March 16, 2015 – Chemotherapy is often the first line of defense for patients suffering from mesothelioma. Many mesothelioma patients are not eligible for surgery at diagnosis, so chemotherapy is the best option for increased survival rates. Citotoxic therapies have their drawbacks, however, and mesothelioma in particular is resistant to chemotherapy. New research surrounding targeted therapies might help to break through treatment plateaus and allow doctors to personalize mesothelioma treatment plans for patients.
Targeted cancer therapies take a different approach to treating cancer, which may help to avoid some of the challenges with chemotherapy. Whereas chemotherapy aims to kill cancer cells by injecting them with toxic chemicals, researchers are testing methods to block the molecular pathways that allow the cancer to spread. Immunotherapy is also showing promise as a mesothelioma treatment option, bolstering the body’s own immune system to fight cancer.
Targeted Therapies Interfere With Tumor Growth
One of these new targeted therapies, called NGR-hTNF, prevents the growth of new blood vessels in the tumors, which will prevent cancerous cells from receiving oxygen and nutrients. Researchers tested this treatment on 57 patients who had been previously treated with chemotherapy in a phase II clinical trial. The patients had a median survival rate of 12.1 months, and 46% of the 57 patients saw a reduction in tumor size or stable disease. NGR-hTNF will now move to a phase III trial with a much larger patient group. Researchers are hopeful that this will demonstrate its effectiveness in increasing survival rates on its own, or in conjunction with chemotherapy.
Another targeted therapy called ganetespib also aims to starve tumors of nutrients, this time focusing on the protein HSP90 which can foster tumor growth. Without signals from HSP90 telling the tumor to expand, researchers are hopeful that they can slow or prevent tumor growth. Ganetespib has already proven an effective second-line treatment for non-small cell lung cancer and will be entering clinical trials for pleural mesothelioma. If successful, ganetespib may be a valuable tool in preventing relapse after initial treatment.
Immunotherapy Helps Combat Mesothelioma
An experimental treatment, tremelimumab, helps immune cells target and destroy cancer cells. The treatment blocks a protein receptor called CTLA4, which deactivates anti-cancer immune cells and allows cancer to spread undeterred. Tremelimumab has been effective in preventing cancer progression in chemo-resistant mesothelioma patients, and will be entering a larger study to determine its effectiveness in extending survival for mesothelioma patients who are ineligible for surgery.
Fresolimumab, another type of immunotherapy, works to neutralize a protein called TGF-β that is produced by tumors. In smaller tumors, TGF-β inhibits tumor growth, but as tumors advance, the effect is reversed, and the protein prevents the immune system from stopping tumor growth. Fresolimumab was studied in 2013 on 13 previously treated mesothelioma patients, 23% of whom were able to achieve stability with the disease.
Mesothelioma is a particularly lethal form of cancer infecting the lining of the lungs and chest cavity, and many typical cancer treatments are not effective in combating its advance. By diversifying the types of treatments available to mesothelioma patients, oncologists will be able to design treatment plans specific to a patient’s needs. There is still much work to be done in making these revolutionary treatments available to mesothelioma patients, but exploring new biological aspects of the disease can have important benefits.
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