Mesothelioma Guide registered nurse Karen Ritter created a list of questions for people diagnosed with mesothelioma to ask their doctor about immunotherapy. For more information on immunotherapy treatment for mesothelioma and any other questions you might have about this disease, please contact Karen at karen@mesotheliomaguide.com.
Immunotherapy is growing in popularity as a treatment option for mesothelioma. There are three immunotherapy drugs approved for people with specific types of mesothelioma: Keytruda, Opdivo and Yervoy, all approved for patients diagnosed with unresectable malignant pleural mesothelioma.
The approvals make immunotherapy available for people who cannot have surgery to remove their mesothelioma tumors. Most studies show that mesothelioma immunotherapy is easier for patients to manage than chemotherapy and can improve their life expectancy.
However, patients and their caregivers should ask their doctor some important questions before choosing immunotherapy as a treatment plan.
How Does Immunotherapy Work?
When a virus, infection or cancer invades the body, the immune system will typically identify the intruder and attack to protect the body. Immunotherapy helps boost the immune system’s response or overcome some of the challenges presented by the disease.
Mesothelioma cancer cells have a way of hiding from the immune system, allowing them to multiply in numbers and size without resistance. Immunotherapy for mesothelioma works to block the suppression mechanisms the cancer cells use to hide from the immune system.
Immunotherapy is proving to be an effective first-line treatment for mesothelioma. It is improving survival for many patients and giving them better quality of life than other standard treatments. While immunotherapy is showing positive results for patients diagnosed with mesothelioma, it is not without side effects and reactions that may be problematic or require the treatment to be stopped.
There is ongoing research to improve and optimize immunotherapy and other treatment options. Treating mesothelioma is challenging but thanks to the new advancements in technology, pharmaceutical knowledge and increasing understanding about this disease, there is hope for new and innovative therapies for patients.
What Are the Differences Between Keytruda, Opdivo and Yervoy (the Approved Mesothelioma Immunotherapy Drugs)?
Keytruda, Opdivo and Yervoy are approved immunotherapy drugs approved to treat mesothelioma. They are part of a drug class called checkpoint inhibitors and currently only approved for the treatment of unresectable pleural mesothelioma, which forms in the lining of the lungs. Immunotherapy is available for patients diagnosed with peritoneal mesothelioma (forms in the lining of the abdomen) through clinical trials.
- Keytruda (pembrolizumab) – This checkpoint inhibitor blocks the connection or interaction between a protein found on the immune system’s T cells (PD-1) and a protein often excreted by mesothelioma cells (PD-L1). Cancer cells use the connection of PD-1 and PD-L1 to hide from an immune system attack. By blocking this interaction, the immune system can freely find, target, and destroy the cancer cells.
- Opdivo (nivolumab) and Yervoy (ipilimumab) – These two immunotherapy drugs are designed to work together as a combination therapy for mesothelioma. Opdivo, like Keytruda, blocks the interaction between PD-1 and PD-L1, preventing the mesothelioma cells from hiding from an immune response attack. Yervoy blocks a different T-cell protein, called CTLA-4. CTLA-4 is used by the immune system as a regulator to prevent the attack of healthy cells. CTLA-4 links with B7 on mesothelioma cells to suppress the immune system. Blocking these proteins helps boost the immune system’s ability to attack cancer tumors.
How Long Do I Need to Take Immunotherapy for the Treatment to Work?
The duration of mesothelioma immunotherapy treatments depends on many factors and is evaluated carefully by the doctors. These factors include: disease progression, side effects and the patient’s response to the therapy.
Disease progression is when the cancer worsens or spreads despite receiving treatment. When this occurs, doctors may opt to discontinue the immunotherapy treatment or change to a different treatment option to achieve better results.
Immunotherapy is typically better tolerated than chemotherapy, but it is not without risks. Immune-related side effects can vary from mild to severe. Doctors are often able to manage and treat mild to moderate side effects with medications and other therapies to ease the symptoms. Severe or life-threatening side effects will result in the immediate halt of the immunotherapy treatment.
Another factor that can affect the duration of the immunotherapy treatment is a patient’s response to the therapy. Patients may see a quick and sustained positive response to immunotherapy – meaning the cancer has stopped progression, there has been a pronounced shrinkage of tumors, or the patient has obtained a cancer free or remission status. Under these circumstances, doctors may consider ending the immunotherapy treatment cycle early.
Immunotherapy is typically given for up to two years – pending tolerance, side effects and response. Treatment beyond two years is still being studied.
How Soon Can I Begin Immunotherapy Treatment?
Mesothelioma is a rare and aggressive cancer. For that reason, getting an official diagnosis and starting treatment quickly is a priority.
Once there is a confirmed diagnosis from a doctor – and doctors are aware of the extent of the disease and the mesothelioma cell type – treatment can begin. Immunotherapy has been FDA-approved for the treatment of unresectable pleural mesothelioma, which means surgery is not an option. Immunotherapy has rapidly become the treatment of choice for many mesothelioma specialists in these nonsurgical cases.
Immunotherapy treatments can be a standalone treatment or part of a multimodal treatment plan – paired with surgery or chemotherapy, usually through a clinical trial. Ask your doctor if immunotherapy is a treatment option.
Will You Work With My Local Oncologist so I Don’t Need to Travel to Receive My Immunotherapy?
Finding a mesothelioma specialist can be a crucial step after receiving a diagnosis of mesothelioma. There are mesothelioma specialists across the country, but it is often necessary to travel to see a doctor with the knowledge and experience needed to treat this rare cancer.
Doctors understand the desire and need for patients to be close to home, their family and their support system. The ability to stay close to home and family can greatly impact the success of a treatment.
Ask your doctor if they would be willing to work with your local oncologist. This will allow you to receive your systemic treatments close to home. Treatments are typically given every 3-4 weeks, and this amount of travel can put unwanted physical, emotional and financial strain on the patient and the family. Mesothelioma specialists understand this and will take all aspects of your care into consideration.
Mesothelioma specialists often agree to virtual consultations. Patients have the ability to meet with a mesothelioma expert and receive individualized treatment recommendations without having to leave their house. Ask your doctor if they are willing to work with your local oncologist and schedule virtual consultations.
What Side Effects Can Immunotherapy Cause?
Immunotherapy checkpoint inhibitors like Keytruda, Opdivo and Yervoy are designed to help the immune system identify and destroy mesothelioma cancer cells.
While the results of these FDA-approved treatment options have shown to be an effective alternative to traditional chemotherapy, they are not without their own risks and side effects. As a result of the boost in the immune response – immunotherapy can cause immune-related adverse events (irAEs).
Common mild to moderate side effects include:
- Mild to moderate fatigue
- Skin reactions (rash, itching or dryness)
- GI symptoms (nausea, diarrhea, or abdominal discomfort)
- Flu-like symptoms (fever, chills or body aches)
Severe or life-threatening side effects can include:
- Fever
- Low blood pressure
- Rapid heart rate
- Difficulty breathing
- Multi-organ dysfunction or failure
irAEs can cause the immune system to attack normal tissue, resulting in:
- Colitis (inflammation of the colon)
- Hepatitis (inflammation of the liver)
- Pneumonitis (inflammation of the lungs)
- Myocarditis (inflammation of the heart)
Severe and life-threatening side effects will result in the immediate stop of all immunotherapy drugs. Doctors monitor patients closely for any side effects or adverse reactions.
Are There Any Clinical Trials Offering Immunotherapy for Mesothelioma?
All medical treatments must go through rigid safety and effectiveness testing before being approved for use with patients. This testing is conducted through clinical trials.
There are clinical trials researching the efficacy of immunotherapy on peritoneal mesothelioma, chemotherapy and/or radiation paired with immunotherapy, and a multimodal therapy plan of chemotherapy and surgery followed by immunotherapy.
Immunotherapy is the newest therapy to join the ranks of standard mesothelioma treatments. At this time, it is FDA-approved for unresectable pleural mesothelioma. There is hope in the research community that the approval will soon be extended to peritoneal mesothelioma. Even newer studies are formulating combination therapies so that mesothelioma patients can benefit from integrated advanced treatment options.
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