Mesothelioma is a terrible disease from asbestos exposure. In recent years there are many therapies that are working towards fighting the disease and lengthening life expectancy
IMMUNOTHERAPY
Also known as biotherapy, immunotherapy or biotherapy is treatment that uses parts of the immune system to fight diseases such as cancer. Immunotherapy still plays a fairly minimal role in cancer treatment. For mesothelioma patients, it is only an option in clinical trials but has shown some helpful qualities. When used with other conventional treatments such surgery and chemotherapy, immunotherapy can relieve symptoms and improve survival rates.
CHECKPOINT INHIBITORS
Immune cells determine whether a cell is normal or abnormal. These cells need their specific molecules known as “checkpoints” to be activated or inactivated to trigger the immune response. One of these molecules is a protein called PD-1. When PD-1 on the immune cell interacts with PD-L1 a protein on the normal cell, PD-1 is inactivated and the immune cell knows not to attack the cell. Since some cancer cells can have many PD-L1 proteins on their surface, they can avoid being attacked by the immune system.
Checkpoint inhibitors can help increase the immune response to cancer cells by binding to PD-1 or PD-L1 and prevent them from binding to each other. Immune cells can attack the cancer cells, because the checkpoint is blocked or inhibited. In 2015, the FDA approved PD-1 checkpoint inhibitor nivolumab (Opdivo) for treatment of non-small cell lung cancer. Other checkpoint inhibitors (Keytruda, Tecentriq) have been approved for other cancers, and Keytruda is currently being tested as a mesothelioma treatment.
Monoclonal Antibodies
Monoclonal antibodies target specific proteins nvolved in tumor development, maintenance and their progression. The FDA has approved a few to treat lung cancer. Bevacizumab (Avastin) blocks formation of new blood vessels that support the tumors and ramucirumab (Cyramza) blocks a protein that activates signaling pathways that support tumor vessel growth. Bevacizumab has also been shown to be useful in treating mesothelioma. In fact, the National Comprehensive Cancer Network – a network of 27 of the world’s leading cancer centers – recently updated their guidelines to include bevacizumab as part of a first-line treatment for nonresectable mesothelioma, in combination with chemotherapy. Several others are currently being tested in clinical trials. The work on antibodies such as this continue.
Therapeutic Vaccines
Therapeutic vaccines trigger an immune response against tumor-specific antigens. Vaccines for lung cancer are in clinical trials. These include HyperAcute: a vaccine containing lung cancer cells . TG4010 targets MUC1 and was designed for patients with non-small lung cancers. DPV-001 was designed to target nine cancer antigens and includes an agent that activates toll-like receptors, proteins that contribute to the activation of the immune response.
Adoptive Cell Therapy
In adoptive cell therapy, specific immune cells called T cells are extracted from the patient, modified with chemicals or genetically and injected back into the patient. The modified cells are predicted to enhance the anticancer immune response. While currently not FDA approved for lung cancer, several are in clinical trial.
All of these therapies should be discussed with your doctor and considered to be an option for treatment.