Novel Insights Into Mesothelioma Therapy: Emerging Avenues and Future Prospects

Our plain-English summary of Novel Insights Into Mesothelioma Therapy: Emerging Avenues and Future Prospects, by L. Kuryk, G. Rodella, M. Staniszewska, et al (Frontiers in Oncology, 2022).

The study

• Authors: L. Kuryk, G. Rodella, M. Staniszewska, K.W. Pancer, M. Wieczorek, S. Salmaso, P. Caliceti, M. Garofalo
• Journal: Frontiers in Oncology
• Published: 2022;12:916839
• Type of article: Review
• Cited by: 20 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant mesothelioma is a rare and aggressive cancer that develops in the thin layer surrounding the mesothelium and is mainly caused by asbestos exposure. Despite improvements in patient prognosis with conventional cancer treatments, such as surgery, chemotherapy, and radiotherapy, there are still no curative treatment modalities for advanced disease. In recent years, new therapeutic avenues have been explored. Improved understanding of the mechanisms underlying the dynamic tumor interaction with the immune system has led to the development of immunotherapeutic approaches. Numerous recent clinical trials have shown a desire to develop more effective treatments that can be used to fight against the disease. Immune checkpoint inhibitors, oncolytic adenoviruses, and their combination represent a promising strategy that can be used to synergistically overcome immunosuppression in the mesothelioma tumor microenvironment. This review provides a synthesized overview of the current state of knowledge on new therapeutic options for mesothelioma with a focus on the results of clinical trials conducted in the field.

Copyright © 2022 Kuryk, Rodella, Staniszewska, Pancer, Wieczorek, Salmaso, Caliceti and Garofalo.

In plain English

This article was a review, not a new study. The authors summarized published research on treatments for malignant mesothelioma, mostly malignant pleural mesothelioma, with a focus on clinical trials. As background, they stated that about 80% of cases are associated with prior asbestos exposure and that crocidolite is considered the most carcinogenic form of asbestos. They reviewed surgery, chemotherapy, radiotherapy, immune checkpoint inhibitors, cancer-killing (oncolytic) viruses, cancer vaccines and engineered T cells. Among the trials they described was CheckMate743, a first-line trial in 605 patients with nonresectable malignant pleural mesothelioma. It reported overall survival of 41% with nivolumab plus ipilimumab versus 27% with platinum and pemetrexed chemotherapy, at a time point the review did not state. The DETERMINE trial of tremelimumab, in 569 previously treated patients, reported 18-month overall survival of 17.4% versus 18.2% with placebo, which was not a significant increase. The authors concluded that clinical practice has not changed dramatically in recent decades. They also concluded that checkpoint inhibitors used alone have a small effect on survival, and that hope comes from newer approaches such as oncolytic viruses combined with checkpoint inhibitors.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: narrative review of published clinical trials and preclinical studies on mesothelioma treatment
• Who was studied: No study population of its own; the review covered published and ongoing trials and animal studies, mainly in malignant pleural mesothelioma (MPM)
• Exposure: Not an exposure study. As background, the authors stated that about 80% of cases are associated with prior asbestos exposure. They named chrysotile and the amphibole fibers crocidolite, amosite, anthophyllite, tremolite and actinolite, and described crocidolite as considered the most carcinogenic form.
• Main results:
  • Reviewed trial CheckMate743 (605 patients, first-line treatment of nonresectable MPM): overall survival was 41% with nivolumab plus ipilimumab versus 27% with platinum and pemetrexed chemotherapy, as reported by that trial. The review does not state the time point at which these percentages were measured.
  • Reviewed trial DETERMINE (569 previously treated patients): tremelimumab did not significantly increase 18-month overall survival (17.4%) compared with placebo (18.2%)
  • Reviewed phase III chemotherapy trial (456 patients): pemetrexed plus cisplatin improved overall survival by nearly 3 months compared with cisplatin alone
  • Reviewed trial CONFIRM (nivolumab in relapsed mesothelioma): overall survival was 10.2 months with nivolumab versus 6.9 months with placebo, which the authors described as a modest improvement
  • Reviewed ONCOS-102 phase 1/2 trial (31 patients: 20 receiving ONCOS-102 plus chemotherapy, 11 receiving chemotherapy only): median overall survival at 30-month follow-up was 25.0 months for the subgroup of randomized first-line ONCOS-102-treated patients (n=8)
• The authors' conclusion: The authors concluded that checkpoint inhibitors used alone have a small effect on survival in MPM. They concluded that hope comes from innovative therapies such as oncolytic viruses combined with checkpoint inhibitors, and from new mesothelioma-specific targets.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Malignant Mesothelioma, Mesothelium, Asbestos Exposure, Prognosis, Chemotherapy, Clinical Trial, checkpoint inhibitors.

Related studies

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• Emerging avenues in immunotherapy for the management of malignant pleural mesothelioma — S.G. Gray (2021)
• Clinical Trials with Oncolytic Measles Virus: Current Status and Future Prospects — P. Msaouel, M. Opyrchal, et al. (2018)
• Risk of occupational exposure to asbestos, silicon and arsenic on pulmonary disorders: Understanding the genetic-epigenetic interplay and future prospects — P. Bhattacharjee, S. Paul, et al. (2016)
• Immunotherapy for malignant pleural mesothelioma. Current status and future prospects — R.M. Wong, I. Ianculescu, et al. (2014)
• Cancer genomics of lung cancer including malignant mesothelioma: A brief overview of current status and future prospects — S.C. Jhanwar, X.L. Xu, et al. (2020)

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