After receiving a diagnosis for pleural mesothelioma, one 68-year-old man started for the standard treatment path of surgery followed by chemotherapy. Unfortunately, the standard treatment wasn’t working for him, as is the case with many mesothelioma patients.

His care team decided to try immunotherapy instead and started him on nivolumab. After he began the new treatment, his condition improved from likely being fatal in a few weeks, to the point where he was able to return to work. Now, 36 months after his initial diagnosis he is still doing well.

Background of the Case

The prognosis for pleural mesothelioma is poor. Currently, the median survival rate is only 12 months. For one 68-year-old male, even surviving for 12 months seemed like a pipe dream. After undergoing an extrapleural pneumonectomy (EPP), he began chemotherapy—the standard frontline treatment.

Chemotherapy only works for around 35 to 41% of mesothelioma patients, and the 68-year-old male in this case study was not one of those individuals. The treatment was failing him.

According to the Karnofsky Performance Status (KPS), which determines how able a patient can perform everyday tasks, he was functioning at only 50%. He was suffering from dyspnea, a cough and he needed to be on oxygen.

New Treatment Plan With Immunotherapy

Something needed to change. Because of some previous health issues, his medical team decided that immunotherapy would be the best way to go and the team started him on a treatment of nivolumab. Five weeks after starting the therapy, his condition improved.

His dyspnea and cough disappeared, and his KPS went up to 80%. Then his oxygen no longer needed to be supplemented after 8 weeks. Within 4 months his KPS was at 90%, and he was able to return to work.

Of course, his prolonged recovery wasn’t free from any side effects. He did develop mild hypothyroidism, and his body began producing slightly more lipase—the protein that helps your body digests fat—than usual, which can be a symptom of other problems. However, while he continues to receive a nivolumab infusion every other week, he is still active and remains in remission.

How Nivolumab Compares to Other Treatments

Unlike chemotherapy, which uses a cocktail of drugs to kill cancer cells, or radiation, which uses either external or internal radiation to destroy tumors, immunotherapy helps the patient’s body combat cancer on its own by enabling the body to recognize cancer cells as being harmful.

One way that mesothelioma cells hide is by using programmed death-1 (PD-1) receptors which prevent the immune system from activating. However, nivolumab can block the PD-1 receptors, which means the body’s immune system can recognize that the tumor cells are a threat.

When the PD-1 receptors are blocked, the body’s white blood cells, specifically their T-cells, activate, meaning the T-cells will seek out cancerous cells and destroy them.

The Future of Immunotherapy and Mesothelioma Research

Right now the standard treatment for mesothelioma involves chemotherapy. However, many patients, including the 68-year-old male mentioned above, don’t respond well to it or stop responding after a short time.

Unfortunately, there aren’t any current FDA-approved alternative treatments for mesothelioma patients who have stopped responding to chemotherapy. Mesothelioma researchers are hoping to change that.

Since nivolumab and other PD-1 inhibitors are showing such promise, researchers have a direction to focus. Now that they know PD-1 inhibitors do allow the body’s immune system to be activated, the scientists can keep tailoring these drugs to make them safer and work better.

More clinical trials involving nivolumab are popping up. While many of these trials are still in the beginning stages, if they keep performing well, patients will soon have easier access to these treatments. Undergoing novel therapies like nivolumab may allow patients to return to their lives and experience more prolonged periods of remission than before.

For more information on new mesothelioma therapies, contact our Patient Advocates today. Call us at (800) 584-4151 or receive a FREE Mesothelioma Help Guide to learn more about participating in clinical trials.

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Sources
  1. Jones, R. G., Karthik, F., Dugar, A., Kanagarajan, K., Desai, K., & Bhandari, M. (2018). Nivolumab Immunotherapy in Malignant Mesothelioma: A Case Report Highlighting a New Opportunity for Exceptional Outcomes. American Journal of Case Reports. Retrieved from: http://doi.org/10.12659/AJCR.909584. Accessed July 13, 2018.
  2. National Cancer Institute. NCI Dictionary of Cancer Terms. Retrieved from: https://www.cancer.gov/publications/dictionaries/cancer-terms/def/karnofsky-performance-status. Accessed July 13, 2018.
  3. WebMD. What is a Lipase Test? Retrieved from: https://www.webmd.com/digestive-disorders/what-is-a-lipase-test#1. Accessed July 17, 2018.

Last modified: October 24, 2018