At the end of May, in a brand new virtual format, the annual meeting for the American Society of Clinical Oncology (ASCO) was one of the first such meetings to take place since COVID-19 caused disruptions and cancellations across the board. Scientific meetings such as this one are an important venue where scientists and researchers report their newest finding among an audience of their peers. As you read through these studies, please use caution in interpreting statistical figures.
Adding to Chemotherapy in Mesothelioma
“We are on the cusp of several promising advances being mature enough to get integrated into patient care. I am so thankful to the patients and families who participate in these trials as it is the only way to move this field forward.”
Dr. Marjorie G. Zauderer, a thoracic medical oncologist at Memorial Sloan Kettering Cancer Center and the chair of the Board of Directors of the Mesothelioma Applied Research Foundation.
Dr. Zauderer was a discussant in the session titled “Adding to Chemotherapy in Mesothelioma” discussing two studies, both of which examined the addition of agents beyond cytotoxic chemotherapy in the treatment of mesothelioma. The first study listed below looked at the addition of an immunotherapeutic agent to standard chemotherapy in previously untreated patients. The second study looked at the addition of a VEGF inhibitor, ramucirumab, in previously treated patients.
Immunotherapy/Chemotherapy in Pleural Mesothelioma
Last week, the much awaited results from the Phase 2 trial PrE0505: Phase II multicenter study of anti-PD-L1, durvalumab, in combination with cisplatin and pemetrexed for the first-line treatment of unresectable malignant pleural mesothelioma (MPM)—A PrECOG LLC study of combination immunotherapy (durvalumab) with standard chemotherapy (cisplatin/pemetrexed) were released showing much promise in this space. The study enrolled 55 patients and showed a median survival of 20.1 months. Of those 55 patients, 31 demonstrated a partial response, and 22 had stable disease. Most frequently observed adverse events included fatigue, nausea, anemia, and constipation – all which are typically seen with platinum-based chemotherapy. Among adverse events that investigators thought were possibly related to immunotherapy are hypothyroidism and rashes. We wrote more about this study here.
Anti-Angionesis/Chemotherapy in Pleural Mesothelioma
This Italian study, Randomized phase II study on gemcitabine with or without ramucirumab as second-line treatment for advanced malignant pleural mesothelioma (MPM): Results of Italian Rames Study, randomized 161 previously treated patients into two arms. Researchers added ramucirumab (an anti-angiogenesis drug that blocks growth of new blood vessels therefore limiting the supply of oxygen to the tumor similar to bevacizumab) to gemcitabine in one of the arms. They then compared outcomes between the arm receiving both drugs vs. the arm receiving only gemcitabine. Researchers found that overall median survival was significantly improved in the group receiving both ramucirumab and gemcitabine (13.8 months vs. 7.5 months).
Important to note is that in 2015, a relatively large French study showed a significant survival benefit when bevacizumab (a similar agent blocking the formation of new blood vessels) was added to the standard chemotherapy of pemetrexed (Alimta)/cisplatin in a first-line therapy setting. Also of note is that another large phase 3 randomized study using a similar agent called nintedanib did not meet its progression-free survival endpoint and we wrote about that study here.
Peritoneal Mesothelioma
Immunotherapy/Angiogenesis in Peritoneal Mesothelioma
A new approach of anti-PD1 immunotherapy (atezolizumab) combined with bevacizumab (an agent that blocks growth of new blood vessels therefore limiting the supply of oxygen to the tumor), was tested in a Phase 2 clinical trial for patients with malignant peritoneal mesothelioma. The study (A phase II trial of atezolizumab and bevacizumab in patients with relapsed/refractory and unresectable malignant peritoneal mesothelioma), enrolled 20 patients, of which 7 responded to treatment. The 1-year overall survival was 79%. At 1-year, in 59% of patients’ disease didn’t progress. Hypertension and anemia were two most common adverse events. Peritoneal mesothelioma occurs in 10% to 15% of all mesothelioma cases – for this reason, research into this type of mesothelioma is extremely rare.
The Mesothelioma Applied Research Foundation is the only 501(c)(3) nonprofit organization working to eradicate mesothelioma and end this national tragedy. Its programs include the funding of promising and peer-reviewed research, education, support and advocacy. The organization strives to bring together thought-leaders in the field to identify the most direct path to a cure.
