Immunotherapy Treatment for Mesothelioma

Medically Reviewed by Melinda Ratini, MS, DO on December 07, 2021
3 min read

Could immunotherapy, a type of cancer treatment that uses your body’s own immune system to fight tumors, help people with mesothelioma? Early research shows benefits for this hard-to-treat form of cancer.

Mesothelioma often starts in your pleura, a thin lining between your lung and the inside of your chest. Usually, it affects people who’ve breathed in asbestos, a material used in roofing and insulation. Tiny asbestos fibers go into your lungs and cause cancer cells to grow in the lining.

Mesothelioma treatments include chemotherapy, like cisplatin, gemcitabine, and pemetrexed. In October 2020, The FDA approved the immunotherapy drug Opdivo (nivolumab) in combination with Yervoy (ipilimumab) to treat mesothelioma that cannot be removed by surgery.

Where Is Immunotherapy Now?

Larger clinical trials with more mesothelioma patients will offer a better look at how well immunotherapy works and what side effects it can cause.

Other drugs are being studied for mesothelioma:

  • Atezolizumab (Tecentriq)
  • Nivolumab (Opdivo)
  • Pembrolizumab (Keytruda)
  • Tremelimumab

How Does Immunotherapy Work?

Unlike chemotherapy drugs, which kill both cancer and healthy cells, immunotherapy is more targeted.

It spurs your own defenses to fight the cancer. White blood cells in your immune system spot cells that aren’t supposed to be in your body, like bacteria or viruses. Immunotherapy drugs tell the white blood cells to sense certain proteins on the surface of cancer cells, then seek out and destroy those cells.

Block the Blocker

It sounds simple, but in mesothelioma, these proteins can block your immune system’s attack. They’re called checkpoints. They distract your white blood cells so they don’t attack the cancer inside. Checkpoint proteins include PD-1 and PD-L1.

Immunotherapy drugs like atezolizumab, durvalumab, nivolumab, and pembrolizumab are called checkpoint inhibitors because they block the proteins’ defense. Checkpoints normally act as an off switch for immune cells attacking tumor cells. Immunotherapy reveals the tumor cells. The checkpoint inhibitor pulls the mask off so the immune cells can do their job.

When Is It Used?

Mesothelioma is hard to treat because its tumor cells are high in checkpoints. So current trials test different mixes of immunotherapy drugs, as well as use of immunotherapy to rev up your immune system before cancer surgery.

The results: People who’ve failed other treatments often respond well to immunotherapy.

Right now, immunotherapy is mainly given to people with mesothelioma in clinical trials. So how and when do you know if you should sign up for one?

Every trial is different. Each has its own requirements for who can enroll based on the type of mesothelioma you have and what treatments you’ve already tried that didn’t work.

You and your doctor can talk about immunotherapy when you’re diagnosed and go over your treatment options. The type of mesothelioma you have and how far it has spread will help you decide if you should try chemotherapy or surgery first. Usually, you go into a drug trial if other treatments have failed. But some mesothelioma immunotherapy trials don’t require that.

How Do You Take Immunotherapy?

These drugs are all given as infusions, so you go to a clinic to get an IV drip every 2 to 3 weeks.

Immunotherapy can cause side effects including diarrhea, nausea, muscle pain, joint pain, rash, and inflamed organs.

Next Steps

Researchers want to find biomarkers, like genes or those proteins on the tumors, that could help immunotherapy drugs better hit their targets. Also, most people don’t respond to a single drug, so scientists are looking into combinations with surgery, other cancer drugs, and other immunotherapies.

More trials on more patients with mesothelioma may tell us how well they work in different types of this cancer, and why they seem to work when other drugs have failed. Doctors will go back and figure out why people had the response they did, whether it was partial or very good.

Your doctors will decide what treatments will work best for your unique situation. They may use immunotherapy first if it seems like it would be more successful than standard chemotherapy in treating your mesothelioma.