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Vanessa Blanco, patient advocate for the Mesothelioma Prognosis Network
Written By Vanessa Blanco
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Reviewed By Dr. Susan E. Lawrence

In the mid-1980s, when some of today’s leading mesothelioma doctors were just starting their careers, we didn’t know much about this rare cancer. There was practically no government funding for research, and treatment options were limited to surgery and a chemotherapy drug only proven to work for test mice in the lab.

Fortunately, times have changed. Patients seeking treatment in the U.S. now have access to world-class cancer centers. Several centers even have programs dedicated to treating and studying mesothelioma. Medical studies called clinical trials have helped researchers create treatment plans that can achieve long-term survival.

The future of mesothelioma treatment is exciting, but mostly uncertain. Promising new therapies emerge at a steady pace, but it can take many years for regulators to prove a new treatment is better than current options and safe enough for widespread use. Take a look at the latest developments in mesothelioma research and some promising therapies and technologies on the horizon.

Drugs and Treatments of the Future

As research progresses, cancer experts will discover new chemotherapy drugs and the best ways to deliver them. These innovations will help us conquer some of the biggest threats to life expectancy, like poor responses to chemotherapy and high rates of the cancer returning after treatment.

Some of the latest drugs and treatment approaches under investigation include:

Assortment of pills and a stethoscope
Keytruda Immunotherapy checkpoint inhibitor

Keytruda is an immunotherapy drug designed to reveal cancer cells to the immune system, so a patient’s body can fight cancer naturally.

Keytruda works by blocking the interaction of PD-L1 proteins on cancer cells with PD-1 proteins on immune system cells. Mesothelioma cancer cells often use PD-L1 proteins like a mask to hide from the body’s immune system.

Immunotherapy usually has milder side effects than chemotherapy, and Keytruda has extended survival for some mesothelioma patients. Mesothelioma clinical trials are testing the drug, and it is also available through the FDA’s Expanded Access program

Blood cells
Cediranib Starving tumors of nutrients

Researchers are combining Cediranib with the current drugs pemetrexed and cisplatin. Together, they believe these drugs can destroy harmful cells more effectively and stop them from spreading. Cediranib works by blocking enzymes that pleural mesothelioma cells need to grow. It may also cut off blood flow to tumors, causing them to shrink. Other drugs in development also prevent tumors from growing blood vessels that sustain their growth. Doctors call this approach anti-angiogenesis.

Scientist analyzing a DNA double helix
Photodynamic Therapy A light-based treatment

Photodynamic therapy (PDT) uses a light-activated drug to fight cancer. Doctors inject the experimental drug into the patient’s bloodstream, which spreads the medicine throughout the body. Along the way, it is absorbed by more cancer cells than healthy cells. When doctors shine a special laser on key areas, it triggers a chemical reaction that kills the cancer while leaving normal cells largely unharmed. Some trials have tested PDT before surgery, in which researchers deliver the drug before surgery and activate it during the procedure.

Blood sample
Gene Therapy Using genetics to guide treatment

With gene therapy, doctors modify a patient’s genes to treat or prevent cancer. They may repair or replace mutated genes that were damaged by asbestos exposure, or even change the genetic code of cancer cells to make them easier to kill.

One clinical trial for gene therapy modifies the patient’s blood cells so they can target cancer cells and possibly shrink tumors. Researchers think this technique may be useful for patients with advanced cancer who have not responded well to standard treatments, but further testing is needed.

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Future Technology

In years to come, the technologies doctors use to diagnose and treat mesothelioma will evolve alongside the latest drug breakthroughs. Select treatment centers now offer new options like robot-assisted surgery and IMRT, an advanced form of radiation therapy. Only time will tell what groundbreaking tools will emerge next.

Diagnostic Tests

Researchers are developing new and improved tools for diagnosing mesothelioma earlier. Survival is generally best when doctors can catch the disease early and begin treatment before the cancer starts to spread out of control.

Unfortunately, doctors commonly mistake mesothelioma for other cancers and give patients treatments for the wrong disease. A leading genetics company offers the Rosetta Mesothelioma Test, which measures the levels of a substance called microRNA in tumor tissue to confirm a diagnosis. As diagnostic technologies continue to improve, it will be much easier for doctors to diagnose mesothelioma with a high level of confidence.

IMRT

Researchers are seeing impressive early results from a new form of radiation therapy called intensity modulated radiation therapy (IMRT). This technology allows doctors to deliver higher doses of radiation with more accuracy, which may reduce accidental damage to healthy tissue.

A study at MD Anderson Cancer Center in Texas called IMRT promising and feasible. None of the 28 patients treated with the technique had the cancer return locally after a median follow-up of nine months, but the cancer still spread to other parts of the body. Researchers think combining IMRT with chemotherapy may solve this problem.

Robotic Surgery

In 2013, Dr. Farid Gharagozloo performed the world’s first robot-assisted surgery for pleural mesothelioma. With the help of a robotic system, he performed an extrapleural pneumonectomy (EPP), which removed the patient’s diseased lung, heart lining and diaphragm.

Robotic surgery has several benefits, including:
  • Speedier recovery
  • Less pain and bleeding
  • Smaller scars
  • Lower risk of infection
  • Shorter hospital stays

Even though Gharagozloo’s historical surgery was a success, experts are unsure if it is the best option for patients. Future studies will either improve the technology or determine that better options for surgery exist.

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Hot Topics in Research

A worldwide community of researchers is working together to solve some of the most difficult challenges of treating this disease. As ongoing studies break new ground in these research areas, patients gain more treatment options and a higher chance for long-term survival and a better quality of life. No matter how small, every breakthrough can be a steppingstone toward a reliable cure.

Improving the Standard of Care

The most effective and widely-used treatment plan available is called the standard of care. According to the strongest evidence we have, patients fare best after multimodal treatment, which combines surgery, chemotherapy and radiation therapy. However, the standard of care will change if clinical trials find more effective ways to approach treatment.

We know that a combined treatment strategy is best, but researchers are still experimenting with different ways to deliver therapy. They hope to improve survival rates by finding the most effective chemotherapy doses, better drug combinations and the ideal order to give treatments.

Discovering new treatments will benefit patients in the future, but it’s just as important to learn the best ways we can help patients today get the most out of therapy.

Personalizing Treatment Options

Decades ago, doctors wondered why some mesothelioma patients respond to mesothelioma treatment better than others. As science and technology advanced, they learned that every case is unique and a one-size-fits all approach to treatment won’t work. It turns out the key to personalizing treatment involves studying the patient’s genes.

Genes are hereditary molecules in our DNA that tell our cells how to grow, function and stay healthy. Certain genes can be harmed by cancer-causing substances like asbestos. This can cause a single cell to divide out of control and form cancerous tumors.

With a tool called the gene chip, researchers can study a tumor sample and see how all of it genes interact. There’s a good chance this information contains the secret to curing cancer, but the chip produces an overwhelming amount of data.

Scientists are trying to understand this data and turn it into better treatments. Clinical trials currently are investigating a variety of ways doctors can use genes to predict how well patients will respond to therapy before it is given. This should lead to more targeted treatments with much higher success rates.

Earlier Diagnosis

Many patients start therapy too late, when they are no longer healthy enough for major surgery or difficult cycles of chemotherapy and radiation. If we can diagnose mesothelioma earlier, before it has a chance to spread, survival will likely improve.

Researchers have discovered chemicals in the blood that indicate a patient has cancer. They call these chemicals biomarkers, and use them to diagnose the disease sooner than current methods. Doctors can detect biomarkers with a simple blood test instead of invasive diagnostic surgeries or imaging scans.

Although biomarkers look promising, they are not yet reliable enough to confirm a diagnosis on their own. In the future, experts hope to find better biomarkers to increase the accuracy of diagnosis.

New Therapies in Clinical Trials

You may be surprised that the treatments of the future are available today in clinical trials. These medical studies recruit patient volunteers so we can learn what works best in cancer care. A clinical trial may help researchers learn:

  • How well a new treatment works
  • How safe a medication or therapy is for patients
  • Which drugs and treatment combinations bring the longest survival

The following drugs take an interesting new approach to treatment, and might bring us closer to finding a safe and functional cure for mesothelioma.

The following drugs take an interesting new approach to treatment, and might bring us closer to finding a safe and functional cure for mesothelioma.

Taking pills
Defactinib A biological therapy

This international trial compares defactinib (VS-6063) with a dummy drug to find out how it affects survival and quality of life for patients with pleural mesothelioma. The biological treatment works by blocking signals that cancer cells need to multiply and grow. Participants must have previously completed at least four cycles of chemotherapy with pemetrexed/cisplatin or pemetrexed/carboplatin without their cancer advancing.

Locations: Illinois, Maryland, New York, Ohio, Pennsylvania, Texas, Australia, Belgium, Canada, France, Japan, Netherlands, New Zealand, Spain, Sweden, United Kingdom

Doctors performing surgery
PDT During Surgery Combining techniques

This trial tests the safety and effectiveness of photodynamic therapy (PDT) when given alongside surgery for pleural mesothelioma or non-small cell lung cancer. The treatment uses a light-activated drug called pormifer sodium that can kill cancer cells and damage the tumor’s blood supply. Participants must have stage III or IV mesothelioma, or lung cancer that spread to the pleura, and must also qualify for surgery.

Location: Ohio

Needle in medicine
WT-1 Vaccine Preventing recurrence after treatment

This trial will help researchers learn if the Wilms Tumor-1 vaccine can help prevent or delay mesothelioma from returning after surgery and other treatments. The vaccine will be combined with the drugs montanide and GM-CSF, which strengthen the immune system to help fight the cancer. Participants must have previously completed surgery and also treatment with chemotherapy and/or radiation therapy.

Locations: New York, Texas

Doctor analyzing a blue liquid
SS1P Tweaking the immune system to kill cancer

This trial will study the effectiveness of the experimental drug SS1P, which was designed to target cancer cells and leave healthy cells unharmed. Researchers will combine SS1P with two drugs that weaken the immune system to make SS1P work better. Participants must have completed at least one prior chemotherapy regimen and have either the epithelial or the biphasic subtype of cancer.

Location: Maryland

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Joining a clinical trial is an important decision that you must make for yourself. There’s no guarantee that an experimental therapy will work for you, but many patients in clinical trials have been helped by new drugs available nowhere else. Many take pride in being part of a study that advances cancer research and may even bring a cutting-edge therapy into wide use.

For a full list of clinical trials currently recruiting mesothelioma patients, visit ClinicalTrials.gov. You can talk to your doctors to learn more about the goals of any trial and whether or not you qualify.