Experimental Mesothelioma Treatments: The Cutting Edge

Mesothelioma care is constantly evolving, thanks to the hard work and determination of medical researchers. New treatments are constantly being developed and rigorously trialed in order to improve the prognoses and improve the quality of life of patients.

A number of experimental treatment methods for mesothelioma at the forefront of that evolution. These new treatments expand and improve upon the current tools that mesothelioma patients have at their disposal to treat their condition and improve their quality of life.

Current Standard Treatments for Mesothelioma

The standard mesothelioma treatment has been composed of three standard mainstays, often referred to as “first-line treatments”: surgery, radiation, and chemotherapy. Multiple therapies are often combined in mesothelioma treatment, which is referred to as “multi-modal treatment.” Importantly, all three of these first-line mesothelioma treatments can be utilized both therapeutically (i.e., with the goal of combatting the cancer and improving prognosis/lifespan) and palliatively (i.e., with the goal of making the patient more comfortable and lessening the severity of symptoms).

Not all mesothelioma patients will benefit from every treatment method, and the strategy employed in patient’s treatment depends on the type, stage, and characteristics of the patient’s cancer, as well as number of other demographic and health-related factors.

Each patient’s mesothelioma treatment strategy also depends on the priorities of the patient. Some patients opt to improve quality of life above all, while others opt to improve projected prognosis and lifespan above all. Your mesothelioma care team will help you decide which treatment regimen is right for you.

The Cutting Edge: Promising Experimental Treatments

Cutting edge treatments seek to address these challenges in new and innovative ways, with the hope of finding better, more effective mesothelioma treatment solutions. Examples include:

• New Targeted Therapies and New Drugs: The current first-line drugs approved for the treatment of mesothelioma generally only affect the cancer short-term, which make them ineffective in the long run. New targeted drugs seek to extend the effectiveness of mesothelioma treatment to extend patient lifespans, improve prognoses, and alleviate symptoms. 

A number of drugs are currently being developed for this sort of mesothelioma treatment. Most of these drugs are used in conjunction with other treatments, and often with other chemotherapy and mesothelioma drugs. One type of new mesothelioma drug specifically targets a type of protein called mesothelin, which helps other chemotherapy drugs differentiate tumor cells from healthy cells. This reduces damage to healthy cells and improves the effectiveness of the drug against cancer cells. 

• New Multi-Modal Treatment Regimens: Innovations in mesothelioma treatment sometimes involve re-organizing and re-imagining the current most effective front-line treatment (i.e., multi-modal treatment combining chemotherapy, surgery, and/or radiation). New and improved combinations include:
• Four-Modality Treatment: This type of regimen adds a fourth treatment to the standard three: immunotherapy, which will be discussed below.
• Chemotherapy-Immunotherapy: The combination of standard chemotherapy with immunotherapy drugs looks to be promising for mesothelioma patients who do not qualify for surgery.
• SMART Protocol: SMART stands for Surgery for Mesothelioma After Radiation Therapy. It involves administering modulated radiation therapy to shrink the edges of tumors before performing surgery to remove cancerous tissue. Large-scale studies have found improved outcomes in some patients who had surgery after this type of radiaton. 

• Gene Therapy: Another type of targeted therapy, gene therapy uses a mesothelioma patient’s genetic information to determine which medication or treatment regimen will be most effective for them. Sometimes it involves manipulating the genes in the DNA of certain cells. 

One specific area of focus for mesothelioma treatment involves the BAP1 genetic mutation. In patients with this mutation, specific drugs injected into the cell (often through the use of modified viruses) may inhibit a protective enzyme, making cancer cells easier to kill with other treatments.  

Some targeted gene therapy may also offer less invasive treatment delivery methods for mesothelioma patients. A recent Japanese study published in the May 2022 issue of Scientific Reports examined the use of inhalable versions of two such gene therapy drugs to treat pleural mesothelioma. The treatment delivered targeted gene therapy directly into the lungs, which is far less invasive than standard mesothelioma treatment methods.

• Immunotherapy: Immunotherapy is one of the most widely studied and promising experimental treatment fields for mesothelioma. Immunotherapy uses the patient’s own immune system to target and destroy cancer cells, shrink tumors, and treat symptoms. 

Immunotherapy is a wide field, and there are a number of different types of immunotherapy currently being studied as mesothelioma treatments. These include:

1. Vaccine Immunotherapy: Some immunotherapy drugs are delivered through the same mechanism as a vaccine. Dead tumor cells are re-encoded and modified as tumor antigens, delivered through carriers (or “vectors”) injected into the body that trigger specific immune responses. These drugs can also be designed to attach to cancer cells so that the immune system more easily recognizes those cells as pathogens and attacks them.

1. Virotherapy: In virotherapy, viruses are engineered to work together with the immune system in order to more effectively target and attack cancer cells. Many clinical trials are currently being conducted on the effectiveness of virotherapy for pleural mesothelioma treatment, especially for patients for whom first-line therapies have not been effective. 

In one such trial, being conducted on hundreds of patients at medical centers around the world over the course of seven years, an engineered cancer-fighting gene called alpha-2b is inserted into millions of viruses, which are then injected directly into the patient’s chest. Used alongside standard chemotherapy (in this case, gemcitabine), alpha-2b is designed to target the genes that tell cancer cells to replicate, which may help slow or even stop tumor growth in some patients.

1. CAR T-Cell Therapy: This type of immunotherapy utilizes T-cells, which are a type of white blood cell. T-cells are removed from the body and engineered/re-created in a lab through CARs (chimeric antigen receptors) to fight cancer cells, before being re-injected into the chest cavity. Currently, many forms of CAR T-cell therapy being researched target the protein mesothelin (as in targeted drugs mentioned above). 

CAR T-cell therapy has been studied over the course of many years, and the growing body of research indicates that CAR T-cell therapy may be effective in shrinking mesothelioma tumors—often without any toxic side effects. The use of combination drugs like anti-PD1 may help extend the life and therefore the effectiveness of CAR T-cells.

1. Suicidal Gene Therapy: Suicide gene therapy is so-named because it uses cancer cells to transfer and replicate potentially cancer-fighting genetic material. This therapy is being tested on the premise that the new genetic material will work within mesothelioma tumors to kill cancer cells.

1. Cytokine Gene Therapy: Another gene-transfer treatment, cytokine gene therapy aims to transfer a gene triggering an anti-tumor immune response, which sends a signal to tumors to stop growing. While this therapy is still being developed, it holds a great deal of promise as a low-toxicity treatment for mesothelioma, as it is applied only to diseased cells (limiting the collateral damage to healthy cells).

• Photodynamic Therapy (PDT): Photodynamic therapy is a light-based mesothelioma treatment that is most useful in conjunction with other treatments. It involves injecting a targeted photosynthesizing solution (mthpc) directly into the patient, which is designed to be absorbed by cancer cells. A light is then shined on the affected area, specifically onto the tumor or tumors. This activates the injected photosynthesizer, causing a chemical reaction that kills the cancer cells that have absorbed it. Because it is cancer-centric, PDT can be effective with minimal collateral damage to healthy cells. 

PDT can be especially useful intraoperatively (during open surgery), during which it can help keep mesothelioma cells localized, preventing metastasis (the spread of cancer cells to other parts of the body).

Generally, PDT is most effective in treating localized, earlier-stage cases of mesothelioma, rather than later-stage cases that have spread throughout the body. However, there are applications currently being tested with the aim of activating the body’s immune response, bolstering the fight against both cancerous and pre-cancerous cells throughout the body.

• Tumor Treating Fields (TTFields): This type of treatment uses electrical fields to target, damage, and destroy cancer cells. It involves the delivery of alternating low intensity and intermediate frequency electric fields via adhesive pads applied to the skin. to destroy cancer cells. Though this treatment is still being studied, it is believed to work by disrupting the cell division process, interfering with the internal structures that have to separate in order for the cells to divide and multiply. 

A recent phase II STELLAR clinical trial studied TTFields’ effectiveness as a mesothelioma treatment and yielded promising results—especially alongside chemotherapy using pemetrexed and cisplatin or carboplatin. It indicated that TTFields may improve prognoses, lengthen lifespan, and alleviate symptoms, all without surgery, invasive procedures, or serious side effects.

TTFields is specifically recommended for use in patients with non-resectable mesothelioma (i.e., patients who are not eligible for surgery). Importantly, unlike some other treatments, TTFields can be used to treat both advanced local area mesothelioma, as well as mesothelioma that has metastasized to other parts of the body.

• Cryotherapy: Cryotherapy (sometimes called cryosurgery) involves using liquid nitrogen to freeze, damage, and kill cancer cells. Investigation into cryotherapy as a mesothelioma treatment is still in its early days, but some researchers are optimistic about the possible applications. Cryotherapy may be used before surgery to shrink tumors, or after surgery to treat recurrences and any remaining cancer cells/tumors. It can also be used palliatively to control symptoms.

• Gold Nanotubes: Another newly initiated area of mesothelioma treatment involves the use of tiny gold nanotubes (around one-thousandth the width of a strand of hair), which are designed to be absorbed by mesothelioma cells. Once absorbed, the tubes are activated and heat up, killing the cells from the inside. This treatment, which is slightly more on the experimental side, has not yet been trialed in humans. However, pre-human trials show promise.

Accessing Experimental Mesothelioma Treatments:

While all of these treatments are exciting, especially to mesothelioma patients facing lackluster prognoses, they must be specifically sought out. Some more common and established treatments, such as immunotherapy and gene therapy, are available at a number of specialized cancer treatment centers. The best way to access these treatments is to seek out cancer centers and specialists who specifically focus on the cutting-edge treatment of mesothelioma.

Another excellent way to access experimental treatments is to seek out clinical trials. Participation in clinical trials can both give patients access to otherwise unapproved or unavailable treatments and allow them to contribute to the greater good of medical research, improving the odds for future patients like them.

Your mesothelioma care team should be able to provide information on these treatments and whether they can provide access to them, as well as information and assistance in seeking out and applying for clinical trials.

Are you or a loved one interested in hearing more about experimental mesothelioma treatments, as well as how you might access them? Call us toll-free at 855-385-9532 or fill out our contact form to schedule a free consultation.