A collaborative clinical trial involving three of America’s leading cancer centres could change the surgical treatment of pleural mesothelioma.
Researchers at the Sidney Kimmel Cancer Center at John Hopkins University, MD Anderson Cancer Center at the University of Texas and Greenebaum Cancer Center at the University of Maryland are hoping that their work will make surgical resection of mesothelioma more effective.
There are two surgeries that are eligible for the study, pleurectomy and decortication or extrapleural pneumonectomy surgery.
Pleurectomy and decortication involves a surgeon opening the chest cavity and removing the lining of the lung(s) and then removing all visible tumours from the surface of the lung and the chest cavity.
Extrapleural pneumonectomy (EPP) surgery removes the lining of the heart and lungs, parts of the diaphragm and in some cases, lymph nodes. All visible tumours and cancerous tissues are removed, this can include an entire diseased lung. Once removed, the linings and diaphragm are reconstructed using medical grade mesh lining. In some cases, heated intrapleural chemotherapy is used before reconstruction to target any remaining cancer cells.
Eligible types of mesothelioma
The study is including patients with epithelioid or biphasic cell type mesothelioma. Patients with sarcomatoid mesothelioma are not eligible for the study.
Opdivo and Yervoy
The study is hoping to measure the safety and efficacy of two immunotherapy drugs, Opdivo (nivolumab) and Yervoy (ipilimumab). Both drugs are known to be immune checkpoint inhibitors. They work in similar ways but each targets a different surface protein, this negates their effectiveness and so stops the tumours from growing.
Currently, neither of these drugs have been approved by the US Food and Drug Administration for the treatment of mesothelioma however they have shown effectiveness on their own, without surgery, for a small percentage of mesothelioma patients.
The lead researcher, Dr Patrick Forde, is a thoracic oncologist at Johns Hopkins University and is hopeful the study will produce good results, “The study is building on work already done for other cancers. Initial results in other cancers, such as breast and lung cancer, have been promising with this approach.”
The study hopes to look at 15 patients having Opdivo prior to surgery and a further 15 having Opdivo and Yervoy.
The Opdivo will be administered three times, 42, 28 and 14 days prior to surgery whereas the Yervoy will be administered just once, 42 days prior to surgery. After surgery, participants in the study will be able to receive regular immunotherapy treatments for up to a year, or until their disease begins to progress. They will also have the option of standard chemotherapy before and/or after their surgery, as well as receiving the immunotherapy drugs.
Forde said; “We know from other cancers that giving immunotherapy prior to surgery has been shown to lead to regression of the tumour and infiltration of the immune system attacking the cancer. We know from other cancers that it can be effective.”
We look forward to the results of this study and hope that it can help in providing effective treatment to mesothelioma patients.
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ClinicalTrials.gov. (2019, October 18). Neoadjuvant Immune Checkpoint Blockade in Resectable Malignant Pleural Mesothelioma.
Retrieved from: https://clinicaltrials.gov/ct2/show/NCT03918252
Forde, P. et al. (2017, August 25). Pre-Op Delivery of Checkpoint Inhibitor Shrinks Tumors in Nearly Half of Patients. Retrieved from: https://journals.lww.com/oncology-times/Fulltext/2017/08251/Pre_Op_Delivery_of_Checkpoint_Inhibitor_Shrinks.13.aspx