From the blog

Keytruda as a Second Line Treatment for Mesothelioma

Published: August 26, 2022

A new second line treatment has been developed for pleural mesothelioma. The treatment was created at the Netherlands Cancer Institute in Amsterdam. Research was done as a single-arm, open-label clinical trial combining pembrolizumab (Keytruda) and lenvatinib. The results were presented at the IASCL 2022 World Conference on Lung Cancer in Vienna, Austria. The two drugs are showing great synergy when combined. Researchers conducting the study are happy with the results, but they believe more research is needed for the drug combination.

There were 38 patients with mesothelioma who could not receive surgery in the study. Their cancer started progressing after their chemotherapy regimen failed. Patients started in the study from March 5, 2021 through January 31, 2022. All patients received pembrolizumab intravenously once every three weeks and Lenvatinib once a day orally. There are still patients being treated in the study. Early results show that there was a median overall survival of 11.4 months and a median progression free survival of 5.7 months. These numbers are promising, but they are still early results, so more research needs to be done to ensure all data is accurate.

Keytruda has been successful as a single therapy for some cancers, but it does not work well by itself for mesothelioma. Its response rate for mesothelioma is only 20 percent, but with Lenvatinib the response rate was 58 percent. Keytruda was approved for certain metastatic tumors in 2020 but researchers still need to find the right drug to use alongside Keytruda for mesothelioma. Lenvatinib is a good candidate because it can block tumor growth by targeting proteins that Keytruda cannot. It has only been found to be effective alongside certain cancers, so it working for mesothelioma is great news. Lenvatinib has been approved to treat endometrial cancer alongside Keytruda. It is also used alone to treat hepatocellular carcinoma, which is a cancer of the liver. It can also be combined with other drugs to treat renal cell carcinoma.

Since many people do not respond to first line mesothelioma treatments, a second line treatment needs to be found. Currently, the average life expectancy for someone diagnosed with mesothelioma is 12 to 21 months. Mesothelioma is primarily caused by asbestos fibers, which become lodged in lung and mesothelial tissue after being inhaled. Around 3,000 new cases are diagnosed in the United States every year. In 2020, Opdivo and Yervoy were approved for use in mesothelioma patients. The immunotherapy combination does not work well long term for the disease though. The research being done could find a good second line treatment, but larger trials are required to find the right treatments. Patients in the study had a median age of 70.5 years and 89.5 percent had the most treatable type of mesothelioma, epithelioid mesothelioma. There was a range of serious to minor side effects in ten of 38 patients, including hypertension, hoarseness, fatigue, diarrhea, and anorexia. Seventy-six percent of patients needed a reduction or discontinuation of Lenvatinib during the trial.

Jordyn Sava, “Pembrolizumab/Lenvatinib Combo Shows Positive Clinical Activity in Recurrent Pleural Mesothelioma” World Conference on Lung Cancer (August 7, 2022). [Link]
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