Mesothelioma is a rare cancer caused by inhaling or ingesting asbestos fibers. Mesothelioma can take 40 years or more to develop, after asbestos exposure. Although there are treatments to slow the development of the disease, in most cases survival time is little more than one year. Unfortunately mesothelioma often times comes back. So, new treatments that can extend the survival of mesothelioma patients are exciting news even if they don’t offer a cure. Opdivo mesothelioma immunotherapy is one promising avenue of mesothelioma treatment that is bringing relief to many patients and their families.
Mesothelioma Immunotherapy Basics
Asbestos can cause different types of cancer, including lung cancer, but the part of your body most sensitive to toxic asbestos fibers is the tissue of your mesothelium. The mesothelium is a thin, multi-layered lining or sac that protects certain internal organs.
There are four mesothelioma types:
- pleural mesothelioma (the most common form, accounting for around two thirds of mesothelioma cases) affects the mesothelium around your lungs
- peritoneal mesothelioma (about 20 percent of mesothelioma cases) affects the mesothelium that lines the inside of your abdomen and protects the organs inside
- pericardial mesothelioma (a very rare form) affects the pericardium, the mesothelial membrane around your heart
- testicular mesothelioma (extremely uncommon) affects the lining inside your testicles.
Any of these mesothelioma types may be treated with immunotherapy. Whether immunotherapy will work for you and which type of mesothelioma immunotherapy is suited to your condition depends on the mechanism your tumor uses evade your immune system and grow unchecked.
What Is Immunotherapy?
There is one disease-fighting force more powerful than vaccines, antibiotics, chemotherapy, or radiation: your immune system. For every virus that knocks you off your feet, your immune system has probably prevented dozens if not hundreds of others from ever getting a foothold.
Immunotherapy is a type of treatment that activates your body’s immune response to fight cancer. To understand how immunotherapy works, it’s helpful to understand the mechanisms of the human immune system.
How Does the Immune System Work?
Your immune system protects you 24/7 from invaders that would make you sick. Your defenses start with your innate immune system, which is your first line of defense against foreign organisms. If invaders get in, your immune system may get a request for help from the cells they attack. Sometimes the immune system simply recognizes foreign cells as not belonging and goes after them.
Your body sends extra blood to the area that’s been invaded, which can cause pain, redness, heat, and swelling. Those symptoms are all signs that your immune system is hard at work. Then your immune system’s white blood cells do everything in their power to attack the invading cells. Natural killer cells come along and kill the cells that were injured by the invaders, to make sure they don’t become hosts to the bad guys, spreading disease throughout your body.
The next line of immune defense is your adaptive immune system. When you develop immunity after having a cold or flu, it’s your adaptive immune system cells that have memorized the virus and won’t let it through the door again. There are several types of cells that make up your adaptive immune system; T cells are the most important kind for cancer patients. When dangerous cells are present, your body manufactures more of these cells, creating its own immunity army.
Your immune system doesn’t only go after viruses. It conducts something called immune surveillance to find and eradicate tumors such as cancer. Killer T cells, which kill off damaged cells, have the job of destroying tumors.
Killer T cells are powerful, but they will only take out tumors if they recognize the cells in them as foreign to your body. Different types of cancer cells have developed methods to fool T cells into thinking they are normal cells or to block T cells from doing their job.
That’s where treatments like Opdivo mesothelioma immunotherapy come in. Immunotherapy works by showing your immune system that cancer cells are malignant and letting your T cells do the rest.
Is Immunotherapy Different from Chemotherapy?
Different types of immunotherapy work in different ways, but all mesothelioma immunotherapy treatments target specific pathways or mechanisms that cancer cells use to hide from your immune system. Immunotherapy drugs prevent cancer cells from using the tricks they have developed to fool your immune system. Without those tricks, your immune system goes to work.
Chemotherapy operates in a different way. Chemotherapy drugs are chemicals that are designed to seek out and kill cancerous cells. Different types of chemotherapy drugs do this in different ways, but all mesothelioma chemotherapy directly kills cancer cells.
Immunotherapy and chemotherapy can work well together. Most mesothelioma patients receive more than one type of treatment. Your doctor may use both treatments as part of your multimodal mesothelioma treatment.
First-line and Second-line Mesothelioma Treatments
First-line mesothelioma treatments are the drugs and procedures that doctors choose as your first defense against mesothelioma. First-line treatments for mesothelioma almost always include chemotherapy. For early stage mesothelioma, surgery to remove the main tumor and as much additional cancerous tissue as possible is also a first-line treatment.
Second-line cancer treatments are the therapies that doctors turn to when first-line treatments don’t work or stop working. A common pattern for mesothelioma patients is that the cancer returns sometime after first-line treatment with surgery and chemotherapy.
Immunotherapies such as Opdivo are first-line treatments for some cancers, but they are usually second-line mesothelioma treatments. Studies have shown some promising results with mesothelioma immunotherapy. Some patients whose mesothelioma had come back after first-line treatment were able to have a second remission, thanks to treatments like Opdivo mesothelioma immunotherapy.
Types of Mesothelioma Immunotherapy
There are a number of different immunotherapy treatments available to mesothelioma patients. As the name suggests, all immunotherapy drugs leverage the strength of the human immune system to fight cancer.
Different immunotherapies work in different ways. Each drug targets a specific part of the immune response.
Some immunotherapy drugs direct your immune system to go after cancer cells. They rely on tumor-associated antigens. These drugs are referred to as active immunotherapy.
Other immunotherapy drugs support your existing immune defense system. These use substances such as monoclonal antibodies, lymphocytes, and cytokines. They are called passive immunotherapy. Opdivo mesothelioma immunotherapy (generic name nivolumab) is a passive immunotherapy that uses monoclonal antibodies.
Opdivo Mesothelioma Immunotherapy
Nivolumab is an immunotherapy drug marketed as Opdivo by Bristol-Myers Squibb. Opdivo is a type of immunotherapy drug known as a checkpoint inhibitor. It uses the body’s PD-1 checkpoint to stop tumor cells from fooling the immune system.
The PD-1 immune system checkpoint was discovered by scientists in 2000. By 2005, researchers had developed nivolumab. There are other immunotherapy drugs that use this same checkpoint (most notably pembrolizumab, marketed as Keytruda).
How Does Opdivo Mesothelioma Immunotherapy Work?
Programmed death-ligand 1 or PD-L1 is a protein found in the human body. It suppresses the body’s immune response to foreign objects. This mechanism can be useful at times. When a woman is pregnant, for instance, PD-L1 keeps the immune system from attacking the baby. This natural defense can also be used against us by cancer cells.
PD-1 is a protein on the outside of T cells. When PD-1 binds with PD-L1, it deactivates the T cell. Some cancerous tumors have an excess amount of PD-L1 and use this to cripple the immune system’s T cell response. Opdivo keeps PD-1 from bonding to PD-L1. That way, T cells stay active. They recognize the mesothelioma cells as cancerous invaders and kill them off.
Who Can Get Opdivo Mesothelioma Immunotherapy?
Opdivo mesothelioma immunotherapy isn’t suitable for every patient. If you have an auto-immune illness such as ulcerative colitis, Crohn’s disease, lupus or sarcoidosis, nivolumab might worsen your condition. If you have a transplanted organ, this type of immunotherapy could cause organ rejection problems.
If you’re pregnant, you should probably not take nivolumab, because it could cause you to lose the baby.
Opdivo mesothelioma immunotherapy will be most effective for tumors that are PD-L1 positive. Studies show that about 20 percent of pleural mesothelioma tumors fall into this category. Your doctor may want to analyze the tissue that was taken from your tumor in a biopsy to determine what factors are active at the cellular level in your cancer.
Your doctor may recommend Opdivo mesothelioma immunotherapy as a second-line treatment even if your tumor is not PD-L1 positive. A number of mesothelioma patients have had positive results, including an additional year of survival time, in clinical trials of nivolumab.
Most of the patients who have used Opdivo mesothelioma immunotherapy so far have had pleural mesothelioma, simply because this is the most common form of the disease. You are potentially eligible for this treatment if you have peritoneal, pericardial, or testicular mesothelioma.
While some treatments are not useful for late stage mesothelioma, Opdivo is particularly useful for advanced cases. Even if your cancer has metastasized (spread to another part of your body), this immunotherapy treatment may be appropriate. This is one of the reasons that immunotherapy has generated so much excitement in the mesothelioma community: it offers hope to patients who have run out of other treatment options.
Opdivo Mesothelioma Immunotherapy Drug Combinations
Nivolumab is sometimes used in combination with another immunotherapy drug, ipilimumab, which is marketed under the trade name Yervoy. Yervoy, like Opdivo, is a monoclonal antibody. It works with a protein receptor called CTLA-4 to activate the body’s immune response.
Multimodal Mesothelioma Treatments
It is likely that your mesothelioma treatment plan will involve two or more types of treatment. Research has shown that this multimodal approach to mesothelioma care is much more effective than one treatment alone. Multimodal mesothelioma treatment is the current standard of care for most patients.
Opdivo mesothelioma immunotherapy may be used in combination with surgery, chemotherapy, or radiation, or with two or more of these. If surgery is not possible, you may still be able to receive immunotherapy treatment.
What to Expect During Opdivo Mesothelioma Immunotherapy
Opdivo mesothelioma immunotherapy is administered in a hospital or other treatment facility. You will have an IV inserted so the drug can be given intravenously. You’ll sit with the IV for an hour or more, while the dose of Opdivo is administered.
You’ll come back for another infusion approximately every two weeks. If you tolerate the drug and it helps your mesothelioma, you may keep receiving treatment over several months or more. Your doctor will determine how long you should receive Opdivo, based on your response and any side effects.
Opdivo Mesothelioma Immunotherapy Research
Clinical trials of nivolumab are ongoing. One recently released study showed that, after 12 weeks (six cycles) of Opdivo mesothelioma immunotherapy, close to half of patients saw their tumors shrink. Those who received a combination of Opdivo and Yervoy had better results than those who took only Opdivo. The treatment stopped the cancer from advancing for several months in the patients whose tumors responded to this immunotherapy. Those who got the Opdivo-Yervoy combination had a longer period of remission.
Ask your mesothelioma specialist whether you can join an Opdivo clinical trial. Your participation in research will not only give you access to top-notch medical care during the trial; the information that comes from the research will help future mesothelioma patients.
You may be able to take Opdivo even if you aren’t in a clinical trial. Ask your doctor if this immunotherapy option is available to you and whether it’s the best option for you.
Opdivo Mesothelioma Immunotherapy Side Effects
Most of the mesothelioma patients in recent studies of nivolumab had very mild or no side effects. A few patients did have to drop out because of negative side effects.
The most common side effects, to date, from Opdivo are similar to traditional chemotherapy. These can include:
- Nausea or low appetite
- Fever and achiness
- Itchiness or rash
- Cough, runny nose, scratchy throat, similar to the symptoms of a cold
More serious side effects are possible. Some patients are not able to tolerate Opdivo mesothelioma immunotherapy. Tell your doctor about any symptoms you have during treatment; your therapy will be stopped if it’s putting you in danger.
Since Opdivo stimulates your T cells into overdrive, your immune system can attack healthy organs in your body. If you take nivolumab in combination with ipilimumab, your chances of experiencing more extreme side effects increase.
Potentially dangerous side effects of Opdivo include:
- Pneumonia or other lung problems
- Colitis, which may cause a hole in your intestine; look for symptoms including bloody or tar-like stools or severe stomach pain
- Hepatitis: symptoms include yellow tinge to your skin or eyes, extreme nausea, or pain on the right side of your abdomen (where your liver is)
- Kidney issues: if you aren’t urinating much, check with your doctor
- Swelling on your brain, which can result in symptoms including confusion, fatigue, or seizures.
This and other new forms of immunotherapy are exciting news for mesothelioma patients; you should be sure to ask your doctor if they are worth trying in your case. Often there is manufacturer or university financial support for such treatments but if not, talk to your mesothelioma attorney who can help make sure you can get the treatment that might help you.