Mesothelioma Community Hopes for the Same “Spectacular” Results As Seen in Melanoma Trial
Chemotherapy is considered the most effective single modality for the treatment of mesothelioma, an asbestos-caused cancer. However, the cancer has proven to outlive the effects of the drugs, and the average prognosis for mesothelioma patients is typically less than one year. Now, oncologists are hailing the results of an immunotherapy clinical trial for melanoma as “spectacular” and are predicting chemotherapy may someday be a thing of the past.
During the annual American Society of Clinical Oncology meeting held at the end of May in Chicago, Jedd D. Wolchok, MD, PhD, of Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, presented the results of the Checkmate 067 international clinical trial. The Phase III trial for metastatic melanoma patients, carried out at 137 sites globally on 945 patients, targeted advanced stage melanoma patients with a combination of two immunotherapy drugs, nivolumab or ipilimumab, or through therapy with just one of the drugs.
Results showed that in those patients who received the combination therapy the median progression free survival (PFS) was 11.5 months, compared with 6.9 months in the nivolumab only group, and 2.9 months in the ipilimumab only group.
“Together these drugs could release the brakes on the immune system while blocking cancer’s ability to hide from it,” said Dr. Alan Worsley, Cancer Research UK’s senior science information officer, according to a June 1 article with Sky News.
Many cancers, including mesothelioma, shut down the immune system – the body’s own defense mechanism – leading to uncontrolled growth of the cancer cells. Immuno-oncology medicines target reactivating the immune system so the body can fight off the diseased cells.
The two immunotherapy drugs used in the trial were nivolumab, a PD-1 checkpoint inhibitor, marketed as Opdivo by Bristol-Myers Squibb, and ipilimumab, a CTLA-4 checkpoint inhibitor, marketed as Yervoy by Bristol-Myers Squibb, according to Wolchok. Ipilimumab and nivolumab are both approved by the FDA to treat melanoma, but they have not been approved as a combination therapy. In March, the FDA approved the use of nivolumab for patients with previously-treated advanced squamous non-small cell lung cancer (NSCLC).
Sky News reports Professor Roy Herbst, chief of medical oncology at Yale Cancer Center, said that the results of the combination of drugs in the Checkmate 067 trial were “spectacular,” and that immunotherapy could replace chemotherapy as the standard cancer treatment within the next five years.
Immunotherapy Drug Shown Effective in Fight Against Mesothelioma
Wolchok reported that patients in the Checkmate trial who expressed the PD-L1 biomarker had better results than those who did not. These results point to assessing patients for a PD-L1 expression for best results with a PD-1 inhibitor.
Another PD-1 inhibitor immunotherapy drug proven effective against melanoma has also shown to be successful against mesothelioma in a clinical trial in which Mavis Nye, of England, is a participant. The six-year mesothelioma survivor has been a patient in a Phase I, no placebo clinical trial for the immunotherapy drug, MK-3475, marketed in the U.S. as Merck’s Keytruda (pembrolizumab). Mavis has been a participant in the trial for over a year and, she says, she has seen “brilliant results” with nearly complete tumor shrinkage.
Nivolumab has also shown success in lung cancer, leading to the FDA’s approval of the drug in March. Nivolumab, is the first and only PD-1 therapy to demonstrate overall survival in previously treated metastatic squamous non-small cell lung cancer.
The use of these immunotherapy drugs is another step towards using personalized medicine in the treatment of mesothelioma. By targeting specific proteins or biomarkers, such as PD-L1, instead of using a one-size-fits-all approach, the chance for survival and quality of life increases.
Pleural mesothelioma, a pulmonary cancer caused by past asbestos exposure, is one of the most difficult cancers to treat. The cancer is aggressive and quickly metastasizes to other organs leaving oncologists with limited treatment options. However, personalized care targeted to a patient’s unique mesothelioma characteristics optimizes the potential for success of the treatment and offers treatment options that may not otherwise have been considered.
“If we understand who to give it to, we can give the right drugs, to the right people at the right time with the right tumor and really dramatically increase the cure rate,” said Dr. Justin Stebbing, Professor of Cancer Medicine and Oncology, Imperial College of London, to Sky News. “And if we can’t cure people, we will increase the number of people living with cancer, as opposed to dying from it.”
“Immunotherapy is very exciting because the immune system is a natural and highly effective tool to fight disease,” said Dr. Axel Hoos, head of the immuno-oncology discovery performance unit at GlaxoSmithKline Pharmaceuticals, in a June 2014 interview with The Atlantic.
“No other drug or course of treatment has been able to generate the long-term benefits and promise for patients seen with cancer immunotherapies,” said Hoos.
Can Doctors Teach the Body to Cure Cancer?
Combined Nivolumab and Ipilimumab or Monotherapy for Untreated Melanoma
Doctors Hail ‘Spectacular’ Cancer Breakthrough
Nivolumab, Ipilimumab Combination Effective in Advanced Melanoma; Cost Questions Raised
Phase III CheckMate -067 Trial Demonstrates Superior Progression-Free Survival of Opdivo+Yervoy Regimen or Opdivo Monotherapy vs. Yervoy Monotherapy in Previously Untreated Patients with Advanced Melanoma
Phase 3 Study of Nivolumab or Nivolumab Plus Ipilimumab Versus Ipilimumab Alone in Previously Untreated Advanced Melanoma (CheckMate 067)