The University of Pittsburgh Medical Center is testing a new immunotherapy approach in a clinical trial geared toward treating patients with malignant peritoneal mesothelioma.

Peritoneal mesothelioma, a cancer of the abdominal lining caused by asbestos, only accounts for roughly a fifth of all cases of mesothelioma, so there are relatively few clinical trials for this disease.

The name of the clinical trial is a mouthful for anyone: “aDC1 Vaccine + Chemokine Modulatory Regimen (CKM) as Adjuvant Treatment of Peritoneal Surface Malignancies.”

So what does this mean? Here’s the breakdown:

  • aDC1 vaccine – This is a novel cancer drug that activates cells in the immune system so they can attack mesothelioma cells.
  • Chemokine modulatory regimen (CKM) – CKM is a combination of three immunotherapy drugs that work with specialized white blood cells to kill mesothelioma cells.
  • Adjuvant treatment – This refers to secondary treatment designed to keep cancerous cells from returning after an initial treatment.

Dr. Pawel Kalinski of UPMC developed this treatment and even personally sponsored the trial.

“We have recently developed a new platform of vaccination against cancer and established infections, utilizing alpha-type-1-polarized dendritic cells (aDC1s) that instruct the immune system to treat tumors as virally-infected tissues,” Dr. Kalinski says on his website.

But cancer vaccines, a form of immunotherapy, like the one in this trial aren’t like preventative vaccines that are used to preclude diseases like measles. Instead, cancer vaccines inspire an immune response against cancerous cells already present in the body, which is why these drugs can be an effective treatment for diseases like mesothelioma that take decades to develop.

An Immunotherapy Cocktail for Mesothelioma

Although the title of this clinical trial gives the impression that there are two drugs used to treat participants in the study, there are actually four different drugs involved.

The first is an alpha-DC1 vaccine that initiates a reaction amongst dendritic cells. Dendritic cells are responsible for signaling hunter T-cells in the immune system. The aDC1 vaccine essentially alerts T-cells to the presence of mesothelioma cells in the body, allowing the T-cells to eliminate the cancerous cells.

The chemokine modulation regimen (CKM) is a combination of three drugs: celecoxib, interferon alpha-2b and rintatolimod. Chemokines are substances that draw white blood cells toward cancerous cells. Each of these drugs are immunotherapy drugs that work with aDC1 to fight mesothelioma.

These drugs will hopefully become an effective form of adjuvant treatment for peritoneal mesothelioma.

Adjuvant treatments are those used after primary treatments to keep cancerous tumors suppressed. In this clinical trial, the goal of the aDC1 and CKM immunotherapies are to prevent mesothelioma from returning after patients have surgery to remove the tumors.

“Our latest research led to the identification of a new class of “combinatorial adjuvants” that selectively induce pro-inflammatory cytokines and chemokines (rather than suppressive factors) within tumor lesions, without affecting healthy marginal tissues, and counteract tumor-associated immunosuppression,” Dr. Kalinski said.

Who Is Eligible?

This treatment is intended to prolong the survival of patients who had cytoreductive surgery with heated intraperitoneal chemotherapy (HIPEC). This surgery is used to remove any visible tumors in the abdomen while HIPEC is used to kill any microscopic mesothelioma cells that can’t be removed surgically. This treatment alone has led to impressive survival times in patients with peritoneal mesothelioma; many patients are living more than five years after having this surgery.

Any patients who have been treated with cytoreduction and HIPEC may be considered eligible for this clinical trial.

In order for mesothelioma patients to be eligible for this trial, they must also:

  • Have not received prior immunotherapy treatments in the past three weeks
  • Have healthy heart function
  • Not be allergic to non-steroidal anti-inflammatory drugs

The purpose of the adjuvant immunotherapy treatment is to keep the mesothelioma at bay and hopefully generate a long-term, disease-free survival.

“We have evaluated a similar (although older) combination of aDC1 vaccine [plus] adjuvant in our trial in brain cancer…with very impressive results,” Dr. Kalinski told Mesothelioma Guide. “Overall more than 70 patients with different cancers have been treated with aDC1s so far.”

If this trial is successful, it could be the next big step toward a cure for peritoneal mesothelioma.

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    About the Writer, Andrew Devine

    Andrew Devine is a contributing writer for Mesothelioma Guide. He has developed an interest in educating patients and their families on everything from new treatments to what to expect after diagnosis.