Mesothelioma — clinical advances offer hope for patients

Mesothelioma is an aggressive cancer invariably linked to past exposure to asbestos. Only 5% of patients survive five years after clinical diagnosis with a median survival time of 18.1 months (CheckMate 743 study).

Micro RNA — 34a

Many cancers like mesothelioma contain genes which are resistant to cancer therapies. The substance MicroRNA-34a is usually missing in cancer cells but is prevalent in healthy cells and slows down cell division.

By treating mesothelioma patients with a modified version of MicroRNA-34a, scientists led by Andrea Kasinski, Associate Professor of Biological Sciences at Purdue University (as reported in Oncogene), have found that this “acts like the brakes on a car”, in slowing mesothelioma tumour progression.

NERO trial — University of Southampton

Building on the back of earlier findings revealed in a University of Leicester study (MiST 1) led by Professor Dean Fennell, researchers at the University of Southampton have launched a fresh study of 84 mesothelioma patients focused on the intravenous delivery of a PARP inhibitor — Niraparib.

The MiST 1 study suggested that treating patients with PART inhibitors acted as a block to prevent cancer cells repairing their DNA — causing cancer cells to die after conventional chemotherapy or radiotherapy treatment.

The clinical trial “NERO” is led by Doctor Judith Cave, a medical oncologist working alongside Professor Dean Fennell, and will see 84 patients given Niraparib in a ratio of 2:1.

Those patients not assigned Niraparib will have their condition monitored closely and be offered a range of alternative treatments if/when their symptoms progress.

PARP inhibitors have previously been shown to be effective in the treatment of both breast and ovarian cancers.

Multimodal therapy

In the United States, the dual combination of Opdivo and Yervoy as a first line treatment became, in 2020, the first drug regime approved for mesothelioma by the Federal Drug Agency (FDA) in 16 years.

In September 2023 “asbestos.com” reported for the first time on the use of multimodal therapy in treating mesothelioma, concluding that, “Combining traditional and emerging therapies will become the new gold standard”.

The new treatments include:

• TTFIelds — a type of anti-cancer therapy which uses alternating electrical fields to limit cancer growth
• HIThoc — a way of delivering chemotherapy drugs to the chest cavity during surgery
• SMART Protocol — radiation therapy before extra pleural pneumonectomy surgery

Clinicians hope that one day mesothelioma will become a treatable condition. Both ongoing clinical trials and new treatments offer hope that median survival times for those diagnosed with mesothelioma will improve markedly over the next decade. According to HSE estimates, past asbestos exposure is responsible for 5,000 deaths in the UK each year.