When people learn they have peritoneal mesothelioma cancer, the first treatment they consider is surgery. This option provides the best chance for the longest survival.

If surgery isn’t possible, patients are usually left scrambling to decide between a few therapies that aren’t likely to have the same benefit. This reality leaves doctors searching for a new therapy to suggest to patients worried about their prognosis.

A new study tested apatinib, a drug that inhibits a growth factor linked to cancer cells growing and spreading. This drug was tested on select people with peritoneal mesothelioma, and the survival data mirrored that of patients who underwent surgery.

Mesothelioma Guide has compiled a blog article examining what apatinib is, how it works, why it could be used for peritoneal mesothelioma, and how patients fared in this apatinib clinical trial.

 

What Is Apatinib?

Apatinib, also known as rivoceranib, is part of the tyrosine kinase inhibitor class of cancer treatment. The inhibitor blocks the vascular endothelial growth factor receptor-2, also called VEGF receptor-2.

How Does Apatinib Work?

VEGF is part of the “angiogenesis” process, which is the steps the body takes to create new blood vessels. The creation of new blood vessels supplies nutrients to tissue cells, both healthy and cancerous.

When tumor cells multiply and create new cells to form tumors, they require more blood vessels to supply more nutrients to account for the larger number of cells. VEGF plays a role in this process, which also applies to peritoneal mesothelioma.

Why Apatinib Can Work for Peritoneal Mesothelioma

The cells that make up peritoneal mesothelioma tumors need blood vessels to help them grow strong enough to survive against the immune system. The nutrients also give the peritoneal mesothelioma cells energy to multiply into new cells, continuing the growth and spread of deadly cancer.

Stopping the supply of these nutrients can modify the environment and limit the growth of cancer cells. This is why anti-VEGF drugs like apatinib have value for treating mesothelioma.

Apatinib blocks VEGF by linking with VEGF receptors. Blocking this growth factor puts a brake on angiogenesis, leading to a pause in the creation of additional blood vessels. The effect of this is new cancer cells are not receiving the nutrients they need to survive, much less flourish and multiply into more cells. The cancer cells eventually die due to a lack of oxygen caused by a lack of nutrients.

Apatinib is not the only anti-VEGF drug used to treat cancer, even mesothelioma. Ramucirumab and bevacizumab are two other VEGF inhibitors currently in testing for malignant mesothelioma.

 

Success Using Apatinib for Peritoneal Mesothelioma

In the aforementioned clinical trial, which was published in Frontiers in Oncology, a total of 27 patients received apatinib treatment for peritoneal mesothelioma. The median overall survival was 59.4 months, which is an extraordinary length for any treatment that isn’t surgery.

The main surgery for peritoneal mesothelioma is cytoreduction with HIPEC (heated intraperitoneal chemotherapy). This surgery removes visible tumors and washes the abdominal cavity with hot liquid chemotherapy. The intent is to remove large chunks of diseased tissue and bathe the entire cancer area with chemotherapy to eliminate any smaller, hidden tumors.

Various cancer centers for mesothelioma report average survival lengths of 3-5 years after cytoreduction with HIPEC. Any treatment for peritoneal mesothelioma that comes close to this length is much better than the usual standard of chemotherapy.

Apatinib Can Stop Peritoneal Mesothelioma Growth

Apatinib’s median survival in this study was just shy of five years. The overall response rate was nearly 60%. This means the treatment worked in stopping the growth and spread of peritoneal mesothelioma tumors, at least initially, for most patients. Four of the study participants had a partial disease response, meaning the cancer shrunk. Close to half of the patients (12 of 27) had a stable disease, meaning the cancer didn’t show any significant signs of growth or shrinking.

This result makes sense. The intent of VEGF inhibitors is to stop cancer from growing by preventing new cells from thriving – by stopping the creation of new blood vessels.

Existing cancer cells already have blood vessels supplying nutrients, so a VEGF inhibitor isn’t likely to kill well-established and strong cancer cells. None of the 27 study participants had a complete response (all tumors were eliminated).

 

What You Should Do About a Peritoneal Mesothelioma Diagnosis

Apatinib clinical trials are just one option for people with peritoneal mesothelioma. The first step is getting an official diagnosis, followed by talking about your options with a patient advocate.

Mesothelioma Guide has a team of patient advocates to help patients, caregivers and loved ones navigate a peritoneal mesothelioma cancer diagnosis. This team is led by Karen Ritter, RN. Karen’s priority is to help you find a cancer center to either have surgery to remove the peritoneal mesothelioma cancer or to explore other options, such as clinical trials for apatinib or other novel therapies.

Karen’s email is karen@mesotheliomaguide.com. Please email her if you have any questions or need any help understanding your diagnosis and figuring out how to fight this cancer.

    Sources & Author

    • Efficacy and Adverse Events of Apatinib Salvage Treatment for Refractory Diffuse Malignant Peritoneal Mesothelioma: A Pilot Study. Frontiers in Oncology. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/35847956/. Accessed: 09/28/2022.
Devin Goldan image

About the Writer, Devin Golden

Devin Golden is the content writer for Mesothelioma Guide. He produces mesothelioma-related content on various mediums, including the Mesothelioma Guide website and social media channels. Devin's objective is to translate complex information regarding mesothelioma into informative, easily absorbable content to help patients and their loved ones.

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    Sources & Author

Picture of Devin Golden

About the Writer, Devin Golden

Devin Golden is the content writer for Mesothelioma Guide. He produces mesothelioma-related content on various mediums, including the Mesothelioma Guide website and social media channels. Devin's objective is to translate complex information regarding mesothelioma into informative, easily absorbable content to help patients and their loved ones.