Past, Present and Future: How Far We've Come With Mesothelioma

CURE® spoke with one expert about the various treatment options and current clinical trials available to patients with mesothelioma, as well as what they have to look forward to in the future.
BY Kristie L. Kahl
PUBLISHED July 29, 2019
The first case of asbestos was found in 1899, from which 50 deaths were linked to its discovery. As a result, the naturally-occurring yet toxic minerals were linked to mesothelioma in the 1950’s.

Lucky enough, treatment for the disease has come a long way in that time. CURE® spoke with Dr. Katy Moncivais, who holds her Ph.D. in biomedical engineering from the University of Texas at Austin, about the various treatment options and current clinical trials available to patients with mesothelioma, as well as what they have to look forward to in the future.

CURE®: What are some treatment options individuals should be aware of?
Moncivais: As with many cancers, chemotherapy, radiation and surgery are the most common treatments for mesothelioma. Overall, they are far less effective in mesothelioma than they are in the other cancers, which is disheartening. However, certain combinations of these gold standard cancer treatments and new immunotherapy options are showing promise.

When complete surgical removal of the cancer is not possible, some patients may be good candidates for hyperthermic intraperitoneal chemotherapy. With this variation, high strength chemotherapy is heated well above normal body temperature and circulated within the abdominal cavity, giving it the opportunity to come into contact and infuse as many cancer cells as possible. Since chemotherapy is taken into cancer cells more readily than regular cells, this gives both the chemo and the heat of the treatment a very good chance at killing cancer cells while limiting the damage to normal cells. In some cases, this type of treatment has substantially increased survival rate.

For me though, the most promising options are immunotherapies. One of the biggest challenges we face in all cancers is the impossibility of surgically removing every single cancer cell when they’ve spread to multiple locations throughout the body. But our immune systems already go to all those places. So, if we can teach the immune system how to target cancer cells without harming healthy cells, it will revolutionize this disease. Right now, both Keytruda (pembrolizumab) and Opdivo (nivolumab), which are Food and Drug Administration-approved immunotherapies for melanoma, are used in patients with mesothelioma. We don’t have enough data yet to say they’re truly more or less effective than other treatments, but patients do report far fewer negative side effects versus chemo.

Are there any exciting clinical trials currently ongoing in the mesothelioma space?
There are multiple clinical trials running right now with chimeric antigen receptor (CAR)-T cell based immunotherapies specifically engineered for mesothelioma. Most of them target mesothelin, which is highly overexpressed in most but not all types of mesothelioma. There is one targeting a different protein, FAP, which I think is most exciting. FAP is overexpressed on all major subtypes of mesothelioma, and I hope to see promising results from this study very soon.

(The FAP trial) looks like they’ve completed enrollment, so we just have to wait for results.

What do you think the future of mesothelioma looks like?
We’re making such incredible leaps and strides in cell therapy technologies every single day, including immune cell therapies like CAR-T cell technologies. At this breakneck pace, I hope to see CAR-T cell and other immunotherapies overtake chemo and radiation as first-line treatments for mesothelioma. These technologies will change prognosis in general, and I think we’ll see mesothelioma become more like melanoma where we can’t cure it but can keep it at bay long term.

What is your biggest piece of advice for a newly-diagnosed patient with mesothelioma?
Oh my goodness, what a difficult question. I think I would say, above all else - find and embrace a dependable support network - and it doesn’t have to be family! There are plenty of non-family support options available through many mesothelioma organizations. Because at the end of the day, that support network will help you decide if you need a different doctor, a second opinion, a break from chemo, or just a good laugh. The support network, wherever you find it, will take care of the rest. So that would be my number one recommendation.

My second biggest piece of advice: Remember that no one is going to be a better advocate for you than you. So, if you need to ask another question, ask it. Need to call and talk to a nurse, do it. There are countless medical professionals available to help you through this, and they’re all wonderfully caring people who want to help. But they do sometimes move a post-it accidentally, because like us, they are human. So, ask questions, follow-up and generally don’t feel bad about advocating for yourself, your health and your recovery.
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