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Immunotherapy vs. Chemotherapy Findings Major Topic at 2018 ASCO Meeting

At the start of 2018, the American Society of Clinical Oncology (ASCO) released its first ever mesothelioma guideline. In the guideline, which covers all aspects of disease management, the ASCO reported that chemotherapy continues to be the mainstay of treatment for malignant pleural mesothelioma (MPM). The guideline said:

“Patients who are surgical candidates should undergo procedures as part of multimodal therapy that includes chemotherapy with or without additional radiation therapy.” The organization added that while ongoing clinical trials “suggest promising activity of several new agents in MPM, they are not sufficiently mature to make treatment recommendations."

The new guideline went on to discuss the ASCO’s recommendations for five clinical areas including diagnosis, staging, chemotherapy, surgery, and radiotherapy, with strong recommendations for maximal surgical cytoreduction for patients with early-state disease, adjuvant radiation therapy after resection of histologically positive intervention tracts, and preferred first-line chemotherapy of pemetrexed-cisplatin doublet, or referral to a clinical trial. The guideline noted that the addition of bevacizumab (Avastin) to pemetrexed-cisplatin improved survival in selected patients.

By summer 2018, the largest clinical trial of the immunotherapy drug pembrolizumab (trade name Keytruda) was on track to be presented at the 2018 American Society of Clinical Oncology (ASCO) Annual Meeting. At the meeting, the results the randomized phase III trial were revealed, showing that pembrolizumab was a more effective initial, standalone treatment than chemotherapy for the majority of patients with the most common type of lung cancer. Although not as rare as MPM, lung cancer is similar to the disease, so many of the same drugs are used to treat the two conditions. 

The clinical trial consisted of 1,274 patients, with a median follow-up time of 12.8 months. The study revealed that, “people with advanced non-small-cell lung cancer (NSCLC) with a PD-L1 expression of 1% or more who were first treated with immunotherapy pembrolizumab lived a median of 4-8 months longer than those who received chemotherapy. In addition, severe side effects occurred in fewer patients receiving pembrolizumab than chemotherapy (18% vs. 41%).”

Based on earlier findings in a smaller clinical trial, the ASCO reported that the “U.S. Food and Drug Administration (FDA) approved pembrolizumab for initial treatment of NSCLC with high PD-L1 expression (score of at least 50%), which account for about one-third of these cancers.” Pembrolizumab is currently the only approved immunotherapy for initial treatment of lung cancer. It is approved for use as both a standalone treatment and in combination with chemotherapy.

At the meeting, the ASCO discussed the next steps. Highlights included more research to define patient groups who benefit from pembrolizumab and “current ongoing research exploring use of pembrolizumab after surgery (adjuvant) and combinations of immunotherapy with bevacizumab-containing combination regimens as part of initial therapy for NSCLC.”

If you have been diagnosed with mesothelioma, talk to your doctor about innovative treatment options such as pembrolizumab. Newer and emerging treatment options could be helpful in treating your specific type of mesothelioma, so talk to your doctor today.

 

Sources

Bankhead, Charles. "ASCO Releases First Mesothelioma Guideline." MedPageToday.com. MedPage Today, LLC., 26 Jan. 2018. Web. 10 Nov. 2018.

Fisher, Alise. "Immunotherapy Pembrolizumab Works Better Than Chemotherapy Alone as Initial Treatment for Most Advanced Lung Cancers." ASCO.org. American Society of Clinical Oncology (ASCO), 03 Jun. 2018. Web. 10 Nov. 2018.