Once mesothelioma returns there aren’t a lot of other treatment options for patients. The immunotherapy drug avelumab for mesothelioma treatment may change that.

Mesothelioma is a highly resistant form of cancer, which means it can start growing again while a patient is being treated and it will likely come back once treatment has stopped. Once that happens, the options for additional forms of treatment are limited. However, a new study by the National Cancer Institute (NCI) is hoping to change that.

The researchers looked at avelumab, which is also known by its brand name Bavencio, to see if the mesothelioma would respond to it after previous therapies stopped working.

Avelumab as a Second-Line Mesothelioma Therapy

Using chemotherapy as a second-line treatment for mesothelioma has been mostly unsuccessful, which is why researchers and doctors are looking elsewhere. Right now, using immunotherapies, such as the drug avelumab, seems promising when Pemetrexed (Alimta) and cisplatin (the current standard of care) stops working.

The study by Dr. Raffit Hassan and his colleagues wanted to learn if avelumab would work and make sure it was a safe option for patients who had already undergone other types of treatments.

One of the reasons they decided to focus on avelumab is that the drug has already been approved for use as a second-line treatment for a bladder cancer called metastatic urothelial carcinoma.

However, because different cancers react differently to medications and treatments researchers can’t just assume what works for one disease will work for all cancers. This is why even though it has already been deemed safe to use in some cases, the research team is studying the efficacy and safety of avelumab for mesothelioma.

How Avelumab Works

Avelumab is a form of immunotherapy, which means it teaches your body to defend itself from tumors. It works with your body’s white blood cells, specifically t-cells, which attack foreign invaders like mesothelioma cells.

In a healthy individual, t-cells are monitored by proteins called programmed death ligand-1 (PD-L1), to ensure that they don’t attack healthy cells by mistake. However, mesothelioma produces PD-L1 excessively. This means the body’s t-cells are less active than usual and the body is making fewer t-cells than normal.

Avelumab stops PD-L1 from interacting with the t-cells, enabling your body’s immune system to recognize the cancerous cells as invaders and begin attacking them.

In this study, patients were given one avelumab dose of 10 mg/kg every two weeks until the disease progressed, they withdrew from the study, or their tumor disappeared. When the researchers stopped collecting the data, four participants were still receiving treatment.

Study Findings

Over the course of the study, the researchers demonstrated that avelumab could control unresectable (cannot be surgically removed) mesothelioma in the long term without becoming too toxic for the patient—even if the patient has been heavily pretreated with platinum or pemetrexed-based chemotherapies.

While the results of the study are promising, the authors urge caution because it’s only a phase 1b trial. This means the results are based on a small number of individuals, in this case, 53 individuals participated.

Of the participating individuals, 1 had a complete response (the tumor disappeared), 4 saw their tumors shrink and just over 50% saw their cancer stabilize.

However, because the initial results of this study are so promising, it suggests that avelumab for mesothelioma could be an excellent second-line treatment for patients. This means that more research into its effectiveness is justifiable, including investigating it in combination with another therapy such as mesothelin-targeted CAR t-cell therapy.

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Sources
  1. "Avelumab Safe, Active in Previously Treated, Unresectable Mesothelioma" Oncology Learning Network. Retrieved from: https://www.oncnet.com/news/avelumab-safe-active-previously-treated-unresectable-mesothelioma. Accessed January 16, 2019.
  2. "Efficacy and Safety of Avelumab Treatment in Patients With Advanced Unresectable Mesothelioma" JAMA Oncology. Retrieved from: A https://jamanetwork.com/journals/jamaoncology/fullarticle/2719756. Accessed January 16, 2019.
  3. "Bavencio (Avelumab)" Immuno-Oncology News. Retrieved from: https://immuno-oncologynews.com/bavencio/. Accessed January 16, 2019.

Last modified: January 29, 2019