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Mesothelioma Immunotherapy

Immunotherapy, also called biologic therapy, is a new type of cancer treatment that uses the body’s own immune system to fight cancer. Mesothelioma specialists are currently running clinical trials to test the effectiveness of immunotherapy for mesothelioma. This treatment option has already proven successful for other types of cancer.

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What Is Immunotherapy for Mesothelioma?

Mesothelioma immunotherapy uses the body’s own immune system to fight malignant mesothelioma by teaching the body to recognize cancer cells as harmful, by preventing the cancer from decreasing the immune response, or by helping the body’s immune system kill the cancer cells.

Unlike other forms of mesothelioma treatment such as chemotherapy and radiation therapy, immunotherapy only attacks cancerous cells, leaving the healthy tissue. However, it can also produce side effects.

Because side effects are usually not as severe as from chemotherapy for most patients, they usually, although not always, tolerate immunotherapy better.

Quick Facts About Mesothelioma Immunotherapy

  • Immunotherapy works by improving how the patient’s own immune system fights cancer.
  • Clinicaltrials.gov currently lists dozens of mesothelioma immunotherapy trials that are available to mesothelioma patients.
  • Current studies suggest that immunotherapy works best when combined with surgery or chemotherapy.
  • In 2018, the Nobel Prize in Physiology or Medicine was awarded to the discoverers of immunotherapy for cancer, marking just how promising this new cancer treatment is.

Benefits of Immunotherapy for Mesothelioma

Immunotherapy has already helped many cancer patients, and now the many benefits of the innovative treatment are being used for mesothelioma patients.

Benefits of immunotherapy for mesothelioma include:

  • Improved survival rates: According to a 2017 study by Dr. Gerard Zalcman, the one-year overall survival rate for mesothelioma patients was 51% when they were taking the immunotherapy drug nivolumab (brand name Opdivo®), and 58% if they combined that drug with ipilimumab.
  • Fewer side effects: Another benefit of using immunotherapy is that it uses the patient’s own natural defense system to attack the cancer cells — meaning fewer side effects and less damage to healthy tissue surrounding tumors. However, it can cause serious side effects.
  • Faster recovery time: Patient recovery times are usually faster and more comfortable than with other treatment programs.

As doctors continue to make immunotherapy advances for mesothelioma treatment, more patients may be able to access these benefits.

Mesothelioma Prognosis After Immunotherapy

Immunotherapy may improve mesothelioma prognosis — the general course doctors expect a patient’s mesothelioma to take — in some patients, but it is too soon to declare how much and what kind of patient benefits most from immunotherapy.

Many cancer immunotherapy treatment options are still being tested in clinical trials, but with promising, they are moving toward becoming first-line treatment options. These treatments work well by themselves and as an addition to chemotherapy or surgery.

These treatments are working well for most patients that try them, and so when the positive results are confirmed in studies, they will become more of a standard treatment option.

To learn more about improving your prognosis, reach out to our team of Patient Advocates.

How Mesothelioma Immunotherapy Works

Whenever someone gets sick, their body’s immune system kicks into action to fight off the bacteria, viruses, or cancers, allowing the individual to get better.

However, because mesothelioma cells are normal lung lining (pleural) cells that have mutated, it may be harder for the immune system to notice something is wrong and longer to gear up to fight it.

Sometimes the body is able to recognize there is a problem, but the immune system is unable to keep up and fight off the tumor because the cancer cells grow quickly or because they produce substances that down-regulate the immune response.

This is where mesothelioma immunotherapy comes in. When a patient receives immunotherapy, they are given specific types of drugs that help the body fight off cancer in several different ways. Immunotherapy can be either active or passive.

Mesothelioma Immunotherapy Treatment Process

Mesothelioma immunotherapy is a process in which the patient’s immune system is changed in a way that helps it better recognize the checkpoints in cancer cells, and therefore fight the cancer.

It may also involve drugs that are taken that help block the checkpoints, helping the immune system fight the cancer.

Immunotherapy is still in clinical trials, so right now it is most commonly used on patients who have already tried chemotherapy or surgery but not responded well to it and have few other options.

When discussing treatment options with a mesothelioma doctor, they can help you decide if an immunotherapy clinical trial is the right choice for you.

Get our free Mesothelioma Justice Guide for more information about mesothelioma treatment options.

Other Names for Immunotherapies

Checkpoint inhibitors like Keytruda and Opdivo are PD-1 inhibitors, which is another name for them. Tecentriq, Avelumab, and Durvalumab are ODL-1 inhibitors, another type of checkpoint inhibitor.

These drugs stop tumor inhibition of T-cells so that they can fight cancer cells more effectively. These drugs are given through an IV every 2-3 weeks and cause mild side effects.

Drugs like Yervoy block CTLA-4, an immune system protein that helps regulate the immune cells. By blocking this protein the immune system has a better chance of attacking the cancer cells. Yervoy is often combined with Opdivo for greater effect.

Types of Mesothelioma Immunotherapy

Immunotherapy for mesothelioma can be divided into many categories based on how the treatment is administered, the desired effect, how it affects the immune system, and other factors.

Did You Know?

There are two main types of immunotherapy: passive and active.

Active Immunotherapy

Active immunotherapy teaches the patient’s immune system to recognize cancer cells and realize that they are harmful to the body, triggering an immune response against these cells.

Antibodies (sera) collected in recovered patients is an example of passive immunotherapy.

In passive immunotherapy, the ready to fight cells are prepared outside of the patient and are then infused into him or her. Another type of passive immunotherapy is when medical specialists analyze cancer cells in a lab and identify their antigens.

They then grow the patient’s own immune cells in the lab, teach them to recognize the antigens (targets) that they identified in the lab, and infuse them back into the patient.

This is a more time-involving and complex process that is not available everywhere.

Active immunotherapy is divided further into two types:

  • Specific: Specific immunotherapy involves designing a treatment to stimulate a specific immune response against cells with certain antigens that all cancers of particular type share. The idea behind specific active immunotherapy was to produce the immune cells that could best fight cancer to maximize results. However, this approach is becoming less popular due to less than ideal results in multiple studies over several decades.
  • Nonspecific: This approach to immunotherapy involves using agents that trigger a general immune response, activating many different types of immune cells. It strengthens a patient’s overall immune activity to better fight cancer. This approach has had some success, but tends to be toxic and may is not productive in mesothelioma

Active immunotherapy can trigger checkpoints on immune cells, which some cancers can inhibit. The cells become more effective in fighting cancer.

The checkpoints on these immune cells operate like an “off switch” so they can avoid attacking other cells in the body, and cancer cells can take advantage of their presence to deflect immune response.

Checkpoint inhibitors are an exciting new and very promising new approach to prevent cancers from tuning down the immune response, and several such drugs have been approved in various cancer types.

One major type of active immunotherapy for mesothelioma includes cancer vaccines. Much like a typical vaccine, cancer vaccines are used to help the immune system learn to recognize cancer cells sooner.

These are the most common types of immunotherapy in common clinical use and being studied for mesothelioma:

  • Immune checkpoint inhibitors: Drugs that the patient takes to allow their immune system to respond appropriately to cancer cells.
  • Monoclonal antibodies: These antibodies make cancer cells more recognizable to T-cells and other immune cells of the patient.
  • Cytokines: These are proteins, sometimes grown in a lab, that help the body increase the nonspecific immune response to cancer cells. Some cytokines help the immune system cells grow more quickly, while others help the body resist cancer cells.

Some checkpoint inhibitors are:

  • Pembrolizumab (Keytruda)
  • Nivolumab (Opdivo), often used with Ipilimumab Atezolizumab (Tecentiq) and Avelumab (Bavencio)
  • Durvalumab (Imfinzi)
  • Cemioimab (Libtayo)
  • Avelomab (Bavencio)

Because immunotherapy is a newer treatment type, it continues to be studied and advanced. Your doctor will be able to help you determine if and which immunotherapy treatment is right for you.

Passive Immunotherapy

In passive immunotherapy (also known as adoptive immunotherapy), patients receive antibodies and geared up immune cells developed in a lab.

Like active immunotherapy, passive immunotherapy can be specific or nonspecific.

Types of passive immunotherapy for mesothelioma include:

  • Monoclonal antibodies: These are antibodies designed to attach to specific cancer cell proteins, like immune checkpoint inhibitors.
  • CAR-T therapy: These are expanded specialized T-cells that are primed to fight cancer cells.

Cancer Vaccines

Cancer vaccines work with the immune system to help the body learn to defeat cancer cells. These vaccines are usually made by either editing your own immune cells to better respond to cancer cells, or by helping your immune cells better identify which cells are cancerous.

Many times the immune system will have difficulty knowing which cells are cancerous, so cancer vaccines come in to teach the immune system which cells to attack.

These vaccines are often used in tandem with surgery or chemotherapy drugs such as cisplatin and pemetrexed (Alimta). Mesothelioma cells are normal cells that have mutated, which can make it very difficult for an immune system to identify which cells to attack.

These vaccines, used with other treatment options, give a patient the best chance of reducing tumor size while keeping good cells.

Monoclonal Antibodies

When an antibody attaches to a cell’s antigen, that cell is marked for destruction by T-cells.

However, because mesothelioma cancer cells are normal cells that have mutated, it can be difficult for the immune system to identify cancer cells as dangerous, and therefore they don’t always get marked for destruction.

Monoclonal antibodies are lab designed antibodies that help the immune system by attaching to antigens that are popular in cancer cells. They are introduced through an IV and cause minimal side effects.

These drugs are sometimes used with other treatment options but sometimes used as their own treatment.

Other Types of Mesothelioma Immunotherapy

The last major types of immunotherapy being tested are immunomodulators. These drugs work with the immune system by heightening some proteins and calming down others.

These drugs include:

  • Thalidomide
  • Lenalidomide
  • Pomalidomide

Other immune therapies that are being studied include:

  • Bacillus Calmette-Guerin: A germ that infects human tissue and activates the immune system. This is usually a liquid treatment for bladder cancer. This is one of the oldest immunology treatments for cancer.
  • Imiquimod: A drug for skin cancer, usually a cream that promotes a local immune system response where applied.

Mesothelioma Immunotherapy Multimodal Treatment

Doctors often use immunotherapy for mesothelioma in combination with other treatment plans like chemotherapy, virotherapy, and surgery.

Chemotherapy and Immunotherapy

Researchers are aware that it is vital for the body’s immune system to recognize cancer cells as harmful so that it can control, prevent and shape the tumors growing in the patient’s body.

However, some chemotherapy for mesothelioma is ineffective when it comes to teaching the body’s immune system to recognize and attack cancer cells.

While the chemotherapy fights off cancer, active immunotherapy can fill in the gap, teaching the immune system to recognize cancer cells as harmful.

Surgery and Immunotherapy

Immunotherapy for mesothelioma can be used as adjuvant or additional therapy after a patient has had mesothelioma surgery. Immunotherapy after surgery reduces the risk of recurrence by enabling the body to recognize and fight off cancer cells that are trying to spread and grow.

Virotherapy and Immunotherapy

In virotherapy, viruses are altered so that they duplicate themselves better inside tumor cells than in healthy cells. Then, immunotherapy can be used to target drugs to go where the virus is and target cancer cells through their proximity.

Mesothelioma victims may be eligible for financial compensation to help them afford various treatment costs.

Immunotherapy Side Effects

While mesothelioma immunotherapy has fewer side effects than other cancer treatments, it still has some. These side effects may be different for each person, and they will depend on the specific drugs and types of immunotherapy being done.

Some of the possible immunotherapy side effects include:

  • Weight gain due to the patient’s body holding in more fluids
  • Inflammation near the injection site, which appears as pain or itching and burning sensation near the site
  • Flu-like symptoms such as fever, chills, nausea, and congestion
  • Changes to the patient’s blood pressure or heart palpitations
  • Trouble breathing, tiredness, dizziness or muscle pains
  • Reactivation or triggering of an immune response against normal body organs, such as the lining of the heart or lungs, colon, joints, or other organs

Because some of these treatments are new and you may be encountering them while part of a clinical trial, all side effects will be monitored closely.

Consulting with your doctor can help determine what your symptoms may be and which treatment option will be best for you based on the symptoms you may experience.

Next Steps for Mesothelioma Immunotherapy

In addition to the study by Dr.Gerard Zalcman, there was a clinical trial from France called MAPS2. Unfortunately, all patients who are diagnosed with mesothelioma relapse once they stop receiving treatment.

Did You Know?

For 50% of mesothelioma patients, recurrence will happen within 6 months after stopping treatment.

Research such as the MAPS2 trial — which looks into new treatment methods or ways to make current treatments more useful — is critical for preventing mesothelioma recurrence.

The MAPS2 clinical trial showed that immunotherapy slowed down the growth of malignant pleural mesothelioma after a relapse.

The study had 125 patients. After 12 weeks of treatment using Opdivo, the mesothelioma did not grow larger or spread further in 44% of the patients. This percentage increased to 50% when the patients received both Opdivo and Yervoy.

In fact, in 17% of the patients who received just the Opdivo and 26% of the patients who received the combination, the tumor actually shrank.

Seeking Immunotherapy Treatment for Mesothelioma

Mesothelioma therapies continue to evolve as researchers look for novel ways to boost immune system function in the fight against mesothelioma.

Immunotherapy is a promising treatment that can enhance and improve standard mesothelioma treatments and treatment combinations.

Patients who are looking to use immunotherapy to help treat their mesothelioma should speak with their doctor. Contact the Mesothelioma Justice Network to help you find the appropriate care practitioner.

Mesothelioma Support Team
Reviewed by:Dr. Mark Levin

Certified Oncologist and Hematologist

  • Fact-Checked
  • Editor

Mark Levin, MD has nearly 30 years of experience in academic and community hematology and oncology. In addition to serving as Chief or Director at four different teaching institutions throughout his life, he is also still a practicing clinician, has taught and designed formal education programs, and has authored numerous publications in various fields related to hematology and oncology.

Dr. Mark Levin is an independently paid medical reviewer.

Stephanie KiddWritten by:

Editor-in-Chief

Stephanie Kidd grew up in a family of civil servants, blue-collar workers, and medical caregivers. Upon graduating Summa Cum Laude from Stetson University, she began her career specializing in worker safety regulations and communications. Now, a proud member of the American Medical Writers Association (AMWA) and Editor-in-Chief of the Mesothelioma Justice Network, Stephanie serves as a voice for mesothelioma victims and their families.

View 9 Sources
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