, the FDA approved the combination of the immunotherapy drugs Opdivo (nivolumab) and Yervoy (ipilimumab) as a first-line treatment for pleural mesothelioma.
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What Is Mesothelioma Immunotherapy?
Mesothelioma immunotherapy is a targeted anti-cancer treatment that uses or modifies cells from a patient’s immune system.
In 2020, the US Food and Drug Administration approved the combination immunotherapy Opdivo and Yervoy for the treatment of mesothelioma. These drugs, collectively known as nivolumab and ipilimumab, help the immune system recognize cancer cells and stimulate T-cell production.
Immunotherapy for mesothelioma, such as pembrolizumab, has extended the life expectancy of some patients by almost a year. The drug, known by the brand name Keytruda, is the first FDA-approved immunotherapy for mesothelioma patients with advanced or metastatic disease. Success rates for immunotherapy treatments vary from patient to patient.
How Does Mesothelioma Immunotherapy Work?
Mesothelioma immunotherapy works by changing and improving the immune system’s ability to recognize and eliminate cancer cells. This process is similar to how the body fights off foreign pathogens such as viruses and bacteria. Immune cells also help get rid of other damaged or dead cells.
Active Versus Passive Immunity
Active immunity occurs when the body makes antibodies, and passive immunity involves artificial immune cells that provide protection. After treatment with aggressive immunotherapy, such as cancer vaccines or CAR T-cell therapy, the immune system remembers how to produce anti-cancer antibodies to reduce the rate of cancer recurrence.
Passive immunotherapy, such as immune checkpoint inhibitors or cytokines, does not have long-term immune memory. Once you stop treatment, the anti-cancer effects of your immune system wear off over time. Unlike active immunity, these treatments do not stimulate the body to make long-lasting antibodies.
Patients and caregivers should weigh the benefits and risks of active or passive immunotherapy options. For example, cancer vaccines are most effective at preventing cancer from coming back after success with other treatments. Immune checkpoint inhibitors are very effective for some mesothelioma patients but can cause serious side effects.
Types Of Immunotherapy For Mesothelioma
There are several types of immunotherapy for mesothelioma, including immune checkpoint inhibitors, cancer vaccines, monoclonal antibodies, and T-cell therapy. CAR. The availability of immunotherapy varies according to the cancer stage and the patient’s previous treatment history.
Clinical trials continue to test the safety and effectiveness of new types of mesothelioma immunotherapies. In recent years, thanks to FDA approval, Keytruda and other immune checkpoint inhibitors have made immunotherapy a viable treatment option for mesothelioma.
Cancer Vaccines
Cancer vaccines work like vaccines for flu and other diseases by helping to prevent specific diseases from recurring. There are two types of cancer vaccines: Prevention and treatment. Prophylactic vaccines reduce the risk of cancer coming back, and therapeutic vaccines try to treat the disease aggressively.
A mesothelioma vaccine targeting the OX40 receptor reduced tumor growth and increased survival in mice bearing mesothelioma. Researchers are studying whether this vaccine can be safe in humans and effectively prevent mesothelioma recurrence.
Two mesothelioma vaccines, the listeria-based cancer vaccine CRS-207 and galinpepimut-S (WT1) have shown promise in clinical trials. A phase II trial of the WT1 vaccine reported significantly longer survival and better tumor control among participants receiving the vaccine compared with the placebo.
Monoclonal Antibodies
Monoclonal antibody (mAb) therapy is the most common immunotherapy for many cancers but not necessarily for mesothelioma. Antibody therapy is a targeted treatment that focuses on a single site, called an antigen, inside cancer cells or on their surface. Treatment by making multiple copies of effective antibodies in the laboratory and passing them on to the patient.
Tremelimumab is both a monoclonal antibody and an immune checkpoint inhibitor being studied for mesothelioma. Amatuximab (MORAb-009) is a phase II monoclonal antibody for patients with mesothelioma. Overall survival was 14.8 months, nearly 25% longer than the median survival of mesothelioma patients.
Cell and Protein Therapy
Cultured cell transfer involves transferring whole immune cells into a patient and is being studied for use in patients with mesothelioma. This therapy has been successful for end-stage melanoma and renal cell carcinoma. Another type of cell transfer, CAR T-cell therapy, modifies the immune system’s T cells to make them cancer-specific.
Injections of immune system dendritic cells after chemotherapy were tested in phase I clinical trial for mesothelioma. Ten patients previously treated with cisplatin and pemetrexed tolerated the therapy, and study participants showed a strong immune response.
Cytokines are proteins produced by T cells that coordinate immune responses against cancer and foreign pathogens. Cytokines such as tumor necrosis factor, interferon, and interleukin-2 act independently or as a coordinated attack to kill cancer cells or prevent the birth of new cells.
What Are The Best Immunotherapy Treatments For Mesothelioma?
The best immunotherapy drugs for mesothelioma, such as Opdivo and Yervoy, have shown promising anticancer activity in recent clinical trials. Newer experimental treatments include immune checkpoint inhibitors for peritoneal mesothelioma and targeted therapies, such as the WT1 vaccine.
FDA-approved immunotherapy for malignant mesothelioma includes:
- Keytruda
- Opdivo
- Yervoy
Keytruda is effective against mesothelioma when cancer recurs after the first treatment. It resulted in a median patient survival of 18 months. Opdivo and Yervoy combined immunotherapy is a beneficial option for newly diagnosed patients with pleural mesothelioma who are not candidates for surgery.
A 2021 clinical trial found that patients treated with Opdivo and Yervoy had a median survival of 18.1 months, compared with 14.1 months for chemotherapy patients. In addition, the two-year survival rate was 41% for patients treated with combination immunotherapy but only 27% for the chemotherapy group.
Benefits Of Immunotherapy For Mesothelioma
The main benefit of immunotherapy for mesothelioma is that it is a targeted treatment and only aims to affect cancer cells and avoid damaging healthy tissue. like chemotherapy or radiation. The side effects of immunotherapy are fewer and often easier to manage than with other anticancer treatments.
Immunotherapy and other targeted therapies are widely seen as the future of cancer treatment for patients with mesothelioma. By taking advantage of your immune system’s natural processes, immunotherapy can provide long-term protection against mesothelioma for many years.
Other benefits of immunotherapy for mesothelioma include personalized treatment and financial assistance. Several types of immunotherapy are specific to each patient’s cancer DNA, and immunotherapy is available through clinical trials paid for by the research sponsor.
Advantages And Disadvantages Of Immunotherapy Treatments For Mesothelioma
Advantages:
- Using the immune system and the body’s cells to fight cancer
- Targeted immunotherapy reduces damage to healthy tissues
- When enrolling in a clinical trial, the research sponsor will cover the cost of the trial immunotherapy
- Fewer side effects and more manageable than conventional mesothelioma treatment
Disadvantages:
- Inflammatory reactions such as skin irritation, pneumonia or colitis
- Potential organ damage such as scarring in the lungs or kidney problems
- Fever, nausea, diarrhea, body aches and other flu-like symptoms
Side Effects Of Immunotherapy For Patients With Mesothelioma
Side effects of immunotherapy for mesothelioma patients involve reactions due to an elevated immune response, such as fever or body aches, like fighting an infection. Some side effects, such as cough or fatigue, maybe more bothersome for mesothelioma patients who have difficulty breathing due to cancer.
Most mesothelioma patients experience only mild side effects with immunotherapy, and doctors will monitor whether treatment needs to be delayed or stopped. Almost all side effects of immunotherapy are reversible with rest or medication. In rare cases, more serious reactions can damage sensitive tissues or organs.
Typical side effects of Mesothelioma Immunotherapy include:
- Nausea
- Diarrhea
- Constipation
- Fever
- Weight loss
- Tired
- Mouth Sores
- Skin irritation
- ho khan
- Muscle or joint pain
Serious side effects can occur when the immune system overproduces antibodies that build up in delicate organs such as the lungs or kidneys. Generally, these conditions are associated with inflammation, which can cause scarring or damage to organs over a long period of time.
Serious immunotherapy adverse reactions include:
- Pneumonia: Chest pain, shortness of breath, and persistent cough
- Colitis:Inflammation of the colon causes bloody stools, abdominal pain, and bowel tears.
- Hepatitis: Hepatitis: is characterized by discolored eyes and skin, changes in urine, and right-sided abdominal pain
- Hormone problems: Side effects of hormones include muscle aches, increased heart rate, headaches, and weight loss.
- Kidney problems: Nephritis, or inflammation of the kidneys, leads to urine changes, back pain, hormone imbalances, and potential kidney failure
Early treatment of immunotherapy side effects can help prevent long-term damage. In every patient’s case, it is essential to discuss with the anesthesiologist the potential benefits versus risks of treatment. Lifestyle and habit changes, such as a mesothelioma diet, can improve energy and reduce the severity of some side effects.
Cost Of Mesothelioma Immunotherapy
The cost of immunotherapy for mesothelioma patients can be very expensive for many people, often costing more than $10,000 per month. According to a recent Reuters report, the combined therapy of Yervoy and Opdivo can cost more than $250,000 per year. Other immune checkpoint inhibitors can cost about $150,000 per year.
Medicare and many insurance plans cover cancer immunotherapy, but out-of-pocket costs and lost wages can have a significant impact on personal finances. The VA benefit covers immunotherapy with limits and no out-of-pocket costs, but the veteran claim system can be complicated.
Patient Advocates can help patients and their families identify financial assistance opportunities for medical care, such as clinical trials or legal redress. The Veterans Outreach Team at the Mesothelioma Center can also help patients file a VA complaint.
The Future Of Immunotherapy For Mesothelioma
Future mesothelioma immunotherapy will likely involve combinations with other cancer therapies. For example, several studies have combined immunotherapy with chemotherapy or surgery, and recent results suggest a significant survival benefit for certain patients.
“I believe immunotherapy will become the fourth mainstay of the treatment of mesothelioma [combining surgery, radiation, and chemotherapy]. It can help turn mesothelioma into a chronic disease that people can live with for a long time.”
DR. DAN STERMAN
Director of Pulmonary Medicine at New York University
Future immunotherapy options for mesothelioma may include tumor-infiltrating lymphocytes, a type of white blood cell that infiltrates tumors. This therapy signals a broader immune response along with other treatments and may improve the prognosis of mesothelioma. Advanced preventive vaccines can disrupt asbestos’s carcinogenic potential, reducing post-exposure risk.
Mesothelioma specialists provide access to the latest experimental immunotherapies through tailored clinical trials or compassionate use programs. The recent FDA approval of Keytruda, Opdivo, and Yervoy for the treatment of mesothelioma represents the first steps in the broader provision of immunotherapy options.
Frequently Asked Questions About Mesothelioma Immunotherapy
[toggle title=”Can Immunotherapy Be Used To Treat Mesothelioma?” state=”open”]Immunotherapy is an experimental mesothelioma treatment option. Clinical research trials are currently underway to test the safety and effectiveness of this new therapy. Immunotherapy boosts a patient’s immune system to help treat cancer and is combined with chemotherapy, surgery, and other treatments.[/toggle]
[toggle title=”What Is The Success Rate Of Immunotherapy?” state=”open”]Immunotherapy success varies for each patient based on the type and stage of cancer and the patient’s immune system. Pembrolizumab (Keytruda) is one of the most promising immunotherapy options for malignant pleural mesothelioma. In many cases, Keytruda has extended a patient’s life by nearly a year.[/toggle]
[toggle title=”What Are The Disadvantages Of Immunotherapy?” state=”open”]Immunotherapy outcomes vary because treatment largely depends on the activity of the patient’s immune system and the presence of biomarkers on the tumor surface. Mesothelioma symptoms and treatment side effects may also be more severe in some patients based on the intensity of the immune response.[/toggle]
[toggle title=”Is Immunotherapy Better Than Chemotherapy?” state=”open”]There are advantages and disadvantages to each treatment method. Some patients may have fewer side effects with immunotherapy, while chemotherapy for mesothelioma may have better control of their tumor growth. Many oncologists use a combination approach that uses both therapies for optimal impact.[/toggle]