The April 2017 issue of Translational Lung Cancer Research features an article titled Immunotherapy and radiation therapy for malignant pleural mesothelioma written by a group of investigators known within the Meso Foundation’s community: Evan W. Alley, MD, PhD, Sharyn I. Katz, MD, and Keith A. Cengel, MD, PhD, of the University of Pennsylvania, and Charles B. Simone, MD, of the University of Maryland.
The investigators take a look at the use of immunotherapy in malignant pleural mesothelioma, why it may be beneficial to combine immunotherapy with radiation therapy, and the efficacy of the treatment combination that has been seen thus far.
The authors have provided us with a summary of their article here:
There has been an increasing recognition that the immune system plays an important role in the cancer response to treatment, and that malignant pleural mesothelioma is able to provoke a more prominent immune response than many other cancers. As a result, numerous types of immunotherapy have been trialed for mesothelioma over the past approximately 15 years.
A newer class of immunotherapy called immune checkpoint inhibitors is currently being investigated in mesothelioma. Early results of recently completed and ongoing clinical trials have shown that these drugs targeting the PD-1/PD-L1 pathway can achieve very encouraging long-term disease control in select patients, but that the overall number of patients who respond to these drugs is still relatively limited. Therefore, novel ways to improve the efficacy and response rates of immunotherapy for mesothelioma are needed.
Radiation therapy is a standard treatment option for malignant pleural mesothelioma, and this therapy is also known to be able to alter the immune system. Radiation therapy can effectively treat mesothelioma disease that is being targeted, and in select patients it can also allow for tumor responses outside of the area being irradiated as a result of a stimulatory signal to the immune system from the local anti-tumor effects of irradiation. Combining radiation therapy and immunotherapy may allow for improved therapeutic effects in some patients by enhancing the antitumor responses of immune checkpoint inhibitors.
Data on combining radiation therapy and immunotherapy in malignant pleural mesothelioma to date are spare. Therefore, when combining radiation therapy with immunotherapy for mesothelioma, the optimal dose of irradiation, type of radiation therapy, timing of radiation therapy relative to immunotherapy, and type of immunotherapy are not currently known. Additional clinical data are needed, and ongoing clinical trials will help define the role of combining radiation therapy and immunotherapy in the treatment of mesothelioma.
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