Mesothelioma, and particularly diffuse pleural mesothelioma (DPM), is a rare and aggressive form of cancer linked to asbestos exposure. Despite global research seeking a cure, treatment options remain limited and ineffective in the long term. A newly released study published in the journal Nature Medicine details the promising results of a phase 2 trial examining the use of perioperative nivolumab or nivolumab plus ipilimumab.
Immunotherapy and Mesothelioma
Recently, immunotherapy—drugs that help the body’s immune system attack cancer—has shown great promise in treating mesothelioma. Clinical trials have shown that combining immunotherapy drugs like nivolumab and ipilimumab, or pembrolizumab with chemotherapy can extend patients’ lives when compared to chemotherapy alone. These combinations are now approved as frontline treatments.
Additionally, mesothelioma is frequently treated with surgery, but whether surgery truly improves survival remains controversial. Past trials that tested adding surgery to chemotherapy showed high complication rates and little survival benefit. One reason for this is that mesothelioma grows differently from other cancers—it spreads across the lining of the lungs rather than forming neat tumors. This makes it difficult to measure the tumors’ response to treatment using standard scans. As a result, doctors are cautious about recommending surgery alone without additional therapies to support it.
New Tracking Methods Show Promise in Mesothelioma
Doctors trying to track whether mesothelioma treatment is working find that traditional scans generally can’t measure the rare form of cancer’s unusual tumor growth patterns. Modified guidelines (mRECIST) help, but the results can still be inconsistent. To improve this, researchers from Georgetown University’s Department of Hematology/Oncology and the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University School of Medicine studied both the use of neoadjuvant nivolumab and nivolumab/ipilimumab in resectable DPM and the feasibility of using “liquid biopsies” that test blood samples for tumor DNA.
The researchers found that using new, ultra-sensitive DNA tests paired with machine learning showed real promise in providing accurate, timely results. They also tested the use of immunotherapy before and after surgery and found that giving patients immunotherapy before surgery was both safe and practical, with most patients still able to undergo surgery on time. Results showed encouraging signs of longer survival, especially when two immunotherapy drugs were combined. While these findings are early and involved small numbers of patients, they align with successes seen in other lung cancers, suggesting real potential for future mesothelioma care.
Mesothelioma treatment continues to favor multi-modality approaches, but research is suggesting innovative protocols that combine surgery, immunotherapy, and advanced testing like liquid biopsies. While more research is needed, especially in larger studies, these new approaches could lead to more personalized treatment and better survival.
If you or someone you love has been diagnosed with mesothelioma and you need access to information, the Patient Advocates at Mesothelioma.net can help. Contact us today at 1-800-692-8608 to learn more.
