Pleural mesothelioma is an aggressive type of cancer that forms in the lining of the lungs and can spread quickly to the lungs. This aggressive spread means many people diagnosed with mesothelioma are not eligible for surgery.
For nearly 20 years, the leading treatment option for pleural mesothelioma in many cases was chemotherapy.
That has changed with the rise of immunotherapy, which is a cancer treatment that activates the patient’s own immune system to more effectively find and attack tumors. The FDA has approved three immunotherapy treatments for unresectable pleural mesothelioma – two immunotherapy drugs are approved as a combination. These approvals placed mesothelioma immunotherapy as an equal to chemotherapy for patients considering treatment.
Now, with the release of new treatment guidelines based on recent study data, a top mesothelioma doctor is saying immunotherapy is “hands down” the superior option for patients with specific types of pleural mesothelioma.
Immunotherapy Preferred Over Chemotherapy for Types of Mesothelioma
Dr. Hedy Lee Kindler is a mesothelioma specialist at University of Chicago Medicine. She leads the Mesothelioma Treatment Program at the University of Chicago Medicine Comprehensive Cancer Center.
During an interview with the ASCO Podcast, which is hosted by the American Society of Clinical Oncology, Dr. Kindler said immunotherapy must be recommended to people diagnosed with a type of pleural mesothelioma called sarcomatoid mesothelioma. This type contains mostly sarcomatoid cancer cells, which usually give patients a poorer prognosis than other cell types.
Dr. Kindler also said people with a type of pleural mesothelioma called biphasic mesothelioma should receive immunotherapy over chemotherapy. Biphasic mesothelioma is a combination of sarcomatoid cells and epithelioid cells. The mesothelioma doctor said chemotherapy is only recommended for patients with epithelioid mesothelioma that cannot be removed with surgery.
“For patients with non-epithelioid histology, immunotherapy is hands down the recommended regimen based on the dramatic improvement in survival for immunotherapy compared with chemotherapy,” Dr. Kindler said.
The podcast interview is a follow-up to publication of the “Treatment of Pleural Mesothelioma: ASCO Guideline Update,” which Dr. Kindler was lead author of.
Immunotherapy Leads to Better Survival for Sarcomatoid Mesothelioma and Biphasic Mesothelioma
For many years, experts said sarcomatoid mesothelioma was associated with poorer prognosis for patients. Sarcomatoid cancer cells have a less-defined cell shape and spread more aggressively. Surgery is often not a treatment option for this type of mesothelioma, and people receiving mesothelioma chemotherapy live on average less than one year.
Immunotherapy is changing these outcomes, and it is now recommended that people with sarcomatoid mesothelioma receive the immunotherapy combination of nivolumab (Opdivo) and ipilimumab (Yervoy).
In a study of people with sarcomatoid mesothelioma and biphasic mesothelioma, those receiving Opdivo and Yervoy lived on average for 18 months. People receiving chemotherapy lived on average for 8 months.
During the interview, Dr. Kindler referenced this study as the main benchmark for why immunotherapy is the preferred treatment option for these types of mesothelioma – and chemotherapy is not.
“(Chemotherapy) is not recommended in patients with non-epithelioid disease unless they have medical contraindications to immunotherapy,” Dr. Kindler said.
Sources & Author
- Podcast: Treatment of Pleural Mesothelioma Update. ASCO Publications. Retrieved from: https://ascopubs.org/do/treatment-pleural-mesothelioma-update-. Accessed: 01/11/2025.
Sources & Author
