Written By: Devin Golden
Immunotherapy for Mesothelioma
Mesothelioma immunotherapy is a type of mesothelioma treatment that helps the patient’s immune system fight cancer. The FDA has approved immunotherapy for mesothelioma, and patients are eligible to receive this treatment if they cannot have surgery.
Medically Reviewed By
Karen Ritter, RN BSN
Registered Nurse
Medically Reviewed By
Karen Ritter, RN BSN
Registered Nurse
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Facts About Mesothelioma Immunotherapy
- Mesothelioma immunotherapy helps the immune system attack mesothelioma tumors. Doctors use specific drugs or make genetic changes to the patient’s own cells to activate the immune system against mesothelioma.
- The FDA has approved two immunotherapy drugs (Opdivo and Yervoy) to treat people who have pleural mesothelioma but cannot have surgery to remove the disease.
- Immunotherapy has helped improve survival times for people with mesothelioma.
- Patients can also receive immunotherapy before or after surgery through a clinical trial.
How Mesothelioma Immunotherapy Works
Mesothelioma immunotherapy helps the patient’s immune system fight mesothelioma. Therapies accomplish this by improving the immune system’s ability to look for, identify, and attack mesothelioma tumor cells.
Cancer and the Immune System
The immune system is responsible for defending our body against all types of diseases. However, the immune system has trouble defending against cancers such as mesothelioma.
Cancer forms when cells mutate and multiply, forming a clump of cells called a tumor. Since cancer comes from our natural cells, our immune system often cannot distinguish between a healthy cell and a cancerous cell. They all look the same to the immune system.
This leads to the immune system ignoring cancer and allowing it to grow and spread without restraint.
Activating the Immune System Against Mesothelioma
Immunotherapy is a type of mesothelioma treatment that activates the immune system against cancer. Immunotherapy tells the immune system how to look for mesothelioma cells in the patient’s body and distinguish them from healthy cells.
There are a few ways immunotherapy can be used to help the immune system against mesothelioma. Some examples are:
- Block certain characteristics that help mesothelioma cells hide from immune system detection
- Use genetic engineering to train the immune system to look for mesothelioma cells
- Act as a magnet that attaches immune system cells to mesothelioma cells
- Use modified viruses to infect and kill mesothelioma cells, and alert the immune system
Explaining How Immunotherapy Works
Step 1. Immune cells don’t recognize cancerous cells as a threat, which allows them to replicate and spread.
Step 2. Immunotherapy attaches to or kills cancerous cells, which alarms the immune system.
Step 3. The patient’s immune cells recognize cancerous antigens and target cells with similar antigens.
Step 4. The patient’s immune cells seek out the remaining cancerous cells, leaving healthy cells unharmed.
Types of Mesothelioma Immunotherapy
The main types of mesothelioma immunotherapy are checkpoint inhibitors, adoptive cell therapy, monoclonal antibodies and oncolytic viruses.
Checkpoint Inhibitors
Checkpoint inhibitors are a type of immunotherapy that helps the immune system identify cancer cells. Checkpoint inhibitors block specific proteins on cancer cells from deflecting the T cells, which are an important part of the immune system.
Proteins on cancer cells – such as PD-L1 and B7 – connect with proteins on T cells to shut off their detection ability. Checkpoint inhibitors block these proteins from connecting, which keeps the T cells active.
Examples of checkpoint inhibitors are:
- Opdivo (nivolumab)
- Yervoy (ipilimumab)
- Keytruda (pembrolizumab)
- Imfinzi (durvalumab)
- Tecentriq (atezolizumab)
The brand names are listed first, and the generic names of the immunotherapies are in parenthesis. Opdivo, Yervoy, and Keytruda are approved for the treatment of pleural mesothelioma. The others are still in clinical trial testing.
Adoptive Cell Therapy
Adoptive cell therapy is a method of genetically changing cells of the immune system to help them fight cancer. Scientists can alter T cells and other immune system cells to direct them to look for cancer cells.
An example of adoptive cell therapy is CAR T-cell therapy. This type of immunotherapy is called cell and gene therapy. Scientists engineer the patient’s T cells to look for cancer cells with a specific protein. For mesothelioma, the CAR T cells are engineered to target the protein mesothelin, which is found on the surface of mesothelioma cells.
CAR T-cell therapy for mesothelioma is in clinical trial testing.
Monoclonal Antibodies
Monoclonal antibodies are immunotherapies that help the immune system attack cancer cells. They bind to protein receptors on the surface of cancer cells and T cells, serving as a bridge.
Examples of monoclonal antibodies for mesothelioma are:
- LMB-100
- Ramucirumab
- Anetumab ravtansine
They are in clinical trial testing.
Oncolytic Viruses
Oncolytic viruses are modified versions of viruses – such as the herpes simplex virus – used to infect cancer cells. Oncolytic viruses are engineered to infect only cancer cells while ignoring healthy cells, which keeps patients safe.
By infecting cancer cells, the virus causes the cancer cells to die and release certain proteins. This release of proteins alerts the immune system to look for and fight other cancer cells containing the same proteins.
ONCOS-102 is an example of an oncolytic virus for mesothelioma. It is currently in clinical trial testing.
Who Can Receive Immunotherapy for Mesothelioma?
People can receive immunotherapy for mesothelioma either through an FDA approval or enrollment in a clinical trial.
People with malignant pleural mesothelioma may be eligible for immunotherapy through an FDA approval. Eligibility depends on whether the patient can have surgery or not.
Clinical trials are another option for patients, including people with malignant peritoneal mesothelioma. These studies test novel immunotherapies on their own or in combination with other treatment options, including surgery and chemotherapy.
Each clinical trial has specific enrollment criteria that patients must meet. The criteria usually accepts patients based on their stage, cell type, and treatment history.
FDA Approvals of Mesothelioma Immunotherapy
The three mesothelioma immunotherapy drugs with FDA approvals are:
- Opdivo (nivolumab)
- Yervoy (ipilimumab)
- Keytruda (pembrolizumab)
All three are approved by the U.S. Food and Drug Administration (FDA) for unresectable malignant pleural mesothelioma. “Unresectable” is the medical term for when surgery is not an option.
In 2020, the FDA approved Opdivo and Yervoy for mesothelioma for use together. In 2024, the FDA approved Keytruda for mesothelioma in combination with chemotherapy.
“I think the dual immunotherapy protocol of Opdivo and Yervoy is one of the best innovations in mesothelioma treatment. It used to be that all you had was surgery. We’d do it and there wasn’t another avenue. I’m not a believer in a single bullet for cancer.”
Mesothelioma Specialist
Benefits of Immunotherapy for Mesothelioma
The main benefit of immunotherapy for mesothelioma is the treatment’s ability to activate the patient’s own immune system against cancer. This can control the disease and even put patients into remission.
“We know cancer is a disease of genetic mutations,” says Dr. Ezra Cohen, of the University of California San Diego Health, “and some of those mutations are revealed to the immune system through immunotherapy.”
Immunotherapy also differs significantly from chemotherapy. Immunotherapy does not pour toxins into the patient’s body. Patients usually experience much fewer and less severe side effects from immunotherapy than chemotherapy.
Success Rates of Mesothelioma Immunotherapy
The success rates of mesothelioma immunotherapy are promising. The average mesothelioma survival for people receiving FDA-approved immunotherapy drugs is approximately 19 months:
75% of patients live for at least one year after they begin treatment
41% of patients live for at least two years after they begin treatment
23% of patients live for at least three years after they begin treatment
These survival rates are significantly better than those associated with chemotherapy.
The FDA approval of Opdivo and Yervoy came after the immunotherapy combination outperformed chemotherapy in a large clinical trial. Opdivo and Yervoy gave patients a median survival of 18.1 months. Chemotherapy was attributed with a median survival of 14 months.
“When we see differences of 2-5 months, we think it’s a huge deal,” says Dr. Raja Flores, a mesothelioma specialist at Mount Sinai Health System.
Mesothelioma Immunotherapy and Long-Term Survival
Some people are achieving long-term cancer remission thanks to mesothelioma immunotherapy:
- A 74-year-old woman credits her 12-month anti-tumor response to Opdivo and Yervoy.
- A 59-year-old man with mesothelioma has been cancer-free since 2021 thanks to Keytruda.
- A 67-year-old man with mesothelioma has been cancer-free since 2018 thanks to Keytruda.
These success stories of long-term survival from mesothelioma immunotherapy deserve to be highlighted. Yet, patient expectations should be tempered. Long-term survival (five or more years) is rare without surgery.
Immunotherapy for Biphasic and Sarcomatoid Mesothelioma Cell Types
Immunotherapy can be especially beneficial for mesothelioma patients diagnosed with the biphasic or sarcomatoid cell types. These cell types are rarer and can be especially difficult to treat with surgery.
In a study of 179 people with mesothelioma, patients with biphasic and sarcomatoid cell types had a 1-year survival rate of 76.2% after immunotherapy. The 1-year survival rate is much lower for people who did not receive immunotherapy.
Side Effects of Mesothelioma Immunotherapy
The side effects of mesothelioma immunotherapy are usually manageable, especially compared to chemotherapy. The main side effects of mesothelioma immunotherapy are:
- Fatigue
- Cough
- Nausea
- Decreased appetite
- Constipation
- Joint pain
- Diarrhea
Some patients may experience allergic reactions to immunotherapy, such as:
- Itching/Rash
- Fever
- Chills
- Dizziness
- Wheezing
- Flushing of the face
Patients should report any side effects immediately to their doctor.
Where Patients Can Receive Mesothelioma Immunotherapy
Patients can receive mesothelioma immunotherapy at mesothelioma cancer centers of excellence. These cancer centers are located throughout the United States. These treatment centers can also work with a local facility to direct immunotherapy treatment so patients can remain close to home to receive their therapy.
The treatment centers follow official protocol to provide mesothelioma immunotherapy to patients who are eligible through an FDA approval or a clinical trial.
Mesothelioma Cancer Centers for Immunotherapy Treatment
Below are examples of mesothelioma cancer centers offering immunotherapy treatment or directing treatment with local treatment facilities:
- Dana-Farber Cancer Institute Brigham and Women’s Hospital (Boston, Massachusetts)
- Dan L. Duncan Comprehensive Cancer Center at Baylor St. Luke’s Hospital (Houston, Texas)
- Mayo Clinic (Rochester, Minnesota)
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Medicine (Baltimore, Maryland)
- Swedish Cancer Institute (Seattle, Washington)
What Is the Cost of Mesothelioma Immunotherapy?
The cost of mesothelioma immunotherapy can be expensive, but health insurance plans usually cover a portion of this cancer treatment.
It is important to be knowledgeable of your medical insurance plan and understand your deductible, out-of-pocket maximum, in-network providers and more. You should also keep track of medical records and bills to ensure you receive appropriate insurance coverage.
Clinical trials are one way to offset the cost of treatment. Many of the costs of immunotherapies are covered by the hospital or the manufacturing company sponsoring the trial. Talk with your mesothelioma specialist for more information about the clinical trials at cancer centers.
Future of Mesothelioma Immunotherapy
The future of mesothelioma immunotherapy is promising. Experts expect more immunotherapy treatments to advance through development and testing. They also hope that more personalized approaches to cancer treatment means more options and better access for patients.
Examples of mesothelioma immunotherapy that could emerge as effective treatment options are:
- Imfinzi (durvalumab)
- Tecentriq (atezolizumab)
- CAR T-cell therapy
- Oncolytic viruses
Patients may also benefit from future advancements in using immunotherapy with other mesothelioma treatment options, such as surgery. A study of 179 patients tested several combinations of mesothelioma treatment. Immunotherapy with surgery and chemotherapy performed the best: median survival of 22.6 months.
Frequently Asked Questions About Immunotherapy for Mesothelioma
What immunotherapy drugs are approved for mesothelioma?
The immunotherapy drugs approved for mesothelioma are Opdivo, Yervoy and Keytruda. The U.S. Food and Drug Administration (FDA) approved Opdivo and Yervoy for unresectable malignant pleural mesothelioma. Opdivo and Yervoy are approved for use as a combination. Keytruda is approved for unresectable malignant pleural mesothelioma in combination with chemotherapy.
How does immunotherapy treat mesothelioma?
Immunotherapy treats mesothelioma by helping the immune system look for and attack cancer cells. The immune system struggles to tell the difference between cancer cells and healthy cells. Immunotherapy activates the immune system against cancer by looking for specific proteins on the surface of mesothelioma cells.
What are the side effects of immunotherapy for mesothelioma?
The side effects of immunotherapy for mesothelioma are: fatigue, coughing, nausea, decreased appetite, constipation, joint pain and diarrhea. Most patients won’t experience all of these side effects, and are often manageable with medication. More serious side effects include allergic reactions to the therapy, resulting in itching, rash, wheezing or flushing of the face.
What is the average mesothelioma prognosis for people receiving immunotherapy?
The average mesothelioma prognosis for people receiving immunotherapy is 1-2 years. In a large study of nearly 600 people with mesothelioma treated with the immunotherapy drugs Opdivo and Yervoy, the average survival time was 18.1 months. This average survival time is better than that of chemotherapy. Some patients have achieved long-term survival of more than three years thanks to immunotherapy.
Where can people go for mesothelioma immunotherapy treatment?
People can go to cancer centers or local medical facilities for mesothelioma immunotherapy treatment. Mesothelioma Guide recommends going to a top mesothelioma cancer center first to learn all your treatment options and discuss your immunotherapy treatment plan with a mesothelioma specialist. Some of the top mesothelioma cancer centers are:
- Dana-Farber Cancer Institute Brigham and Women’s Hospital (Boston, Massachusetts)
- Mayo Clinic (Rochester, Minnesota)
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Medicine (Baltimore, Maryland)
Sources & Author
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- FDA approves pembrolizumab with chemotherapy for unresectable advanced or metastatic malignant pleural mesothelioma. U.S. Food and Drug Administration. Retrieved from: https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-pembrolizumab-chemotherapy-unresectable-advanced-or-metastatic-malignant-pleural. Accessed: 09/18/2024.
- Immunotherapy for Malignant Mesothelioma. American Cancer Society. Retrieved from: https://www.cancer.org/cancer/types/malignant-mesothelioma/treating/immunotherapy.html. Accessed: 09/11/2024.
- Major response of a peritoneal mesothelioma to nivolumab and ipilimumab: a case report, molecular analysis and review of literature. Frontiers in Oncology. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/39091916/. Accessed: 08/06/2024.
- A Complete Response to Pembrolizumab in Malignant Peritoneal Mesothelioma: A Case Report. National Library of Medicine. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/38384604/. Accessed: 02/26/2024.
- Case report: complete response and long-term survival on third-line immunotherapy in patient with pleural mesothelioma. Frontiers in Oncology. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/39267830/. Accessed: 09/16/2024.
- Efficacy and safety of nivolumab with ipilimumab for recurrent malignant pleural mesothelioma after primary surgical intervention. International Journal of Clinical Oncology Retrieved from https://pubmed.ncbi.nlm.nih.gov/36609928/. Accessed: 09/11/2024.
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- The cost of cancer: new drugs show success at a steep price. Reuters. Retrieved from: https://www.reuters.com/article/us-usa-healthcare-cancer-costs/the-cost-of-cancer-new-drugs-show-success-at-a-steep-price-idUSKBN1750FU. Accessed: 04/20/2021.
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