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New immunotherapy treatment for mesothelioma lung cancer proves effective.

Trial results show that pembrolizumab in combination with platinum-pemetrexed chemotherapy is an option for patients with advanced pleural mesothelioma.

Results from a phase III international study (IND.227) were recently published in The Lancet  and evaluated the use of the immunotherapy drug pembrolizumab combined with platinum-pemetrexed chemotherapy. Researchers conclude that as a first-line treatment for patients with unresectable advanced or metastatic pleural mesothelioma, pembrolizumab plus platinum-pemetrexed chemotherapy represents a new treatment option for patients.

“By adding pembrolizumab to platinum-pemetrexed chemotherapy the study demonstrated a significantly improved overall survival, progression-free survival and objective response rates compared to the chemotherapy alone and represents a new treatment option for patients with advanced pleural mesothelioma,” Dr. Penelope Bradbury, Chair of the CCTG Lung Disease Site Committee, a medical oncologist at the Princess Margaret Cancer Centre and one of the highest accruing investigators on the study.

Pembrolizumab therapy works by increasing the ability of the body’s immune system to help detect and fight tumor cells. It is already approved for use in other forms of cancer, including in combination with pemetrexed and platinum chemotherapy in non-small cell lung cancer.

“Only in the last few years have there been any changes in the standard of care for patients with pleural mesothelioma. Illustrating improvements in both progression free survival and overall survival, the results of this study are poised to have a tangible and meaningful impact on patients’ lives,” says Emi Bossio, a lung cancer survivor and CCTG Lung Cancer Patient Representative.

Patients with pleural mesothelioma are not diagnosed until an advanced stage, when the survival rate is lower, and surgery is not an option. Standard treatments have been used for nearly 20 years and only recently have studies shown that new approaches such as immunotherapy improve outcomes.

“I was enrolled in the IND.227 trial. I received chemotherapy and immunotherapy and my cancer disappeared. I am off any treatment since September 2020 and I am still in remission today, enjoying life and playing golf whenever I can,” reveals Joan Davis Prevost, a patient who participated the IND.227 study under the care of Dr Marie Florescu from Centre hospitalier de l'Université de Montréal (CHUM). “I hope all patients with mesothelioma could have access to this combination to get a real chance to crush this cancer.”

Asbestos exposure is the main risk factor for pleural mesothelioma and until recently, chemotherapy was the only available treatment. While this rare form of cancer was considered a fatal disease a few decades ago, significant advances have recently been achieved thanks to clinical research efforts.

IND.227 study results

In the final analysis of the study, pembrolizumab plus chemotherapy significantly improved overall survival, reducing the risk of death by 21% and that survival at 3 years was higher for pembrolizumab and platinum-pemetrexed chemotherapy compared to platinum-pemetrexed chemotherapy (25% of patients alive vs 17% of patients respectively).  Progression-free survival was also significantly improved.

These results were presented earlier this year at the 2023 American Society of Clinical Oncology (ASCO) Annual Meeting.

About pleural mesothelioma

Mesothelioma is a type of cancer that starts in the linings of certain parts of the body, and pleural mesothelioma develops in the lining of the lungs. Worldwide, it is estimated there were more than 30,000 new cases of malignant mesothelioma diagnosed and more than 26,000 deaths from the disease in 2020. Pleural mesothelioma is usually advanced and incurable when diagnosed and is related to exposure to asbestos.

International collaboration

International academic collaborations are an important mechanism to explore new treatments that improve outcomes for patients. This study was led by the Canadian Cancer Trials Group (CCTG) with partners in Italy (NCI-Naples) and France (IFCT).  The trial was supported by a grant from the Canadian Cancer Society (CCS) (707213); Merck supported the trial providing the immunotherapy drug pembrolizumab (KEYTRUDA®) and some funding for the study.