Immunotherapy For mesothelioma Side Effects

 

 

 

Immunotherapy For mesothelioma is a new treatment. To kill malignant mesothelial cells, immunotherapy strengthens the immune system. There are various immunotherapies. Immune checkpoint inhibitors treat mesothelioma. Doctors compare immunotherapy with chemotherapy, with immunotherapy frequently improving survival.

Approved Mesothelioma Immunotherapies

 

Immunotherapy For mesothelioma Side Effects

 

In 2020, the FDA authorized Opdivo and Yervoy for mesothelioma. Only utilize the treatments simultaneously if surgery isn’t possible. Nivolumab and ipilimumab are marketed as Opdivo and Yervoy.

The immunotherapy drug pembrolizumab is branded Keytruda, another checkpoint inhibitor. It was FDA-approved for elevated cancer protein levels. This approval only works for a few pleural mesothelioma patients.

How to Get Mesothelioma Immunotherapy

Mesothelioma immunotherapy is a viable treatment option. Here are three steps:

Research FDA-approved immunotherapy medicine adverse effects and other information. To distinguish between normal and abnormal consequences, be mindful of the usual impacts.

Ask your doctor about hospital immunotherapy. Opdivo and Yervoy are FDA-approved and available at many cancer centers. Other institutions conduct immunotherapy trials.

Ask a patient advocate for assistance in locating a cancer center. We can suggest immunotherapy cancer centers near you.

Immune system makeup

An immune system has many parts. Each contributes to diagnosing and treating malignancies like mesothelioma:

Cancer cells include proteins called tumor antigens, which are foreign invaders like viruses.
T-cells — Immune system warriors that fight and eliminate cancer cells.
B-cells create antibodies to fight off antigens.
Antibodies are proteins that alert the immune system to attack cancer cells.
Dendritic cells (messenger cells) transport cancer cell information, including proteins, to T cells.

Antigens alert the immune system. Mesothelin is a major mesothelioma tumor antigen.

Mesothelin triggers B-cell antibody production. T-cells connect to mesothelin to find and kill sick cells.

Immunotherapy can boost mesothelioma-fighting T- and B-cells.

How Does Mesothelioma Immunotherapy Help?

Immunotherapy helps the immune system combat cancer cells. Mesothelioma bypasses the immune system and spreads unchecked. These disorders are actively targeted by immunotherapy.

Some immunotherapies fight mesothelioma:

Step 1. Because immune cells don’t detect malignant cells as a threat, they can multiply.

Step 2. Immunotherapy alerts the immune system by attaching or killing malignant cells.

Step 3. The patient’s immune cells target malignant and comparable antigens.

Step 4. The patient’s immune cells target malignant cells, sparing healthy cells.

Other immunotherapy medications boost the immune system with lab-altered T-cells or antibodies.

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Fewer Patient Side Effects

Immunotherapy for mesothelioma produces similar adverse effects to chemotherapy, but less frequently and severely. Immunotherapy can cause fatigue, nausea, and dizziness. Weakness, pains, and rashes are other adverse effects.

Immunotherapy and chemotherapy are routinely compared to establish safety and efficacy. Most studies recommend immunotherapy over chemotherapy for mesothelioma.

The link between immunotherapy side effects and survival

Japanese researchers examined whether nivolumab (Opdivo) immune-related adverse effects (IRAEs) improved survival. The study included 11 nivolumab (Opdivo) immunotherapy patients. The results are below:

Disease control was 91% (10 of 11 individuals saw cancer halt or shrink).
The median overall survival was 15 months.
Progress-free survival was 6.8 months.
Eight individuals suffered IRAEs, and six had grade 2 side effects.

Six patients with grade 2 or higher IRAEs survived 13 months progression-free. Five patients with grade 1 or no IRAEs survived 3.8 months progression-free.

Median overall survival was:

Greater than one year for grade 2 or higher IRAEs
8.6 months for grade 1 or no IRAEs.

This suggests immunotherapy may work best when patients are uncomfortable. Medication and palliative care can alleviate pain.

Mesothelioma Immunotherapy Types

Checkpoint inhibitors, oncolytic viruses, adoptive cell treatment, and monoclonal antibodies are the primary mesothelioma immunotherapies. Drugs can activate the immune system actively or passively.

Drugs or viruses are used in active immunotherapy to boost immunity. Passive immunotherapy adds lab-grown immune cells to fight cancer.

Checkpoint inhibitors

Checkpoint inhibitors prevent mesothelioma cells from suppressing T-cells. Blocking mesothelioma cells helps the immune system fight it. This is active immunotherapy.

Some mesothelioma proteins interact with T-cell proteins. The most familiar to clinicians and researchers are PD-L1 and PD-1.

Oncolytic Viruses

Oncolytic viral treatment and immunotherapy are combined in this active immunotherapy.

Normal viruses attack healthy cells, while oncolytic viruses do not. They kill only sick cells that emit immune-stimulating antigens.

Example: ONCOS-102, a mesothelioma oncolytic virus. The therapy destroys mesothelioma cells, releasing antigens. The virus then orders T-cells to swarm the tumor.

Adoptive Cell Therapy

Adoptive cell therapy changes immune system cells in a lab to fight mesothelioma. Immunotherapy experts change T-cells, which fight disease.

CAR T-cell therapy is the most common mesothelioma adoptive cell treatment. CAR stands for chimeric antigen receptor. This immunotherapy targets mesothelioma with lab-made receptors.

IcasM28z is adoptive cell therapy. The mesothelioma cell surface protein mesothelin is targeted by CAR T-cells.

Monoclonal antibodies

Monoclonal antibodies are lab-made mesothelioma treatments. Another passive immunotherapy.

They combat mesothelioma with immune system help and stick to receptors. Monoclonal antibodies include LMB-100, ramucirumab, and ravtansine.

Vaccines for Cancer

Cancer vaccinations train the immune system to combat pathogens like bacteria and viruses. B and T lymphocytes work together to remember and kill invaders. The pathogen activates the immune system to attack mesothelioma cells.

Cancer vaccines target mesothelioma

This customized method helps cancer vaccines activate the immune system to fight cancer. Four steps illustrate the procedure.

In Step 1, immune cells fail to identify malignant cells as a threat, allowing them to multiply and spread.

Step 2: The medicine is given to the patient, adheres to malignant cells, and alerts the immune system.

In Step 3, the patient’s immune cells may now identify and attack malignant cells independently.

In Step 4, the patient’s immune cells target and eliminate malignant cells while preserving healthy cells.

Anti-VEGF

Many cell types, including malignant tumor cells, produce angiogenic VEGF. VEGF helps in bone production, wound healing, and development. VEGF promotes cancer cell proliferation by growing new blood vessels, which feed tumors.

Initial anti-VEGF treatments for malignancies like mesothelioma targeted VEGF’s pro-angiogenic activity to limit new blood vessel formation. Cancer cells suffocate and die when new blood vessels are prevented.

Anti-VEGF medications combined with chemotherapy and radiation are effective against many cancers because they target VEGF’s pro-angiogenic and pro-survival properties.

Mesothelioma Anti-VEGF Treatment Examples

Anti-VEGF medication for mesothelioma includes rivoceranib or Apatinib. This cancer medication is a tyrosine kinase inhibitor. The VEGF-2 inhibitor stops it.

Apatinib is being studied for peritoneal mesothelioma. It is being tested for cases where cytoreductive/HIPEC surgery is impossible.

Blood arteries are necessary for peritoneal mesothelioma tumor cells to survive the immune system. Nutrients also fuel peritoneal mesothelioma cell development and dissemination.

Apatinib associates with VEGF receptors to inhibit VEGF. Blocking this growth factor stops angiogenesis, halting blood vessel growth. This deprives future cancer cells of nutrition. Lack of nutrients deprives cancer cells of oxygen, killing them.

In the Frontiers in Oncology clinical trial, 27 peritoneal mesothelioma patients got apatinib. For non-surgical treatments, the median overall survival was 59.4 months, which is remarkable.

Nearly 60% responded. The treatment initially stopped peritoneal mesothelioma tumor growth in most patients. Four trial participants had partial disease responses, meaning their cancer shrank. About half of the patients (12 of 27) had stable cancer, meaning it didn’t develop or decrease.

Ramucirumab and bevacizumab are other mesothelioma anti-VEGF treatments. Their pleural mesothelioma tests are underway.

Dermal Cell Therapy

Dendritic cells are added to the patient to deliver antigens to T lymphocytes, which kill cancer cells. Immune messenger cells are dendritic cells. Imagine them as mail carriers.

One of the most potent antigen-presenting immune cells, dendritic cells are essential for immunological response. Low T-cell infiltration in mesothelioma tumors. Dendritic cells trigger T lymphocytes to attack tumor cells.

Low mutational burden mesothelioma tumors have low tumor-associated antigen levels, making it hard for dendritic cells to detect tumors and activate T cells. Due to high immunosuppressive cell volumes and low tumor-associated antigen volumes, mesothelioma tumors generally have an immunosuppressive environment.

Dendritic cell treatment matures cells to increase their effectiveness and population. This helps the dendritic cell army detect cancer cells as hazardous and activate T-cells.

Individualized Mesothelioma Treatment: Immunotherapy Potential

Individualized care is medicine’s golden grail. This strategy gives everyone the best chance of long-term survival as everyone gets different therapy.

Each person is unique. Due to genetics, everyone is different. Each person’s cancer is unique because of this. Even mesothelioma is unique, therefore a specialized strategy can help treat it.

Immunotherapy allows individualized mesothelioma treatment.

The Phase 1B experiment is led by UC San Diego Medical Center’s Dr. Ezra Cohen. The trial, dubbed “Personalized Immunotherapy in Adults With Advanced Cancers,” tries to customize treatment for each patient.

Dr. Cohen explained on the show how he and other scientists are making a vaccination for “literally one person in the entire world.” Then they make one for another patient, etc. Pembrolizumab—Keytruda’s chemical name—is also in the trial. Not just mesothelioma cancer is on trial, but that doesn’t matter.

Mesothelioma Immunotherapy Survival Rates

Among FDA-approved mesothelioma immunotherapy therapies, median survival is 18-20 months. Survival factors include immunotherapy type, cell type and stage, and medication combination.

Physician’s Weekly compared mesothelioma treatments. The key finding was immunotherapy outperformed chemotherapy. Both methods of treatment were often paired with surgery, where immunotherapy excelled:

18.2 months for immunotherapy patients
11.7 months for chemotherapy patients
22.6 months for immunotherapy surgery patients
20.7 months for chemotherapy-surgery patients

Both surgery and non-surgery immunotherapy patients had a median survival of approximately 20 months. Without immunotherapy, chemotherapy-only patients survived 12.3 months.

76% of immunotherapy patients survived one year. The chemotherapy group had a 1-year survival rate of < 15%.

Immunotherapy before Mesothelioma Surgery

A Baylor College of Medicine study examined immunotherapy before pleural mesothelioma surgery. Durvalumab and tremelimumab improved the tumor microenvironment, making cancer cells more susceptible to T-cell attack, doctors claimed. T lymphocytes increased in the tumor.

Survival for Mesothelioma Immunotherapy Types

The FDA evaluates applications for survival benefit and safety. Importantly, immunotherapy outperforms chemotherapy for mesothelioma regardless of previous treatments:

Durvalumab and chemotherapy resulted in a 20-month median survival rate, outperforming chemotherapy alone.
ONCOS-102 with chemotherapy achieved a median survival of 20.5 months, seven months higher than chemotherapy alone.
AtezoBev, a combination immunotherapy, had 80% of patients survive at least one year with a median progression-free survival of 17.6 months.
LMB-100 showed a median survival of 11.9 months. 80% of high-PD-L1 patients obtained tumor responses. In one patient, the medication completely cured the condition.
Opdivo with Yervoy has a superior median survival rate for pleural mesothelioma patients (18.1 months) compared to chemotherapy (14.1 months).
Ramucirumab and chemotherapy resulted in a median overall survival of about 14 months, nearly double that of chemotherapy alone (7.5 months).
Anetumab maytansine is most effective when given at 6.5mg/kg every three weeks. Disease decreased with a 31% response rate. Disease control was 75%, suggesting it shrunk or ceased spreading.
Dendritic cell treatment resulted in a median survival of 27 months.
Opdivo and Yervoy significantly impact epithelioid and sarcomatoid mesothelioma patients, the most challenging cell histology. German research demonstrated immunotherapy medicines’ efficacy:
Immunotherapy extended epithelioid survival by 3 months over chemotherapy to 19 months.
Immunotherapy is better than chemotherapy (9 months) for sarcomatoid patients, who lived 17 months.

 

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