Mesothelioma has often been referred to as a cancer resistant to chemotherapy. That attitude changed when in 2004, the combination of Alimta and Cisplatin demonstrated a survival advantage over Cisplatin alone. This was a large randomized study that paved the way for pharmaceutical companies to become interested in this disease often thought to be recalcitrant.
Today, rather than telling our patients to go home and get their affairs in order, we can instead provide them with a wide array of treatment options, whether first diagnosed, after a recurrence, or even after several prior regimens.
Having options is an incredible step forward in this cancer that even merely a decade ago was seen as hopeless. But with options also come some challenges.
One such challenge is the healthcare providers’ lack of time necessary to fully inform patients with mesothelioma about their options. For this reason, providers will often present only a few of the many options to their patients.
Patients are fortunate that some providers unable to fully perform this task are referring their patients to the Mesothelioma Applied Research Foundation. At the Meso Foundation, a dedicated nurse practitioner spends the necessary time to go through the options, taking into account insurance coverage, stage of disease, histology and readiness to participate in a clinical trial.
The initial presentation and consultation during this stage is often complicated by the physical, emotional and legal challenges associated with the diagnosis. Patients and family members are often in a “tail spin” and desperate for information that might lengthen survival time or better yet, make mesothelioma into a chronic disease. It is crucial that time is taken to consider all of the options in a calm, supportive environment to ensure that decision making is optimized.
I outlined below some very promising new clinical trials. PLEASE NOTE: This is not a comprehensive list of available trials. Each mesothelioma case is different, so please only use this list as a loose guide. To obtain a full consultation, which will take into consideration all available treatments, please contact Mary Hesdorffer, APRN.
Among treatment options available today are specialized forms of radiation therapy given before or following a surgical procedure. Recently, a small trial using IMRT (Intensity-Modulated Radiation Therapy) prior to an extrapleural pneumonectory (EPP) demonstrated a 50% increase in survival over historical controls. A randomized trial is now in the planning stages to confirm these results in a larger patient population.
There are other trials currently under IRB review that will look at IMRT following either an EPP or Pleurectomy Decortication (PD). Randomized trials are the only way for scientists to demonstrate whether an intervention is better than the standard of care.
In fact, a randomized trial of a PD vs. PD, coupled with photodynamic therapy (PDT) has recently commenced following an initial, single center, non-randomized trial, which reported a significant increase in overall survival, including patients with advanced disease.
Another trial I’d like to mention uses a vaccine (CRS207) prior to treatment with Alimta and Cisplatin. It has reported a 69% durable response. A larger trial is now underway to confirm these results with plans for a future randomized trial.
Patients who respond or are stable following treatment with Alimta and Cisplatin are also eligible for Defactinib, an agent targeting cancer stem cells with the goal of lengthening the time to relapse or perhaps, in the best case scenario, preventing relapse altogether.
In the second-line setting (for patients who have had a recurrence following first-line treatment), immunotherapy appears to have taken the lead with a multi-nation, placebo-controlled trial of the drug tremelimumab. In melanoma, this agent has induced durable responses and, so far, has shown much promise in mesothelioma.
Definitely worth mentioning is also the NCI’s stellar new drug SS1P, an immunotoxin which utilizes mesothelin (a protein) to gain entry into the cell. Early phase I studies have demonstrated results in advanced patients who had failed multiple prior treatments, and a phase II study is currently underway.
These are just a few of the trials currently offered to mesothelioma patients. We strongly urge clinicians to refer patients to clinical trials in mesothelioma, as they are known to expedite research progress.
For instance, children’s cancers that saw the highest enrollment in clinical trials have experienced significant advances in treatments of those conditions. Our hope is to do the same for mesothelioma.
Visit curemeso.org to view the Meso Foundation’s Clinical Trials Brochure and learn more about enrolling in a clinical trial.