With only one FDA-approved treatment for mesothelioma (a chemotherapy combination of Alimta (pemetrexed) and cisplatin), most advances in mesothelioma treatment are still considered experimental. As such, the scientific community’s views about certain approaches vary. Today’s session at the World Conference on Lung Cancer (click here to read why mesothelioma is discussed at a conference on lung cancer), which is currently underway in Toronto, Canada, tackled some of the differences in opinion regarding issues of intrapleural chemotherapy, off-label use of immunotherapeutic agents, and the SMART trial’s approach to radiotherapy.
Here are discussions that transpired.
Intrapleural Chemotherapy
Similarly to HIPEC (hyperthermic intraperitoneal chemotherapy) which is used in peritoneal mesothelioma, some surgeons have utilized a similar approach in the context of surgery for pleural mesothelioma. The idea is to apply the chemotherapeutic agent directly to the pleura after the tumor has been resected.
Argument FOR Intrapleural Chemotherapy (by Dr. Isabelle Opitz):
Case for using local treatments, chemo or immunotherapy. Next up will be the case against it. Presented on behalf of @IsaOpitz pic.twitter.com/a9kGa6088u
— Maja Belamaric (@BelamaricMaja) September 24, 2018
Argument AGAINST intrapleural chemotherapy (by David Rice):
David Rice made a strong case against intrapleural chemotherapy in #mesothelioma but it remains a valid topic of #research . Now the ‘questions’ are personal expressions of strongly held beliefs!! https://t.co/5SSjOtqXxf
— Anna Nowak (@perth_meso_dr) September 24, 2018
To me the benefit of intrapleural chemotherapy remains unclear. Would those in favor support a randomized trial? #WCLC2018 #mesothelioma @curemeso @sloan_kettering
— Marjorie Zauderer (@MGZauderer) September 24, 2018
Immunotherapy in mesothelioma should only be given on clinical trials
Immunotherapy continues to be an area attracting huge interest in mesothelioma, but with response rates at around 20%, scientists agree that more study is necessary to understand why some patients dramatically respond and others don’t.
Case AGAINST administering immunotherapy agents (by Penelope Bradbury) outside of a clinical trial setting in the first image and case FOR administering immunotherapy outside a clinical trial (by Dr. Evan Alley) in the second image.
Important argument about off-label usage of immunotherapy drugs outside of clinical trials. First slide and pro argument by Evan Alley. Second slide and con argument by Penelope Bradbury. pic.twitter.com/uotfGCSQ7X
— Meso Foundation (@curemeso) September 24, 2018
Radiation options: Are we SMART enough?
For context, traditional radiation therapy in mesothelioma is usually administered after the lung is removed because radiation itself can be fatally harmful to the lung. Dr. Marc de Perrot of the University of Toronto pioneered a different approach through his SMART study whereby he applies radiation to the lung which, a couple of weeks later, he removes, thus avoiding radiation side-effects to the lung.
Case for SMART approach (by Dr. John Cho):
Case against SMART approach (by Dr. Chuck Simone):
