Encouraging results from a clinical trial at MD Anderson Cancer Center raised an important question. After approval for pleural mesothelioma, can two immunotherapy drugs work for peritoneal mesothelioma as well?
Mesothelioma Guide spoke to multiple peritoneal mesothelioma surgeons and specialists for their insight. The answers? A resounding “yes.”
“For thoracic mesothelioma, there has been a recent advance in terms of using immunotherapy, which likely is going to be an opportunity for patients with peritoneal mesothelioma as well,” said Dr. Edward Levine, a peritoneal mesothelioma surgeon at Wake Forest Baptist Cancer Center.
Better Survival for Unresectable Peritoneal Mesothelioma
The U.S. Food and Drug Administration approved Opdivo and Yervoy for unresectable malignant pleural mesothelioma. Opdivo and Yervoy are checkpoint inhibitors. They block specific protein receptors and allow the immune system to fight cancer cells.
Opdivo is the brand name for nivolumab. Yervoy is the brand name for ipilimumab.
Peritoneal mesothelioma was not part of the approval. This cancer forms in the lining of the abdomen, which houses many vital organs. The best option is surgery, but non‑surgical cases are left with intravenous chemotherapy and palliative care.
“I think there’s an opportunity and (immunotherapy) has to be part of the conversation,” said Dr. Shanel Bhagwandin, a peritoneal mesothelioma surgeon at Jupiter Medical Center.
Mesothelioma Guide previously reported the results of the MD Anderson Cancer Center study. The two immunotherapy medications led to an overall median survival of 19 months. The one‑year survival rate was 68%. Both are better than chemotherapy or no treatment at all.
There was a 65% disease control rate and the median progression‑free survival was 5.5 months. These statistics indicate an opportunity for expanding therapies for peritoneal mesothelioma.
Future of Systemic Therapy for Peritoneal Mesothelioma
The above data backs what’s being said by many peritoneal mesothelioma specialists. Dr. Brian Loggie, a surgeon at Creighton University Medical Center, explained he is seeing good response for immunotherapy as a first‑ and second‑line option.
“It’s combination therapy,” he said of using immunotherapy with surgery. “Everything is moving towards combination therapy.”
Dr. Joel Baumgartner, a surgical oncologist at Moores Cancer Center at UC San Diego Health, is another in support of the therapy.
“I think there is a future for (immunotherapy). The data is sparse at best,” he said. “The earliest studies included just a handful of peritoneal patients among the many pleural patients.”
Despite the small sample size using Opdivo and Yervoy, he said peritoneal patients have as good, if not better, results than pleural mesothelioma patients.
“I say we use it as a second‑ or third‑line option,” he added. “It’s not something we recommend to give up front.”
Doctors at Vanderbilt University Medical Center are offering immunotherapy with chemotherapy to one patient.
“We are trying immunotherapy in combination with traditional chemotherapy,” said Dr. Deepa Magge, the head of Vanderbilt University Medical Center’s peritoneal mesothelioma treatment.
“There is going to be a trial. We just discussed this at one of the conferences. They do want to figure out a good trial for peritoneal mesothelioma for immunotherapy.”
Hopefully, the support leads to more tests, which lead to more universally approved options for patients.
If you’d like to visit a cancer center open to immunotherapy for peritoneal mesothelioma, contact our medical team. Patient advocate and registered nurse Karen Ritter is reachable via email at karen@mesotheliomaguide.com.
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