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Mesothelioma, how to understand who will respond to immunotherapy

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Use side effects as a signal that the tumor will respond to immunotherapy. We are talking about mesothelioma, lung cancer linked to exposure to asbestos, and the data comes from the congress of the American Society of Clinical Oncology (ASCO) which closes today.

In most patients who develop mesothelioma, the first therapeutic approach is pharmacological and, since 2004, combination chemotherapy has been considered the first line standard of care but only with palliative intent. “Immunotherapy can also play a role, but to date we have no elements to predict the response in patients eligible for this treatment”, explains Rossana Berardi, Professor of Medical Oncology at the Polytechnic University of Marche, Director of the Ospedali Riuniti Oncology Clinic of Ancona and coordinator of AIOM (Italian Association of Medical Oncology) Marche: “The data presented to Asco, however, suggest that developing treatment-related side effects may represent a factor capable of predicting the response and efficacy of immunotherapy”.

I study

In the study, conducted on 61 patients with mesothelioma treated in the first line with immunotherapy, 28% had developed side effects related to early treatment, with an improvement both in terms of activity, or in terms of clinical benefit linked to the disease, and in terms of terms of efficacy, i.e. of impact on survival. Notably, overall survival was higher in patients who developed immune-related side effects (21.1 months versus 4.7 months), as was progression-free survival (6.8 months versus 1.7 months). ). And the increase in clinical benefit was significant (65% versus 27%).

The new data on vinorelbine chemo

It is not the only news regarding this tumor to come out of the congress. “Another study conducted by English colleagues – continues Berardi – has demonstrated the efficacy of chemotherapy treatment with a drug, vinorelbine, already used for other oncological pathologies and as a second line in mesothelioma itself. Until now, however, randomized clinical trials on the role of vinorelbine in case of relapse were lacking, despite its wide off-label use “. 154 patients were enrolled for the study, with relapse after first-line chemotherapy. Progression-free survival reached 4.2 months with supportive vinorelbine compared to 2.8 months with supportive care alone.

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Mesothelioma in Italy

In our country, in 2020, almost two thousand new cases were estimated, but the incidence is constantly growing (there were 1,800 in 2019). The 5-year survival is approximately 9% and the mean age at diagnosis is 70, with no gender differences. “It is a tumor that arises in over 90% of cases from the pleura and, to date, remains a difficult pathology, for which there is no effective curative therapy”, continues the oncologist: “Unlike other solid tumors, even in in the case of early diagnosis, the surgical treatment, however burdened by great complexity, does not have a significant impact on survival due to the high rate of local relapses “. Italy is one of the countries in the world most affected by asbestos-related diseases: this condition is the consequence of the widespread use of this mineral, with almost 4 million tons produced in our country in the period from 1945 to 1992. Production , the processing and sale of asbestos have been prohibited in Italy since 1992. “Today – continues Berardi – the great attention to the issue of asbestos-related diseases, almost 30 years after the ban on all forms of extraction, processing, import and trade, derives from the high incidence of mesotheliomas due to the intense use of the material from the second post-war period up to the 1980s and the long latency of the disease, which can reach over forty years. The studies presented at the Asco Congress – he concludes – are the demonstration that, even in mesothelioma, research is progressing and in the future it will be possible to win the challenge of being able to treat these patients ”.

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