Immunotherapy likely will be a standard treatment for mesothelioma in the future. The lingering question is how long we have to wait for the first drug to receive FDA approval.
One immunotherapy drug, durvalumab, is inching closer to that goal.
Durvalumab is getting support to enter a phase 3 mesothelioma clinical trial. The results from the phase 2 DREAM study show significant survival improvement for pleural mesothelioma patients when durvalumab is paired with chemotherapy. The news is a massive triumph for advocates of mesothelioma immunotherapy.
According to the American Association for the Advancement of Science, the median overall survival was 20.4 months. This result was compared with historical mesothelioma survival data for just chemotherapy (cisplatin plus pemetrexed), which had a median survival of 12.1 months.
Dr. Patrick Forde, the lead investigator in the study, championed the combination of chemotherapy and immunotherapy. Dr. Forde is also the director of the Johns Hopkins Medicine thoracic cancer clinical research program.
“The data signal us to move forward with a phase 3 study,” he said.
How the Durvalumab Phase 2 Study Worked
The study included 55 participants, who enrolled at one of 15 U.S. clinical sites from June 2017 to June 2018. They received the combination of cisplatin, pemetrexed and durvalumab once every three weeks for up to six cycles.
Patients who expressed either stable disease or partial response could continue receiving durvalumab. Most were able to maintain the treatment:
- 31 of the 55 (56.4%) had a partial response, meaning their mesothelioma regressed.
- 22 of the 55 (40%) had a stable disease, meaning it did not shrink or grow.
- Only one patient’s disease progressed.
The study included any mesothelioma cell type, which is even more reason for hope. Most mesothelioma trials only involve patients with either epithelioid or biphasic cell types — excluding sarcomatoid mesothelioma.
Epithelioid mesothelioma usually has a better prognosis and is easier to treat than sarcomatoid mesothelioma. Biphasic mesothelioma is a mix of both cell types.
Studies often exclude sarcomatoid mesothelioma to improve survival results and ensure help for epithelioid patients, who comprise more than half of mesothelioma cases. That this durvalumab study included sarcomatoid mesothelioma — and still succeeded — is significant news.
Other notable, promising statistics include:
- A one-year mesothelioma survival rate of 70.4%
- A two-year survival rate of 44.2%
- 69.1% of patients had progression-free survival at six months
- 10.9% progression-free survival (no disease growth) at two years
- No patients experienced unexpected toxicities, and adverse effects were mild, meaning the treatment is safe
What Is Durvalumab?
Durvalumab, known by the brand name Imfinzi, is an immunotherapy drug that blocks the effects of cancer protein PD-L1. In medical terms, durvalumab is considered a “PD-L1 blockade agent”. The drug strengthens the immune system’s ability to detect cancers like mesothelioma.
PD-L1 is a protein with high expression in mesothelioma cells. The protein’s receptor communicates with the PD-1 protein receptor, which is on the body’s immune system T-cells. When the two receptors link, the mesothelioma cells trick the T-cells into thinking it’s harmless.
Durvalumab — along with fellow immunotherapy drugs nivolumab and pembrolizumab — blocks the receptors’ communication. Without the ability to misinform the T-cells, the mesothelioma cells are now vulnerable to detection. The immune system can then kill the infected cells.
If you’d like more information about durvalumab, a potential phase 3 clinical study or other mesothelioma research efforts, we can help. Our patient advocate and registered nurse, Jenna Campagna, can answer your questions. Email her at firstname.lastname@example.org.
Show Sources & Author
- Durvalumab added to standard chemotherapy improved overall survival in mesothelioma. American Association for the Advancement of Science. Retrieved from:
https://eurekalert.org/pub_releases/2020-05/ecrg-dat052020.php. Accessed: 05/21/2020.
- Phase III Study of Pemetrexed in Combination With Cisplatin Versus Cisplatin Alone in Patients With Malignant Pleural Mesothelioma. Journal of Clinical Oncology. Retrieved from:https://pubmed.ncbi.nlm.nih.gov/12860938/. Accessed: 05/21/2020.
- Patrick Forde, M.B.B.Ch. Johns Hopkins Medicine. Retrieved from:
https://www.hopkinsmedicine.org/profiles/results/directory/profile/0554010/patrick-forde. Accessed: 05/21/2020.