Mesothelioma is an aggressive cancer caused by exposure to asbestos. The cancer affects the lining of organs and is most commonly found on the lining of the lungs (pleural mesothelioma) and the lining of the abdomen (peritoneal mesothelioma).
Mesothelioma is a notoriously difficult cancer to treat and whilst there are treatment options, there is currently no known cure for the condition. Many patients opt for surgery, chemotherapy or radiotherapy, or a combination of the three. Some patients may receive immunotherapy, some forms of which are not currently available on the NHS but can be accessed privately or through participating in clinical trials.
Chemoresistance
Chemotherapy has been shown to be an effective treatment for many cancers however, for mesothelioma patients, less than half experience a positive response to the treatment. This is called chemoresistance.
A new study from researchers in Switzerland and Germany has presented a theory as to why mesothelioma is often resistant to chemotherapy.
Genetics
There have been many studies into the possible genetic basis for mesothelioma and it may be that genetics also play a part in how patients respond to chemotherapy.
The BAP1 gene has already been linked to an increased risk of developing mesothelioma and some other conditions and those with the mutated BAP1 gene produce less of the BAP1 protein.
Many people with the BAP1 mutation will never know they have it and will not have any issues caused by it and so it is not routinely checked for. Researchers from the University Hospital Zurich in Switzerland and the University Hospital Frankfurt in Germany conducted a retrospective study to see if the BAP1 gene could explain the patients’ response to chemotherapy.
BAP1 and chemoresistance
Looking at the records of patients with pleural mesothelioma who had first-line chemotherapy followed by surgery, they found that patients with a BAP1 mutation or deletion were resistant to chemotherapy.
Treatment options
Whilst research has yet to reveal an effective treatment, knowing whether a patient is likely to respond to chemotherapy before they undergo it is extremely helpful. Chemotherapy can involve undesirable side effects and when deciding to undergo treatment for a terminal condition, patients want to know that the outcome is going to outweigh the side effects. If those with the BAP1 gene mutation are alerted to the likelihood that chemotherapy is unlikely to help before they undergo the often gruelling treatment, they can make a more informed decision on their treatment plan.
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Source:
Oehl, K, et al, “Alterations in BAP1 are Associated with Cisplatin Resistance Through Inhibition of Apoptosis in Malignant Pleural Mesothelioma (MPM)”, February 5, 2021, Online ahead of print, https://clincancerres.aacrjournals.org/content/early/2021/02/04/1078-0432.CCR-20-4037