Ground-Breaking Clinical Trial Fights Mesothelioma Caused by Asbestos

Upcoming trial of Opdivo harnesses the immune system to target mesothelioma.

Since the late 1970s, mesothelioma incidence rates have dramatically increased in the UK, with more than 7 cases diagnosed per day.

Although treatment options exist, they mainly keep the cancer under control rather than cure the patient.

In an upcoming trial, scientists will examine whether nivolumab (Opdivo) could be used to treat mesothelioma caused by exposure to asbestos.

Nivolumab is currently approved in the UK to treat advanced melanoma and advanced kidney cancer. It is designed to block the PD-1 protein located on the surface of T cells. By blocking PD-1, it activates the T cells to target and kill cancer cells.

“The UK has one of the world’s highest incidences of mesothelioma and currently there aren’t many ways to treat it,” said co-chief investigator Gareth Griffiths. “Boosting the immune system by releasing killer T cells that have previously been blocked could offer us a new way to treat more patients with this devastating disease.”

For the trial, investigators plan to recruit 304 patients with relapsed mesothelioma from across 20 UK-wide sites, including Leicester and Southampton. CONFIRM is a randomized, controlled phase 3 trial that is funded by Cancer Research UK and supported by Bristol Myers Squibb.

“Preliminary studies targeting PD-1 in mesothelioma have shown promising activity,” said clinical lead Dean Fennell. “CONFIRM aims to definitively asses the true benefit of nivolumab for patients with relapsed mesothelioma in a setting where there is an unmet need. Critically, we aim to understand why patients respond (or not) to this drug, and identify biomarkers to ensure that we can personalize therapy to maximize the benefit for patients.”

Thus far, there have been one patient who has benefited from immunotherapy to fight mesothelioma, according to the study. Mavis Nye was diagnosed with cancer in 2009, and after several different failed treatments, she enrolled in a phase 1 to test pembrolizumab (Keytruda). After 2 years, scans showed that the tumors had decreased by 81% and 3 of the tumors disappeared completely. Nye is currently cancer-free.

“I was just an ordinary woman whose husband worked at the dockyards in Chatham,” Nye said. “We didn’t know what the effects of the asbestos on his clothes might be. Cancer is a terrible and devastating disease that turns everything on its head. I am so thankful that the trial I took part in worked. But it didn’t work for every participant. We need more trials to help improve treatments and survival rates for cancer, and this new trial is a big step in the right direction.”

Immunotherapy is already being used to treat advanced skin and kidney cancers, and has shown promise in other types of cancer as well.

“This clinical trial will find out whether an immunotherapy drug could benefit people with mesothelioma, which is hard for doctors to treat successfully, said Dr Catherine Pickworth, science information officer at Cancer Research UK. “We urgently need trials like this to help improve survival for patients with this aggressive type of cancer.”