After months of wishful thinking, we’re finally getting clinical trials testing immunotherapy for peritoneal mesothelioma.
Two trials, one at the University of Chicago Comprehensive Cancer Center and one at the National Cancer Institute, will examine the role of immunotherapy for this abdominal type of mesothelioma. Immunotherapy is already a growing staple of treatment for pleural mesothelioma.
Doctors and specialists treating peritoneal mesothelioma have long pointed to trials on the verge of starting. These two are now enrolling patients in phase 2 studies.
The U.S. Food and Drug Administration approved Opdivo and Yervoy for mesothelioma in unresectable cases of the pleural variety, which is in the lining of the lungs. Peritoneal mesothelioma is in the lining of the abdominal cavity. It’s a different disease based on location but has similar qualities, such as high levels of the protein biomarkers mesothelin and PD-L1. Both can be targeted with immunotherapy drugs.
Opdivo and Yervoy Before Surgery at University of Chicago Medicine
Dr. Kiran Turaga leads the trial at University of Chicago Medicine. Dr. Turaga is a surgical oncologist for peritoneal surface malignancies. One of the malignancies he treats is peritoneal mesothelioma.
The study, in phase 2, includes up to 37 spots. Patients receive Opdivo and Yervoy, which are the brand names for nivolumab and ipilimumab, respectively. Patients receive these drugs, called immune checkpoint inhibitors, before and after surgery.
The team will examine the tumor response from immunotherapy treatment, plus the time between treatment and surgery. If patients have disease regression (tumors shrink) and aren’t delayed for surgery, it proves Opdivo and Yervoy are helpful against peritoneal mesothelioma.
The trial was posted online in September and plans to begin recruiting in January of 2022.
Using Immunotherapy Drug Atezolizumab With Anti-VEGF and Chemotherapy
Atezolizumab, another immune checkpoint inhibitor immunotherapy, is the feature of a study at the National Cancer Institute in Bethesda, Maryland. It’s in phase 2 and just published, with recruiting now open for up to 66 spots.
Atezolizumab, like Opdivo and Yervoy, is an anti-PD-L1 drug. While it’s not FDA-approved for pleural mesothelioma, there’s evidence from studies showing it works in controlling the tumor spread and growth.
Atezolizumab inhibits the checkpoint interaction of protein receptors PD-L1 and PD-1. Blocking this checkpoint makes T cells more able to recognize cancer cells as dangerous. This sounds off alarms in the body, which intends to fight the cancer naturally. Without a drug like atezolizumab, the cancer cells grow undetected by the T cells.
The study team will examine a few data points: how many patients advance to surgery after immunotherapy treatment; the completeness of surgery; progression-free survival; overall survival; and number of complications.
Atezolizumab is being paired in the study with mesothelioma chemotherapy and an anti-VEGF drug called bevacizumab. This drug blocks the formation of new blood vessels for cancer cells. Without new blood vessels to send nutrients, the cancer cells suffocate and die. Bevacizumab essentially weakens the cancer cells while atezolizumab alerts the T cells to the danger.
Patients receive atezolizumab for 60 minutes, bevacizumab for 30-90 minutes and chemotherapy drugs carboplatin and pemetrexed for 10-30 minutes, all via an IV. This treatment repeats four times every 21 days.
After 4-8 weeks of treatment ending, patients undergo cytoreductive surgery and HIPEC (hyperthermic intraperitoneal chemotherapy). If patients can’t have surgery, they may continue atezolizumab and bevacizumab treatment.
Sources & Author
- A Study of Immunotherapy Drugs Nivolumab and Ipilimumab in Patients w/Resectable Malignant Peritoneal Mesothelioma. Clinical trials.gov. Retrieved from: https://clinicaltrials.gov/ct2/show/NCT05041062. Accessed: 12/01/2021.
- Chemotherapy With or Without Immunotherapy for Peritoneal Mesothelioma. Clinical trials.gov. Retrieved from: https://clinicaltrials.gov/ct2/show/NCT05001880. Accessed: 12/01/2021.