Each year, September 26th marks Mesothelioma Awareness Day, a time devoted to educating the public on this rare form of cancer and extending support to anyone that has been affected by the disease. A mesothelioma diagnosis is exceptionally rare and has placed the spotlight on targeted therapies within clinical trials in order to improve the poor prognosis. While many of these treatments are still in the experimental stages, certain therapies have shown success in improving patient survival rates and are making progress toward becoming a standard form of treatment.
A Difficult Disease to Diagnose
The only confirmed cause of mesothelioma is the worldwide use of asbestos; a fibrous mineral that is found throughout the natural environment in soil and rocks. When this mineral is disturbed, thousands of fibers can be released into the air. If inhaled, these fibers can cause internal scarring and may eventually lead to an asbestos-related illness like mesothelioma. Although this disease can affect the lining of the heart and abdominal cavity, around 80 percent of cases occur in the lining of the lungs.
The cancer continues to present a challenge for patients and healthcare professionals. In some instances, patients do not know when or how they were exposed to asbestos and mesothelioma symptoms can suppress themselves for over 40 years, making an official diagnosis difficult to pinpoint. Usually, the cancer has progressed to the advanced stages by the time a physician identifies mesothelioma, leaving patients with less than one year to live. While the standard form of treatment includes chemotherapy and radiation, targeted therapies are becoming critical to finding a way to improve survival rate.
The Breakthrough Behind Immunotherapy
Immunotherapy has made a name for itself within the field of oncology and continues to deliver encouraging outcomes for cancer patients. This treatment uses the body’s own immune system to recognize and fight off cancer cells. There are several forms of immunotherapy, including checkpoint inhibitors, monoclonal antibodies, cancer vaccines, and other non-specific immunotherapies.
Drug therapies targeting the PD-L1 protein have demonstrated success for many cancers, including malignant pleural mesothelioma (MPM) . Studies have found it to be effective for pleural mesothelioma patients as adjuvant drug therapies along with the standard multimodal approach. Pembrolizumab specifically targets PD-L1 and has shown promising results for MPM patients. However, more research is needed to make this a viable option not only for MPM patients, but for patients suffering with any form of mesothelioma.
Lastly, immunotherapy surrounding (CAR) T cells are also in effect for pleural mesothelioma patients, in which the patient’s immune cells are genetically modified to identify certain antigens within cancer cells.
Progress in Gene Therapy
Gene therapy introduces healthy genes into tumor cells to combat cancerous mutations and has shown potential for mesothelioma patients as well. This therapy is ultimately meant to reduce side effects of harsh treatments, such as chemotherapy, and improve their overall success. It’s worth noting that gene therapy has only been FDA-approved since 2017 and is only available through clinical trials.
Popular gene therapy methods for mesothelioma include oncogenes and tumor suppressor genes such as BAP1 and Neurofibromin (NF2). Researchers have specifically focused on a mutation in the tumor suppressor gene known as BAP1, which is often found in the chromosomes of patients who have a genetic predisposition for malignant pleural mesothelioma. There is also some research into “suicide gene therapy,” which is a form of chemotherapy that could target all infected cells through vector application. This would target all cancer cells and effectively kill them off without harming healthy cells, however, it has not been fully developed.
Researchers are also currently looking into immunogene therapy, where genetic material from a virus is used to stimulate a patient’s immune system to destroy cancer cells. Combining these immune stimulants through viral vectors has made some progress among mesothelioma patients, shrinking tumors and stabilizing their conditions.
Many clinical trials are still in the experimental stages and require patients to sign up and be accepted for treatment. This may require a patient to meet specific standards to be eligible, which is why it’s important to discuss your options with your primary physician. Despite the severity of mesothelioma, research among targeted therapies and clinical trials have shown a promising future for patients suffering from this aggressive cancer. Although alternative treatments may not be effective in all cases, it can help doctors determine the best combination of treatments for patients diagnosed with this often fatal disease, among so many others.
