A Glimpse in the Future of Malignant Mesothelioma Treatment

Our plain-English summary of A Glimpse in the Future of Malignant Mesothelioma Treatment, by G. Pezzicoli, M. Rizzo, M. Perrone, et al (Frontiers in Pharmacology, 2021).

The study

• Authors: G. Pezzicoli, M. Rizzo, M. Perrone, S. Minei, L. Mutti, C. Porta
• Journal: Frontiers in Pharmacology
• Published: 2021;12:809337
• Type of article: Review
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant mesothelioma (MMe) is a rare neoplasm with few therapeutic options available. The landscape of effective therapy for this disease remained unchanged in the last two decades. Recently, however, the introduction of Immune Checkpoint Inhibitors (ICIs) led to small, but nevertheless, promising improvements. However, many efforts are still needed to radically improve the prognosis of MMe. In this review, we analyze all those therapeutic strategies for MMe that are still in a preclinical or early clinical phase of development. In particular, we focus on novel antiangiogenic drugs and their possible combination with immunotherapy. Furthermore, we describe also more complex strategies such as microRNA-loaded vectors, oncolytic viruses, and engineered lymphocytes.

Copyright © 2021 Pezzicoli, Rizzo, Perrone, Minei, Mutti and Porta.

In plain English

This article is a review, not an original study. The authors outlined current treatment of malignant mesothelioma. They then surveyed therapies still in preclinical or early clinical development: new chemotherapy drugs, drugs that block blood-vessel growth (used alone or with immunotherapy), microRNA-loaded minicells, cancer-killing viruses and engineered T cells (CAR-T). The results they discussed come from other researchers' studies. They reported that the CheckMate-743 trial randomized 605 patients with advanced mesothelioma. Median overall survival was 18.1 months with nivolumab plus ipilimumab and 14.1 months with platinum-based chemotherapy. The review described many other trials; three examples follow. In a phase III trial, vorinostat did not significantly change survival compared with placebo. In a small trial of atezolizumab plus bevacizumab in peritoneal mesothelioma, 40% of patients responded. In a trial of a herpes virus (HSV1716) in 13 patients, no objective tumor responses were recorded, but disease stabilized in 50%. The article did not study asbestos exposure. The authors concluded that immune checkpoint inhibitors brought a small improvement. In their view, the road to more effective treatments is still long and complex.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Narrative review of treatment strategies for malignant mesothelioma; not an original study
• Who was studied: Published and ongoing preclinical studies and clinical trials of treatments for malignant mesothelioma (mostly pleural, one trial in peritoneal mesothelioma), as selected by the authors
• Exposure: Not an exposure study; the article reviews drug and other treatments. It mentions only as background that mesothelioma is linked to occupational asbestos exposure, and it names no fiber types.
• Main results:
  • Reviewed trial (CheckMate-743, Baas et al., 2021): 605 patients with advanced mesothelioma were randomized to nivolumab plus ipilimumab or platinum-based chemotherapy. As reported in the review, overall survival was 18.1 vs 14.1 months (HR 0.74).
  • Reviewed trial (VANTAGE-014, Krug et al., 2015): in patients who had progressed after first-line platinum treatment, median overall survival did not significantly differ between vorinostat and placebo
  • Reviewed trial (SAKK, Metaxas et al., 2020): pretreated mesothelioma patients given lurbinectedin alone had a reported median progression-free survival of 4.1 months and median overall survival of 11.1 months
  • Reviewed trial (Tsao et al., 2019, SWOG S0905): in chemotherapy-naive patients, median progression-free survival was 7.2 vs 5.6 months for cediranib plus chemotherapy vs chemotherapy alone; the review reports no significant difference in overall survival
  • Reviewed trial (Raghav et al., 2021): in patients with peritoneal mesothelioma after one prior platinum-based therapy, atezolizumab plus bevacizumab gave an objective response rate of 40%
  • Reviewed trial (Hassan et al., 2019): in treatment-naive patients given CRS-207 followed by chemotherapy, 31 of 35 had disease control, including 1 complete response
  • Reviewed trial (Danson et al., 2020): 13 patients with advanced mesothelioma received intrapleural oncolytic herpes virus HSV1716. There were no objective responses, disease stabilization was seen in 50% of patients, and no major adverse events were reported.
• The authors' conclusion: The authors concluded that immune checkpoint inhibitors gave a small improvement in palliative treatment, a first step, but that the road to more effective treatments for mesothelioma is still long and complex

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Neoplasm, checkpoint inhibitors, Prognosis, Immunotherapy.

Related studies

• Manipulating microRNAs for the Treatment of Malignant Pleural Mesothelioma: Past, Present and Future — G. Reid, T.G. Johnson, et al. (2020)
• Epigenetic Alterations and Biomarkers for Immune Checkpoint Inhibitors-Current Standards and Future Perspectives in Malignant Pleural Mesothelioma Treatment — Y. Yoshikawa, K. Kuribayashi, et al. (2020)
• Novel and Future Treatment Options in Mesothelioma: A Systematic Review — D. Štrbac, V. Dolžan (2022)
• The Current Treatment Landscape of Malignant Pleural Mesothelioma and Future Directions — B. Bertin, M. Zugman, et al. (2023)
• Photodynamic therapy for malignant pleural mesothelioma: the future of treatment? — J.S. Friedberg (2011)
• Immunotherapy, the promise for present and future of malignant pleural mesothelioma (MPM) treatment — V. Gounant, S. Brosseau, et al. (2021)

Browse more research in Frontiers in Pharmacology, or return to medical research.