By Mary Hesdorffer, Nurse Practitioner
Executive Director, Mesothelioma Applied Research Foundation
Mesothelioma is an aggressive cancer most frequently occurring in the lining of the lung or abdomen. Most cases of mesothelioma are associated to asbestos exposure. Mesothelioma has been historically difficult to treat, partly because of its aggressive nature (only between 5 – 10% of patients survive past 5 years), and partly because of limited research focusing on it. While much work remains to be done before we can say our mission of eradicating this cancer has been accomplished, the progress achieved in recent years has been remarkable and I’d like to tell you more about it.
A few days ago, on April 17th AstraZeneca issued a press release on receiving an orphan drug status for its drug, tremeluminab, for the treatment of malignant mesothelioma. This announcement follows completion of a global trial that included 102 locations in 20 countries. What adds to this exciting development, according to Lee Krug, MD, chair of the board of directors of the Mesothelioma Applied Research Foundation, is that the trial, which opened in May, 2013, will, in just 17 months, have enrolled 542 patients!
“This is a notable achievement. To put this in perspective, the last phase III of this magnitude testing Vorinostat, in a comparable group of patients, (VANTAGE Trial) took 5 1/2 years to enroll 660 patients,” added Dr. Krug.
“This accomplishment of completing a trial of this size in such a short period time should be a wake-up call to the pharmaceutical industry. Historically, drug companies have been reluctant to undertake large trials in mesothelioma due to concerns about feasibility and slow accrual. But this trial demonstrates the potential. Patients with mesothelioma urgently need better treatments, and with only one chemotherapy regimen approved, there is a tremendous opportunity to impact the outcomes for these patients,” Dr. Krug further explained.
Unlike chemotherapy, tremeluminab harnesses the patient’s own immune system to fight this aggressive cancer, sparing patients the unpleasant side-effects associated with a more traditional approach of chemotherapy. This is cutting-edge in the world of oncology and, with this announcement today, mesothelioma has attained center stage in the war on cancer.
Does this mean that we are shifting away from chemotherapy? I am not sure that we are ready to do so yet. We have some new trials underway that utilize a new approach of combining immunotherapy with chemotherapy, most notable being CRS 207 which is a vaccine trial that is followed by the standard treatment of pemetrexed and cisplatin. This is a multi center trial built upon data from a Phase I trial where it was found to have very good activity in mesothelioma. There are many scientists who believe that immunotherapy can enhance the effects of chemotherapy, so perhaps we will see more trials using a combinatory approach.
Another approach important to mention is exemplified by another trial called Command, which introduces a different area of immunotherapy that targets cancer stem cells. In this placebo controlled trial, the drug defactinib, or placebo, is given to patients following chemotherapy. The drug attempts to halt future progression of disease by targeting colonies of cells that survived the initial treatment of chemotherapy. This is another global trial showing great success in obtaining the number of clinical trial participants necessary to meet it accrual goals.
Finally, another trial important to mention is the SS1P trial, which has been ongoing for a number of years. SS1P is an immunotoxin that utilizes mesothelin to gain entry into the epithelial mesothelioma cell, delivering the toxin directly to the cancerous cell thus sparing the patient of systemic side-effects.
In March of 2015 the Mesothelioma Applied Research Foundation held its yearly conference cosponsored by the National Caner Institute. All attendees agreed that their was more optimism expressed by the scientific community and that progress is indeed coming to this rare and often neglected disease.