The standard of care for malignant pleural mesothelioma may be about to change based on the results from a recent French study. The addition of bevacizumab (Avastin®) to the current standard of care by the French Cooperative Thoracic Intergroup (IFCT) showed an improved survival of nearly 3 months in the phase lll MAPS trial. The findings of the study were just presented at the 2015 annual meeting of the American Society of Clinical Oncology (ASCO).

Out with the Old and in with the New

Pleural mesothelioma is a rare and fatal cancer, with about 3,200 new cases diagnosed each year in the U.S. This very aggressive disease can take up to 20-50 years to develop in the body. The onset of mesothelioma typically presents itself with vague symptoms like chest pain, shortness of breath, continuous painful coughing episodes, and unexplained weight loss. In the majority of cases, by the time a patient sees his or her physician regarding these symptoms, the cancer is already advanced. A mesothelioma diagnosis can be made by a pleural biopsy.

For those individuals who are diagnosed with mesothelioma in its earlier stages, radical surgery may help in managing the cancer. Individuals who are not candidates for surgery usually undergo chemotherapy to help stop or slow down the growth of cancerous cells. Unfortunately, mesothelioma is highly resistant to radiation therapy, further narrowing options for treatment.

For the past decade, treatment of advanced mesothelioma has involved the use of two chemotherapeutic drugs – Cisplatin combined with Permetrexed (brand name Alimpta®). However, even with this combined therapy method, the median overall survival has not been shown to exceed 13 months. Mesothelioma survivor rate typically does not surpass 3 years. Over the past 2 decades, even with many types of new therapies and chemotherapeutic drugs, there have been very few significant improvements in survival noted.

The latest study from France, however, shows that the addition of bevacizumab (brand name Avastin®) to the standard Cisplatin-Permetrexed combined therapy method, may make a difference in mesothelioma survival.

What is Bevacizumab and How Does It Help Mesothelioma Patients?

Bevacizumab is an anti-angiogenesis agent, which means it can aid in preventing the growth and conservation of tumor blood vessels. What the researchers in France discovered was that the addition of bevacizumab to the current standard of treatment noticeably improved both progression-free survival by 2 months and overall survival by 2.75 months.

The lead investigator and researcher of the study, Arnaud Scherpereel, MD, PhD, clinical director of the Pneumo-Immuno-Allergy Service and professor at the University Hospital of Lille, France, specified that the addition of bevacizumab could usher in a new era of treatment for mesothelioma patients who are not candidates for surgery.

In this study, which was performed in 73 centers and conducted over a period of 6 years, there were 448 patients who were not candidates for surgery. The patients were then randomly assigned to standard chemotherapy which consisted of Cisplatin-Permetrexed combined therapy or to the same regimen plus the addition of bevacizumab. Patients were observed for an average of 39.4 months.

What the Results Say

Patients of the study who received bevacizumab had a better median survival rate compared against the control group who did not receive the new therapy. Median progression-free survival was also higher in the bevacizumab group. Mild adverse side effects from the new therapy included: slightly higher incidence of renal dysfunction, high blood pressure, formation of blood clots, and mild hemorrhage. However, none of these were life-threatening and none demonstrated a drastic impact on patient quality of life. In short, the results of this study may provide hope for some mesothelioma patients who are in need of different treatment options. According to Dr. Scherpereel, the three drugs combined should be the new treatment regimen for patients who are not candidates for life-saving surgery and are, instead, eligible to try bevacizumab.

Cancer experts across the U.S. have called this a “landmark study,” and its findings may change the standard of care and treatment for patients with advanced mesothelioma sooner rather than later. This positive development regarding the treatment of mesothelioma is sure to provide some level of hope and encouragement to oncologists and mesothelioma patients alike.

Dr. Philip Bonomi, Professor of Medical Oncology at Rush University Medical Center in Chicago went on to comment, “These are very exciting data and I hope it becomes the standard of care.”