Immunotherapy and radiation therapy may have a synergistic effect on one another. For people with malignant mesothelioma, this is a source of hope.
Two new clinical trials are testing mesothelioma immunotherapy and radiation therapy together. Both were introduced on the U.S. National Library of Medicine clinical trials website within the last six weeks, so neither is recruiting patients as of yet.
Both should be popular among people with unresectable malignant pleural mesothelioma.
The first is at Memorial Sloan Kettering Cancer Center in New York City. It pairs intensity-modulated pleural radiation therapy with Keytruda, the brand name for the immunotherapy drug pembrolizumab.
The second is at the Mayo Clinic in Rochester, Minnesota. It tests stereotactic body radiation therapy with multiple immune checkpoint inhibitors.
If you’re interested in treating your mesothelioma with immunotherapy and radiation therapy, contact our registered nurse Karen Ritter. She can put you in touch with those running these clinical trials or another study. Email her at firstname.lastname@example.org.
Memorial Sloan Kettering Cancer Center Trial: Keytruda With Radiation Therapy
The study at Memorial Sloan Kettering Cancer Center will enroll 24 patients. They must have an unresectable (no surgery possible) case of malignant pleural mesothelioma. Patients who had radiotherapy or immunotherapy previously cannot join the trial.
Intensity‑modulated pleural radiation therapy (IMPRINT) is a type of radiation therapy. It attempts to avoid healthy tissue and focus solely on damaged cancerous cells in the pleura and near the lungs.
Keytruda is a popular immunotherapy drug. It was approved by the U.S. Food and Drug Administration (FDA) for a small subset of people with malignant pleural mesothelioma.
Doctors will analyze for a maximum tolerable dose of radiation therapy. There’s a starting dose, which can increase up to two times. Each patient will receive five fractions of each dose, with the treatment lasting up to six months. The dose will stop increasing when a patient experiences grade 2 or higher pneumonitis (lung scarring).
Along with radiation therapy, patients will receive a fixed dose of 200mg of Keytruda intravenously every three weeks.
Mayo Clinic Trial: Stereotactic Radiation With Immunotherapy Drugs
The study at Mayo Clinic has room for 20 participants with malignant pleural mesothelioma. The primary focuses will be overall survival, quality of life assessment and T‑cell receptor analysis.
The last focus is linked to a type of immunotherapy drugs called immune checkpoint inhibitors. These drugs “take the brakes off” of T‑cells, which are the immune system’s front‑line defenders. Mesothelioma cells hit the T‑cells brakes with the PD‑L1 and B7 proteins. Immune checkpoint inhibitors like Opdivo (nivolumab) and Yervoy (ipilimumab) block these proteins.
The FDA approved Opdivo and Yervoy for mesothelioma in October 2020. They’re approved for unresectable cases of pleural mesothelioma.
Stereotactic body radiation is a unique type of radiation therapy. It requires special patient positioning to deliver precise radiation beams at a tumor. The dose of radiation is split into several smaller doses over a few days.
Stereotactic radiation is used for brain tumors due to the hyper‑focused delivery. It may benefit patients with pleural mesothelioma since it can avoid damage to lung tissue.
In the Mayo Clinic study, patients will receive 3‑5 fractions of stereotactic radiation each day. The medical oncologist overseeing treatment will determine the specific drugs and dosage of immunotherapy for the patient.
This isn’t the first trial to test stereotactic radiation therapy with immunotherapy for malignant mesothelioma. A trial at Memorial Sloan Kettering Cancer Center pairs stereotactic radiation with avelumab, another checkpoint inhibitor. The study opened in 2018 and is ongoing.
“It is thought that radiation treatment may create a form of ‘vaccine’ against cancer inside the body and immunotherapy may improve this effect,” the Memorial Sloan Kettering study description reads. “The combination of radiation treatment and immunotherapy may be more effective against cancer than either radiation or immunotherapy alone.”
Sources & Author
- A Study of Pembrolizumab and Radiation Therapy in People With Mesothelioma. Clinicaltrials.gov. Retrieved from: https://clinicaltrials.gov/ct2/show/NCT04897022. Accessed: 06/24/2021.
- Stereotactic Body Radiation Therapy With Immunotherapy for the Treatment of Mesothelioma. Clinicaltrials.gov. Retrieved from: https://clinicaltrials.gov/ct2/show/NCT04926948. Accessed: 06/24/2021.
- Stereotactic Body Radiation Therapy and Avelumab Immunotherapy for Treatment of Malignant Mesothelioma. Clinicaltrials.gov. Retrieved from: https://clinicaltrials.gov/ct2/show/NCT03399552. Accessed: 06/24/2021.
Sources & Author