New drugs and new ways of using old drugs – including the controversial pharmaceutical Thalidomide – could vastly improve the prognosis for mesothelioma sufferers.
Breakthroughs in drug treatments as well as an examination of the effectiveness of radical lung surgery are among the most promising areas of research into the disease, which almost always proves fatal within a few years of diagnosis. Dr Nick Pavlakis, Head of Medical Oncology at Sydney’s Royal North Shore Hospital, told the recent Australian Lung Conference in Melbourne that Phase III clinical trials in four key areas promise to vastly improve treatment options for people with mesothelioma.
Dr Pavlakis led the Australian arm of the recently concluded MATES trial which sought to demonstrate whether the drug, which was banned in 1962 for causing terrible birth defects, could delay tumour regrowth while maintaining quality of life in mesothelioma patients who had already received standard chemotherapy treatment using pemetrexed (Alimta®). Dubbed MATES (MAintenance Thalidomide in mESothelioma), the trial was a collaboration between the Australasian Lung Cancer Trials Group and mesothelioma researchers in the Netherlands.
The drug is anti-angiogenetic, meaning that it inhibits angiogenesis – the formation of new blood vessels that supply cancerous tumours with the oxygen and nutrients needed to grow and spread.
The final results of the trial will be released next year but Dr Pavlakis can reveal anecdotally that some patients on the trial appeared to have prolonged remissions.
“What we observed is that a subset of patients experienced prolonged disease remission at a time when it would be expected that the disease would progress very quickly,” Dr Pavlakis said.
“I can tell you from my own personal experience of one patient who was on the trial who has done exceptionally well, feels fine and appears to be in complete remission.
“I think this drug is likely to benefit a sub-group of people. Our next question is: which group of people are they? There are some patients with mesothelioma who have gone on to have long survival rates and we have to ask: is this a patient who is going to do well anyway or is it because of the drug?”
Pharma company Celgene is continuing to develop new and better versions of the drug. Dr Pavlakis sees such partnerships with pharmaceutical companies as vital to the development of better mesothelioma treatments.
“Developing drug treatments is incredibly expensive. Just to run a 60- to 80-patient clinical trial costs over three-quarters of a million dollars – that’s without the cost of developing any drugs nor their supply. So it is important that we convince them (the pharma companies) that mesothelioma is an important area for research.
“For them, it can be beneficial to research a disease such as mesothelioma where there are relatively few drugs rather than go into a popular disease where there may be a dozen other companies competing.”
Other pIII trials that promise to have an impact on the treatment of mesothelioma are:
• MAPS: The Mesothelioma Avastin Pemetrexed Study, coordinated by the French Thoracic Cancer Intergroup. This is examining the addition of the anti-antiogenetic agent Avastin® (generically known as bevacizumab) which is used effectively with chemotherapy to treat other cancers, including colon, to standard pemetrexed chemotherapy.
• SAHA: An American trial for progressive or relapsed malignant mesothelioma that tests the efficacy of Vorinostat (or Suberoylanilide Hydroxamic Acid) which kills cancer cells and stops their division, as well as blocking enzymes that cells need to grow and multiply.
• MARS: The Mesothelioma and Radical Surgery trial in the UK hopes to settle a long-running argument among researchers on whether radical surgery adds usefully to the length and quality of life for mesothelioma sufferers.
Dr Pavlakis is convinced that the MARS trial is a vital part of the quest for the best management of mesothelioma.
“A long-standing area of debate is should people be put through radical surgery?” he said. “Surgical diehards argue that removal of the tumour is a crucial part of cancer treatment. That may be true in all other cancers but mesothelioma is different.
“It’s the biggest chest cancer operation anyone can have. The pleura is like a sheet of plastic wrap over the lung cavity. How can you ever be sure you’ve got it all when it is so fragile?
“If mesothelioma patients survive two to three years they are looking at spending up to six months of that recovering from the operation and living with the loss of a whole lung.”
Despite the length of time clinical trials take to come to fruition, the future is looking much brighter than it once did for those diagnosed with the disease.
“Up until 2003, there were no randomised trials for mesothelioma drugs,” Dr Pavlakis said. “Now we can tell patients that we are making real progress.”
By Catherine Madden