A Summary of Mesothelioma Studies from ASCO 2015

MicroscopeBy Hedy Lee Kindler, MD,  University of Chicago

The American Society of Clinical Oncology meeting was held from May 29 – June 2, 2015 in Chicago. About 30,000 attendees from across the world gathered to discuss the latest research advances in all types of cancer, making this the largest, most important oncology meeting of the year. This was a particularly exciting meeting for those of us interested in mesothelioma. I’ve summarized 3 of the most prominent studies below.

MAPS: A randomized trial of pemetrexed, cisplatin with or without bevacizumab. This oral abstract, presented by Dr. Gerard Zalcman on behalf of the French Cooperative Thoracic Intergroup (IFCT), was clearly the star of the show for those of us who care about mesothelioma. This study is important because it is the first randomized trial in over a decade to show that a new drug improves survival in mesothelioma patients. Bevacizumab is a monoclonal antibody that targets vascular endothelial growth factor (VEGF), which is highly expressed on mesothelioma. Think of it as a drug that targets the blood vessels that feed tumors (angiogenesis). Bevacizumab (the trade name is Avastin) is already FDA approved in multiple cancers, including colon cancer and lung cancer. In the MAPS trial, all 448 patients received standard chemotherapy with pemetrexed plus cisplatin, and half of the patients were randomized to also receive bevacizumab with each dose of chemotherapy. After completing 6 cycles of chemotherapy, patients on the bevacizumab arm also received bevacizumab by itself, every 3 weeks until their cancer started to grow. The time for cancer growth to occur (progression-free survival) was about 2 months longer in the bevacizumab arm (9.59 vs. 7.48 months). Patients treated with bevacizumab also lived almost 3 months longer (18.82 vs. 16.07 months). The addition of bevacizumab did not make patients feel worse (it did not worsen quality of life), although it did cause increased side effects such as bleeding, high blood pressure, and blood clots. Because there was an improvement in survival with the experimental treatment, it is possible that this trial could lead to FDA approval of bevacizumab for mesothelioma—stay tuned!

NGR015: Randomized trial of investigator’s choice of chemotherapy with or without NGR-hTNF. Oral presentations at ASCO are only for the large randomized trials. At most ASCO meetings there are no mesothelioma presentations; this year, there were two! The second oral presentation was by Dr. Rabab Gaafar from Cairo, Egypt on behalf of an international group of investigators. All 400 patients on this trial previously received pemetrexed. They were randomized to receive either NGR-hTNF (another drug that targets angiogenesis) or placebo (sugar water).  In addition, patients could receive chemotherapy either with gemcitabine, vinorelbine, or doxorubicin, or no chemotherapy at all. Unfortunately, the addition of NGR-hTNF to chemotherapy did not affect how long the cancer was controlled, or how long the patients lived. Data is being analyzed to see if certain characteristics might predict which patients might benefit from this drug.

Mesothelin targeted immunotherapy CRS-207, plus pemetrexed/cisplatin chemotherapy. Dr. Raffit Hassan from the National Cancer Institute updated the results of this ongoing trial in a poster presentation. Mesothelin is highly expressed on the surface of mesothelioma. CRS-207 is a vaccine that increases the immune response against mesothelin, and may enhance the activity of chemotherapy. In this study, 2 doses of CRS-207 were given before pemetrexed and cisplatin, as well as after completion of 6 cycles of chemotherapy. Encouraging activity was observed: 60% of patients had tumor shrinkage, and another 34% had disease that did not grow. Thus 94% of patients had disease that was controlled with this experimental vaccine plus chemotherapy. This is much better than would be expected with chemotherapy by itself. Based on these encouraging results, a randomized study to test this combination compared with standard chemotherapy is in development.

Hedy Lee Kindler, MD, an internationally recognized authority on the treatment of mesothelioma, is a Professor of Medicine and the Director of the Mesothelioma and Gastrointestinal Oncology Programs at the University of Chicago. Dr. Kindler is a Past President of the International Mesothelioma Interest Group. She was a member of the Science Advisory Board of the Mesothelioma Applied Research Foundation from 2001-2014, and remains active with the Foundation.  Dr. Kindler chairs the Mesothelioma Subcommittee of the Alliance for Clinical Trials in Oncology, a national cancer clinical trials group. Her research focuses on the investigation of novel agents for the treatment of mesothelioma. Patients from throughout the United States come to Dr. Kindler’s Mesothelioma Clinic at the University of Chicago for her expert care and to participate in her many clinical trials. Dr. Kindler has been listed repeatedly in Best Doctors in America, America’s Top Physicians, America’s Top Doctors for Cancer, and Best Doctors in Chicago.

Updates from ASCO: CRS-207 Vaccine Study Results

MicroscopeAduro BioTech is conducting a clinical trial to test an investigational new immunotherapy for malignant pleural mesothelioma (MPM). This therapy, called CRS-207, is given to a patient in combination with chemotherapy in hopes of encouraging the body’s normal defense mechanisms to fight off the cancer. This trial aims to enroll up to 60 patients at 5 U.S. clinical sites. The company presented data at the American Society of Clinical Oncology (ASCO) conference this week showing that of the 32 patients with MPM treated with CRS-207 and chemotherapy, MPM tumors reduced in size for 19 patients, and tumors remained the same size (stable) in an additional 11 patients. CRS-207 is given prior to and after chemotherapy (cyclophosphamide, pemetrexed and cisplatin) for patients who have not received prior treatment or surgery for their disease.

If you are interested in participating in a clinical trial for this investigational new therapy, please click here.

The 2015 ASCO Annual Meeting, one of the largest oncology meetings of the year, was held from May 29 to June 2 in Chicago, Illinois. The Meso Foundation will be providing more information on studies presented at ASCO in the coming weeks.

LISTEN: Meet the Mesothelioma Experts Interview with Drs. Simone and Alley Now Available

Penn MedicineOn Thursday, May 14, the Meso Foundation interviewed Dr. Charles Simone and Dr. Evan Alley of the University of Pennsylvania Medicine during the Meet the Mesothelioma Experts series. The session was part of a series of interviews focusing on mesothelioma centers of excellence. Drs. Simone and Alley were interviewed by the Meso Foundation’s executive director, Mary Hesdorffer, with whom they discussed the mesothelioma program at the University of Pennsylvania Medicine.

The full interview is now available on demand on the Meso Foundation’s website at curemeso.org/experts.

Drs. Alley and Simone are the co-directors of the Penn Mesothelioma and Pleural Program. Dr. Alley is a medical oncologist and is the leading investigator in the PD-1 inhibitor trial that has recently made big news in mesothelioma. Read more about the trial here. Dr. Simone treats patients with malignant pleural mesothelioma with photon and proton radiation therapy and photodynamic therapy (PDT). He is a National Institutes of Health and Department of Defense funded investigator who performs clinical and translational research investigating the novel use of proton therapy and PDT as definitive therapy and as part of multi-modality therapy for mesothelioma.

As part of the Meet the Mesothelioma Experts series, the Meso Foundation invites specialists in the field of mesothelioma to discuss their current research interests as well as promising developments in the treatment of mesothelioma.

You can listen to this interview and other previous Meet the Mesothelioma Experts sessions at curemeso.org/experts.

Study Shows Bevacizumab Improves Survival in Mesothelioma

VaccineA Phase 3 French study, which will be presented at the American Society of Clinical Oncology (ASCO)’s annual meeting at the end of May, demonstrated improved survival rates for those patients who received bevacizumab in addition to the current standard chemotherapy regimen of pemetrexed/cisplatin. Bevacizumab (Avastin® Genentech, Inc.) is an antibody that blocks angiogenesis (blood vessel growth), and it is already routinely used to treat many other cancers, including lung cancer and colon cancer.

“The mesothelioma community has been waiting for this kind of news for a long time—it is the first positive phase III trial in mesothelioma since the original study of pemetrexed/cisplatin over 10 years ago,” said Dr. Lee M. Krug of Memorial Sloan Kettering Cancer Center and chair of the board of directors of the Mesothelioma Applied Research Foundation.

“The addition of bevacizumab has the potential to become a new standard of care for first-line therapy in this disease,” he added.

The study, conducted between 2008 and 2014, included 448 patients treated in 73 centers. The patients were randomized into two arms– one received standard chemotherapy (pemetrexed and cisplatin) and the other received standard chemotherapy plus bevacizumab. Overall survival was significantly longer in the experimental arm (median: 18.8 months vs. 16.1 months). The study concluded that adding bevacizumab in addition to pemetrexed/cisplatin provides a significantly longer survival in patients with malignant pleural mesothelioma, with acceptable toxicity, making this triplet a new treatment paradigm.

Meet the Mesothelioma Experts: Drs. Alley and Simone of Penn Medicine

Penn MedicineOn Thursday, May 14 at 8PM ET, the Meso Foundation will interview Drs. Evan Alley and Charles Simone of Penn Medicine during a new installment of the Meet the Mesothelioma Experts live teleconference series. The interview will be led by the Meso Foundation’s executive director and expert mesothelioma nurse practitioner Mary Hesdorffer.

This session, titled Focus on Mesothelioma Centers of Excellence: Penn Medicine, is the second installment in a series of interviews highlighting mesothelioma centers of excellence.

The session will be available live on Thursday, May 14 at 8PM ET by dialing into the conference call. The session is available at no charge, but those interested in participating must RSVP ahead of time in order to receive the call-in number. Please RSVP at curemeso.org/experts.

RSVP

Drs. Alley and Simone are the co-directors of the Penn Mesothelioma and Pleural Program. Dr. Alley is a medical oncologist and is the leading investigator in the PD-1 inhibitor trial that has recently made big news in mesothelioma. Read more about the trial here.

Dr. Simone treats patients with malignant pleural mesothelioma with photon and proton radiation therapy and photodynamic therapy (PDT). He is a National Institutes of Health and Department of Defense funded investigator who performs clinical and translational research investigating the novel use of proton therapy and PDT as definitive therapy and as part of multi-modality therapy for mesothelioma.

To RSVP to this session and learn more about the Meet the Mesothelioma Experts series, visit curemeso.org/experts.