Written By: David Statman

Immunotherapy for Mesothelioma

Mesothelioma immunotherapy is a type of mesothelioma treatment that helps the patient’s immune system fight cancer. The FDA has approved immunotherapy for mesothelioma, which gives another option to patients ineligible for surgery.

AI Summary of Immunotherapy for Mesothelioma

Immunotherapy for mesothelioma is a treatment approach that aims to help the body’s immune system recognize and fight mesothelioma cancer cells more effectively. Approved by the FDA in 2020, drugs like Opdivo and Yervoy have shown to extend survival times for patients with advanced, inoperable mesothelioma. This form of treatment offers new hope since it uses the body's natural defenses rather than toxins, often resulting in fewer and less severe side effects compared to traditional therapies like chemotherapy.

Important Facts About Immunotherapy for Mesothelioma

Mesothelioma immunotherapy helps the immune system attack mesothelioma tumors. Doctors use specific drugs or make genetic changes to the patient’s own cells to activate the immune system against mesothelioma.
The FDA approved the mesothelioma immunotherapy drugs Opdivo (nivolumab) and Yervoy (ipilimumab) in 2020 as a first-line treatment for unresectable pleural mesothelioma.
Immunotherapy has helped improve survival times for people with mesothelioma. In clinical trials, patients treated with Opdivo and Yervoy had a median survival of 18.1 months, compared to 14.1 months compared to chemotherapy alone.

How Mesothelioma Immunotherapy Works

Mesothelioma immunotherapy helps the patient’s immune system fight mesothelioma. Therapies accomplish this by improving the immune system’s ability to identify and attack mesothelioma tumor cells.

Cancer and the Immune System

The immune system is a complex network of cells, tissues, and organs. It is responsible for defending the body against diseases, infections, and harmful invaders such as bacteria, viruses, and other pathogens. It identifies and destroys anything it recognizes as foreign or harmful. However, cancers like mesothelioma pose a significant challenge to the immune system due to their unique characteristics.

Cancer develops when normal cells undergo genetic mutations, causing them to grow and divide uncontrollably. Over time, these abnormal cells form a mass known as a tumor. In mesothelioma, these tumors typically develop in the lining of the lungs, abdomen, or heart due to prolonged exposure to asbestos.

What makes cancer particularly difficult for the immune system to combat is it originates from the body’s own cells. Since these mutated cells are derived from healthy tissue, they often retain many characteristics of normal cells.

The immune system relies on certain markers, or antigens, to distinguish between known and unknown. Because cancer cells share most of the same markers as healthy cells, the immune system struggles to differentiate between the two. This allows the cancerous cells to go unnoticed and unchecked.

Adding to the challenge, cancer cells can actively suppress the immune system. They release chemical signals that create an environment where immune cells are less effective, or they exploit immune checkpoints — mechanisms the body uses to prevent autoimmune responses (attacking healthy cells instead of foreign invaders) — to avoid being targeted.

As a result, cancers like mesothelioma can grow and spread without significant interference from the immune system. This unchecked growth can lead to metastasis, where cancer spreads to other parts of the body, making the disease more difficult to treat.

CREATING NEW TREATMENTS WITH RESEARCH

Understanding how the immune system interacts with cancer has paved the way for innovative treatments like immunotherapy. These therapies are designed to overcome the immune system’s blind spots, empowering it to recognize and attack cancer cells effectively.

This offers new hope to patients with mesothelioma and other challenging cancers.

Activating the Immune System Against Mesothelioma

Immunotherapy is a type of mesothelioma treatment that activates the immune system to fight cancer. Immunotherapy tells the immune system how to identify mesothelioma cells in the body and distinguish them from healthy cells.

There are a few ways immunotherapy can be used to help the immune system fight mesothelioma. Some examples are:

Block certain characteristics that help mesothelioma cells hide from immune system detection
Use genetic engineering to train the immune system to look for and attack mesothelioma cells
Act as a magnet to attach immune system cells to mesothelioma cells
Use modified viruses to infect and kill mesothelioma cells, and alert the immune system

Explaining How Immunotherapy Works

Immune cells not recognizing cancer cells

Step 1. Immune cells don’t recognize cancerous cells as a threat, which allows them to replicate and spread.

Immunotherapy alerting the immune system to cancer cells

Step 2. Immunotherapy attaches to and kills cancerous cells, which alarms the immune system.

Immune cells recognizing cancer antigens

Step 3. The patient’s immune cells recognize cancerous antigens and target cells with similar antigens.

Immune cells targeting remaining cancer cells

Step 4. The patient’s immune cells seek out the remaining cancerous cells, leaving healthy cells unharmed.

Types of Immunotherapy for Mesothelioma

Types of mesothelioma immunotherapy are checkpoint inhibitors, adoptive cell therapy, monoclonal antibodies and oncolytic viruses.

Learn more about the different types of immunotherapy and how they help your immune system fight mesothelioma.

1 Checkpoint Inhibitors

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Checkpoint inhibitors are a specialized form of immunotherapy that empowers the immune system to better detect and destroy cancer cells. They target specific proteins used by cancer cells to evade the immune response, particularly T cells, which play a central role in defending the body against disease.

Cancer cells exploit natural immune checkpoints — mechanisms the immune system uses to avoid attacking healthy cells — to avoid detection. These checkpoints involve proteins on the surface of T cells and cancer cells. Proteins on cancer cells – such as PD-L1 and B7 – bind to corresponding proteins on T cells, like PD-1 and CTLA-4, effectively “turning off” the T cells’ ability to recognize and attack the cancer.

EXAMPLES OF CHECKPOINT INHIBITORS

Opdivo (nivolumab) — targets PD-1 and PD-L1
Yervoy (ipilimumab) — targets CTLA and B7
Keytruda (pembrolizumab) — targets PD-1 and PD-L1
Imfinzi (durvalumab) — targets PD-1 and PD-L1
Tecentriq (atezolizumab) — targets PD-1 and PD-L1

Opdivo, Yervoy, and Keytruda are approved for the treatment of pleural mesothelioma. The others are still in clinical trial testing.

2 Adoptive Cell Therapy

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Adoptive cell therapy is a method of genetically changing cells of the immune system to help them fight cancer. Scientists can alter T cells and other immune system cells to direct them to look for cancer cells.

An example of adoptive cell therapy is CAR T-cell therapy. This type of immunotherapy is called cell and gene therapy. Scientists genetically engineer the patient’s T cells to look for cancer cells carrying a specific protein. For mesothelioma, the CAR T cells are engineered to target the protein mesothelin, which is found on the surface of mesothelioma cells.

The patient’s T cells are collected from their blood and genetically modified in a laboratory to more effectively target the patient’s cancer. These new and improved T cells are multiplied and returned to the patient’s blood to begin attacking the disease.

CAR T-cell therapy has shown remarkable success in treating certain blood cancers, such as leukemia and lymphoma, and researchers are actively exploring its potential for solid tumors like mesothelioma. While it is a complex and resource-intensive treatment, CAR T-cell therapy represents a breakthrough in personalized cancer care, offering hope for patients with aggressive or treatment-resistant cancers like mesothelioma.

CAR T-cell therapy for mesothelioma is in clinical trial testing.

3 Monoclonal Antibodies

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Monoclonal antibodies are a type of immunotherapy that enhances the immune system’s ability to recognize and attack cancer cells by targeting specific proteins. These lab-engineered antibodies are designed to bind to protein receptors found on the surface of cancer cells or immune cells, such as T cells.

By doing so, they serve as a bridge, effectively marking the cancer cells for destruction and facilitating an immune response. In mesothelioma treatment, monoclonal antibodies can also block signals that cancer cells use to grow and spread, or deliver toxic substances directly to the cancer cells.

EXAMPLES OF MONOCLONAL ANTIBODIES FOR MESOTHELIOMA

LMB-100, which targets mesothelin, a protein commonly overexpressed in mesothelioma
Ramucirumab, which inhibits the VEGFR-2 protein involved in blood vessel formation, cutting off a tumor’s blood supply
Anetumab ravtansine, which combines monoclonal antibody with a toxin to specifically kill mesothelin-expressing cancer cells

These therapies are currently being tested in clinical trials and represent a growing area of hope for patients with mesothelioma.

4 Oncolytic Viruses

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Oncolytic viruses are modified versions of viruses – such as the herpes simplex virus – used to infect cancer cells. Oncolytic viruses are engineered to infect only cancer cells while ignoring healthy cells, which keeps patients safe.

By infecting cancer cells, the virus causes the cancer cells to die and release certain proteins, which are called antigens. The release of these antigens acts as a distress signal, alerting the immune system and prompting it to identify and attack other cancer cells bearing the same proteins.

By combining direct tumor destruction with the activation of an anti-cancer immune response, oncolytic viruses represent a dual-action therapy with significant potential. They are being actively researched for various cancers, including mesothelioma, and have shown promise in early clinical trials as a powerful tool in the fight against aggressive tumors.

ONCOS-102 is an example of an oncolytic virus for mesothelioma. It is currently in clinical trial testing.

Who Can Receive Immunotherapy for Mesothelioma?

People can receive immunotherapy for mesothelioma either through an FDA approval or enrollment in a clinical trial.

People with malignant pleural mesothelioma may be eligible for immunotherapy through an FDA approval. Eligibility depends on whether the patient can have surgery or not.

Clinical trials are another option for patients, including people with malignant peritoneal mesothelioma. These studies test novel immunotherapies on their own or in combination with other treatment options, including surgery and chemotherapy.

Each clinical trial has specific enrollment criteria that patients must meet. The criteria usually accepts patients based on their stage, cell type, and treatment history.

FDA Approvals of Mesothelioma Immunotherapy

The three mesothelioma immunotherapy drugs with FDA approvals are:

Opdivo (nivolumab)
Yervoy (ipilimumab)
Keytruda (pembrolizumab)

All three are approved by the U.S. Food and Drug Administration (FDA) for unresectable malignant pleural mesothelioma. “Unresectable” is the medical term for when surgery is not an option.

In 2020, the FDA approved Opdivo and Yervoy for mesothelioma for use together. In 2024, the FDA approved Keytruda for mesothelioma in combination with chemotherapy.

“I think the dual immunotherapy protocol of Opdivo and Yervoy is one of the best innovations in mesothelioma treatment. It used to be that all you had was surgery. We’d do it and there wasn’t another avenue. I’m not a believer in a single bullet for cancer.”

<a href="https://www.mesotheliomaguide.com/doctors/dr-daniel-labow/">Dr. Daniel Labow</a>

Mesothelioma Specialist

Benefits of Immunotherapy for Mesothelioma

The main benefit of immunotherapy for mesothelioma is the treatment’s ability to activate the patient’s own immune system against cancer. This can control the disease and even put patients into remission.

“We know cancer is a disease of genetic mutations,” says Dr. Ezra Cohen, of the University of California San Diego Health, “and some of those mutations are revealed to the immune system through immunotherapy.”

Dr. Ezra Cohen

University of California San Diego Health

Immunotherapy also differs significantly from chemotherapy. Immunotherapy does not pour toxins into the patient’s body. Patients usually experience much fewer and less severe side effects from immunotherapy than chemotherapy.

Success Rates of Mesothelioma Immunotherapy

The success rates of mesothelioma immunotherapy are promising. The average mesothelioma survival for people receiving FDA-approved immunotherapy drugs is approximately 19 months.

75% of patients live for at least one year after they begin treatment

41% of patients live for at least two years after they begin treatment

23% of patients live for at least three years after they begin treatment

These survival rates are significantly better than those associated with chemotherapy.

The FDA approval of Opdivo and Yervoy came after the immunotherapy combination outperformed chemotherapy in a large clinical trial. Opdivo and Yervoy gave patients a median survival of 18.1 months. Chemotherapy was attributed with a median survival of 14 months.

“When we see differences of 2-5 months, we think it’s a huge deal,” says Dr. Raja Flores, a mesothelioma specialist at Mount Sinai Health System.

Mesothelioma Immunotherapy and Long-Term Survival

Some people are achieving long-term cancer remission thanks to mesothelioma immunotherapy:

A 74-year-old woman credits her 12-month anti-tumor response to Opdivo and Yervoy.
A 59-year-old man with mesothelioma has been cancer-free since 2021 thanks to Keytruda.
A 67-year-old man with mesothelioma has been cancer-free since 2018 thanks to Keytruda.

These success stories of long-term survival from mesothelioma immunotherapy deserve to be highlighted. Yet, patient expectations should be tempered. Long-term survival (five or more years) is rare without surgery.

Immunotherapy for Biphasic and Sarcomatoid Mesothelioma Cell Types

Immunotherapy can be especially beneficial for mesothelioma patients diagnosed with the biphasic or sarcomatoid cell types. These cell types are rarer and can be especially difficult to treat with surgery.

Chart showing 76.2% one-year survival rate for biphasic and sarcomatoid mesothelioma patients after immunotherapy

In a study of 179 people with mesothelioma, patients with biphasic and sarcomatoid cell types had a 1-year survival rate of 76.2% after immunotherapy. The 1-year survival rate is much lower for people who did not receive immunotherapy.

Side Effects of Mesothelioma Immunotherapy

The side effects of mesothelioma immunotherapy are usually manageable, especially compared to chemotherapy. The main side effects of mesothelioma immunotherapy are:

Fatigue

Nausea

Constipation/
Diarrhea

Coughing

Joint Pain

Decreased
Appetite

SOME PATIENTS MAY ALSO EXPERIENCE ALLERGIC REACTIONS TO IMMUNOTHERAPY

Itching/Rash
Fever
Chills
Decreased appetite
Dizziness
Wheezing
Flushing of the face

Patients should report any side effects immediately to their doctor.

Where Patients Can Receive Mesothelioma Immunotherapy

Patients can receive mesothelioma immunotherapy at mesothelioma cancer centers of excellence. These cancer centers are located throughout the United States. These treatment centers can also work with a local facility to direct immunotherapy treatment so patients can remain close to home to receive their therapy.

The treatment centers follow official protocol to provide mesothelioma immunotherapy to patients who are eligible through an FDA approval or a clinical trial.

Mesothelioma Cancer Centers for Immunotherapy Treatment

Below are examples of mesothelioma cancer centers offering immunotherapy treatment or directing treatment with local treatment facilities:

Dana-Farber Cancer Institute Brigham and Women’s Hospital (Boston, Massachusetts)
Dan L. Duncan Comprehensive Cancer Center at Baylor St. Luke’s Hospital (Houston, Texas)
Mayo Clinic (Rochester, Minnesota)
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Medicine (Baltimore, Maryland)
Swedish Cancer Institute (Seattle, Washington)

What Is the Cost of Mesothelioma Immunotherapy?

The cost of mesothelioma immunotherapy can be expensive, but health insurance plans usually cover a portion of this cancer treatment.

It is important to be knowledgeable of your medical insurance plan and understand your deductible, out-of-pocket maximum, in-network providers, and more. You should also keep track of medical records and bills to ensure you receive appropriate insurance coverage.

Clinical trials are one way to offset the cost of treatment. Many of the costs of immunotherapies are covered by the hospital or the manufacturing company sponsoring the trial. Talk with your mesothelioma specialist for more information about the clinical trials at cancer centers.

Future of Mesothelioma Immunotherapy

The future of mesothelioma immunotherapy is promising. Experts expect more immunotherapy treatments to advance through development and testing. They also hope that more personalized approaches to cancer treatment means more options and better access for patients.

EXAMPLES OF MESOTHELIOMA IMMUNOTHERAPY THAT COULD EMERGE AS EFFECTIVE TREATMENT OPTIONS

Imfinzi (durvalumab)
Tecentriq (atezolizumab)
CAR T-cell therapy
Oncolytic viruses

Patients may also benefit from future advancements in using immunotherapy with other mesothelioma treatment options, such as surgery. A study of 179 patients tested several combinations of mesothelioma treatment. Immunotherapy with surgery and chemotherapy performed the best: median survival of 22.6 months.

Frequently Asked Questions About Immunotherapy for Mesothelioma

What immunotherapy drugs are approved for mesothelioma?

The immunotherapy drugs approved for mesothelioma are Opdivo, Yervoy and Keytruda. The U.S. Food and Drug Administration (FDA) approved Opdivo and Yervoy for unresectable malignant pleural mesothelioma. Opdivo and Yervoy are approved for use as a combination. Keytruda is approved for unresectable malignant pleural mesothelioma in combination with chemotherapy.

How does immunotherapy treat mesothelioma?

Immunotherapy treats mesothelioma by helping the immune system look for and attack cancer cells. The immune system struggles to tell the difference between cancer cells and healthy cells. Immunotherapy activates the immune system against cancer by looking for specific proteins on the surface of mesothelioma cells.

What are the side effects of immunotherapy for mesothelioma?

The side effects of immunotherapy for mesothelioma are: fatigue, coughing, nausea, decreased appetite, constipation, joint pain, and diarrhea. Most patients won’t experience all of these side effects, and are often manageable with medication. More serious side effects include allergic reactions to the therapy, resulting in itching, rash, wheezing, or flushing of the face.

What is the average mesothelioma prognosis for people receiving immunotherapy?

The average mesothelioma prognosis for people receiving immunotherapy is 1-2 years. In a large study of nearly 600 people with mesothelioma treated with the immunotherapy drugs Opdivo and Yervoy, the average survival time was 18.1 months. This average survival time is better than that of chemotherapy. Some patients have achieved long-term survival of more than three years thanks to immunotherapy.

Where can people go for mesothelioma immunotherapy treatment?

People can go to cancer centers or local medical facilities for mesothelioma immunotherapy treatment. Mesothelioma Guide recommends going to a top mesothelioma cancer center first to learn all your treatment options and discuss your immunotherapy treatment plan with a mesothelioma specialist. Some of the top mesothelioma cancer centers are:

Dana-Farber Cancer Institute Brigham and Women’s Hospital (Boston, Massachusetts)
Mayo Clinic (Rochester, Minnesota)
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Medicine (Baltimore, Maryland)

Sources & Author

FDA approves nivolumab and ipilimumab for unresectable malignant pleural mesothelioma. National Library of Medicine. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/33206991/. Accessed: 09/11/2024.
FDA approves pembrolizumab with chemotherapy for unresectable advanced or metastatic malignant pleural mesothelioma. U.S. Food and Drug Administration. Retrieved from: https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-pembrolizumab-chemotherapy-unresectable-advanced-or-metastatic-malignant-pleural. Accessed: 09/18/2024.
Immunotherapy for Malignant Mesothelioma. American Cancer Society. Retrieved from: https://www.cancer.org/cancer/types/malignant-mesothelioma/treating/immunotherapy.html. Accessed: 09/11/2024.
Major response of a peritoneal mesothelioma to nivolumab and ipilimumab: a case report, molecular analysis and review of literature. Frontiers in Oncology. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/39091916/. Accessed: 08/06/2024.
A Complete Response to Pembrolizumab in Malignant Peritoneal Mesothelioma: A Case Report. National Library of Medicine. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/38384604/. Accessed: 02/26/2024.
Case report: complete response and long-term survival on third-line immunotherapy in patient with pleural mesothelioma. Frontiers in Oncology. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/39267830/. Accessed: 09/16/2024.
Efficacy and safety of nivolumab with ipilimumab for recurrent malignant pleural mesothelioma after primary surgical intervention. International Journal of Clinical Oncology Retrieved from https://pubmed.ncbi.nlm.nih.gov/36609928/. Accessed: 09/11/2024.
Advances in Immunotherapy of Malignant Pleural Mesothelioma. Onco Targets and Therapy. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8374846/. Accessed: 09/11/2024.
Opdivo (nivolumab) Plus Yervoy (ipilimumab) Demonstrates Durable Overall Survival at Three Years Compared to Chemotherapy in First-Line Unresectable Malignant Pleural Mesothelioma in Phase 3 CheckMate -743 Trial. Bristol Myers Squibb. Retrieved from: https://news.bms.com/news/details/2021/Opdivo-nivolumab-Plus-Yervoy-ipilimumab-Demonstrates-Durable-Overall-Survival-at-Three-YearsCompared-to-Chemotherapy-in-First-Line-Unresectable-Malignant-Pleural-Mesothelioma-in-Phase-3-CheckMate–743-Trial/default.aspx. Accessed: 09/14/2021.
The cost of cancer: new drugs show success at a steep price. Reuters. Retrieved from: https://www.reuters.com/article/us-usa-healthcare-cancer-costs/the-cost-of-cancer-new-drugs-show-success-at-a-steep-price-idUSKBN1750FU. Accessed: 04/20/2021.
Multimodal Therapy Survival in Malignant Pleural Mesothelioma Patients. Physician’s Weekly. Retrieved from: https://www.physiciansweekly.com/multimodal-therapy-survival-in-malignant-pleural-mesothelioma-patients/. Accessed: 09/17/2024.

About the Writer, David Statman

David Statman is a Content Writer for Mesothelioma Guide. He received both his bachelor's and master's in journalism from West Virginia University, and has been in medical publishing since January 2022. He previously worked in sports journalism, primarily reporting on West Virginia sports for a number of publications.

He lives in Delaware with his wife, dog and two cats, and avidly competes as a professional wrestler in the Philadelphia area.