A flurry of new immunotherapy drugs has brought new hope to mesothelioma patients. Treatments such as TECENTRIQ mesothelioma immunotherapy offer the possibility of longer survival times for people diagnosed with this deadly cancer.
To understand immunotherapy, you have to wade through a sea of medical terminology. An understanding of how TECENTRIQ mesothelioma immunotherapy works and the definitions for some of the terms will help you be a better advocate for your own medical care.
Mesothelioma: The Stealth Cancer
Mesothelioma often seems to strike out of nowhere. This rare cancer, caused by contact with dangerous asbestos fibers, can appear many years after you were exposed. You may be retired or have left a job working around asbestos so long ago that you have almost forgotten about it.
During those years, while you felt completely well, the pointy ends of tiny asbestos shards were working their way into your mesothelium. The mesothelium is the lining that encases and protects many of your organs. After a number of years, the irritation and toxic reactions caused by the asbestos can develop into a mesothelioma tumor.
The most common way to be exposed to asbestos is by inhaling airborne fibers. Because the lungs are the usual point of entry, the majority of mesothelioma patients have pleural mesothelioma which grows in the lining around the lungs.
About one fifth of mesothelioma patients have peritoneal mesothelioma, which develops in the lining around the organs in your abdomen.
A very small number of patients develop mesothelioma in the lining around the heart or pericardial mesothelioma. An even smaller number get testicular mesothelioma, which affects the lining inside the testicles.
Mesothelioma immunotherapy has been studied mostly in patients with pleural mesothelioma, simply because this is the most common mesothelioma type. Immunotherapy treatments have been shown to benefit peritoneal mesothelioma patients and there is hope that they will help patients with pericardial and testicular mesothelioma as well.
How Does Mesothelioma Immunotherapy Work?
Immunotherapy drugs are like professional boxers: cancer makes a move and immunotherapy makes a counter move.
The truth is that, if cancer cells weren’t so deceptive, they wouldn’t stand a chance against your immune system. Your T cells are designed to recognize, dispatch, and eliminate invaders like cancer cells. To get around this, a vast number of cancers have developed ways to fool your immune system or shut it down.
Different tumors use different pathways to block your immune system. This is why there are so many different immunotherapy drugs, of which TECENTRIQ mesothelioma immunotherapy is one of the more recent. Each mesothelioma immunotherapy treatment targets a very specific mechanism.
Because every tumor is individual, your doctor will probably want to do some more testing before you start TECENTRIQ mesothelioma immunotherapy or another immunotherapy protocol. Your doctor will want to find the immunotherapy treatment most likely to fight back against the tricky moves of your particular mesothelioma tumor.
Your Immune System vs. Mesothelioma
Hostile invaders try to get into our bodies all the time: bacteria, viruses, bug bites, and toxins from our environment. Most of these outsiders don’t get very far. Your immune system is on alert around the clock, looking for foreign substances, ready to expel them from your body.
The first thing your immune system does when it senses an invader is to send extra blood to the area. This is what causes your skin to swell and get red and hot after you get a cut or a splinter.
The powerhouse immune system cells that find and kill cancerous and pre-cancerous cells are called T cells. When your body detects a threat, such as cancer cells replicating out of control, it grows more T cells and sends them in to kill off the cancer cells. There is even a special type of T cell called a killer T cell whose only job is to kill off unhealthy cells before they can do you harm.
Your body also has ways of shutting off this immune reaction. Sometimes, you need the killer T cells to stand down. During pregnancy, the immune system would detect the baby as foreign if the immune system didn’t turn down its response to the fetus. When you have an organ transplant, you take drugs to suppress this immune reaction, so your body doesn’t try to kill off the new and foreign organ.
PD-L1 and Mesothelioma Immunotherapy
Some cancerous tumors use the body’s own methods of down-regulating the immune response to dodge the T cells. Treatments such as TECENTRIQ mesothelioma immunotherapy block the cancerous cells from doing this. They are called checkpoint inhibitors because they block the pathways that cancer cells use to talk to T cells.
One specific protein plays a big role in this immune system down-regulation. It’s called programmed death-ligand 1 or PD-L1. PD-L1 binds with programmed death protein 1 or PD-1 on the T cells and turns off the immune response. Some tumors have a lot of PD-L1. Several of the immunotherapy drugs on the market now, including Keytruda and TECENTRIQ, block PD-L1 from binding with PD-1. This frees up the T cells to do their job and kill off cancer cells.
TECENTRIQ Mesothelioma Immunotherapy – Hope for the Future
TECENTRIQ is the trade name for the immunotherapy drug atezolizumab. It is marketed by Genentech and is currently approved for treatment of certain types of bladder and urinary tract cancer. More significantly for mesothelioma patients, TECENTRIQ has also been approved as a second-line treatment for advanced non-small cell lung cancer (NSCLC). Other immunotherapy treatments that work for NSCLC have also been shown to be effective for mesothelioma patients as well.
Checkpoint-blocking immunotherapy drugs like TECENTRIQ have had encouraging results in clinical trials and individual anecdotes from mesothelioma patients. TECENTRIQ has not yet been approved for treatment of mesothelioma, but its early successes with NSCLC offer hope for the future.
How does TECENTRIQ Mesothelioma Immunotherapy work?
TECENTRIQ is a monoclonal antibody. It blocks PD-L1 from binding with PD-1 and with CD80 or B7-1 receptors. This can keep the cancer cells from shutting down your immune response.
Researchers are still studying the exact mechanism at work with atezolizumab. It stops the progress of some tumors with excess PD-L1 but also has worked on some tumors that don’t have unusually high PD-L1.
TECENTRIQ and Mesothelioma
Currently, TECENTRIQ clinical trials are underway for several different types of cancer. Because it has been approved to treat NSCLC, there is hope that clinical trials to determine its effectiveness for mesothelioma will take place in the near future.
TECENTRIQ Mesothelioma Immunotherapy and Multimodal Treatments
Multimodal mesothelioma treatments combine two or more types of treatment (such as chemotherapy and radiation). This has been proven to be more effective than one type of treatment alone.
Immunotherapy can be an effective part of a multimodal mesothelioma treatment plan. Treatments like TECENTRIQ mesothelioma immunotherapy are usually administered after more common mesothelioma treatments, such as surgery and chemotherapy, have stopped working.
Is Immunotherapy a Type of Chemotherapy?
In many respects, immunotherapy is very similar to chemotherapy. You will probably receive an intravenous drug at a hospital or treatment center. TECENTRIQ mesothelioma immunotherapy is given in hour-long sessions every three weeks, similar to many chemotherapy treatments.
This is where the similarity ends, however. Chemotherapy drugs directly kill off cancer cells, while TECENTRIQ mesothelioma immunotherapy sends in your immune system to attack the tumor.
Chemotherapy works basically the same way for every patient. Whether TECENTRIQ mesothelioma immunotherapy works for you will depend on the nature of your cancer cells.
Chemotherapy is a first-line mesothelioma treatment. This means it is one of the first tools your doctor will reach for when treating your mesothelioma. Chemotherapy has been proven to help mesothelioma patients survive longer and almost all mesothelioma patients receive some type of chemotherapy. Immunotherapy drugs are still experimental. They are often given as a last resort, not a first choice.
Mesothelioma Standard of Care
The standard of care is the treatment that is considered the best treatment, based on evidence and experience. For early stage mesothelioma, the standard of care is surgery plus chemotherapy.
The most common surgery for pleural mesothelioma is a pleurectomy/decortication or P/D. P/D is also called lung-sparing surgery, because it removes as much of the cancerous tissue as possible while leaving both lungs intact. P/D may be followed by chemotherapy or radiation, to kill off cancer cells that the surgeon missed. This treatment after surgery is called adjuvant therapy. Sometimes chemotherapy or radiation is given before surgery, as a neoadjuvant therapy, to reduce the size of the tumor and make it easier for the surgeon to remove.
Surgery for peritoneal mesothelioma is called debulking or cytoreductive surgery. This is usually followed by a type of chemotherapy that is particularly effective for abdominal cancers: hyperthermic intraperitoneal chemotherapy or HIPEC. For this type of mesothelioma chemotherapy, the drugs are heated before being circulated directly into the abdomen. This has been found to be much more effective for peritoneal mesothelioma than systemic chemotherapy and it is the standard of care for this mesothelioma type.
Pericardial mesothelioma may be treated with a pericardiectomy, which removes the diseased mesothelium around the heart. Testicular mesothelioma has been most successfully treated with surgery. Removal of the affected testicle, when the cancer is caught before it has spread, has led to longer survival times than other forms of mesothelioma.
Perhaps, one day, when immunotherapy is better understood, mesothelioma immunotherapy treatments will become the standard of care for some mesothelioma patients.
Like other forms of cancer, mesothelioma is diagnosed in stages. The stage reflects how far the disease has progressed before it is diagnosed. Stage 1 means the cancer is localized to the original tumor. By Stage 4, the cancer has metastasized or spread to other organs. Cancer is harder to treat once it has begun to spread throughout the body.
Mesothelioma can be difficult to diagnose. Because it is a rare form of cancer, your doctor may not look for mesothelioma at first. Mesothelioma symptoms overlap with the symptoms of a number of other, more common illnesses, so the cancer may go undiagnosed for some time.
Surgery is only recommended for patients with Stage 1 or 2 mesothelioma. After that, the trauma of surgery may outweigh the benefit. Treatments like TECENTRIQ mesothelioma immunotherapy bring hope to late stage mesothelioma patients, for whom other treatments might be ineffective.
Second-Line Mesothelioma Treatments
Your doctor will consider your mesothelioma treatment to be working as long as the disease doesn’t get worse. This might mean that your tumor shrinks or stops growing, that the cancer isn’t spreading to your lymph nodes or other organs, or that your symptoms are better.
When the cancer progresses, or gets worse despite treatment, your doctor may turn to second-line treatments. TECENTRIQ is approved only as a second-line treatment for certain cancers. Most immunotherapy drugs are used only as second-line or even third-line treatments.
Second-line treatments are important. When the last treatment option stops working, doctors can offer only palliative care, which relieves symptoms but does not slow down the cancer. Second-line treatments offer new hope to extend life for mesothelioma patients.
Can I Get TECENTRIQ Mesothelioma Immunotherapy?
Some patients have been able to receive immunotherapy drugs, even if they aren’t approved to treat mesothelioma, through the FDA’s expanded access or compassionate use program or through special access programs provided by the manufacturer. You need to work with a physician to obtain access to experimental treatments such as TECENTRIQ mesothelioma immunotherapy. Talk to your doctor about whether immunotherapy makes sense for you as part of a multimodal mesothelioma treatment plan.
You will not be able to receive treatment with a checkpoint inhibitor immunotherapy drug if you have had an organ transplant or think you might be pregnant. In addition, patients with autoimmune conditions such as Crohn’s disease may not be able to tolerate TECENTRIQ mesothelioma immunotherapy.
TECENTRIQ Mesothelioma Immunotherapy Side Effects
Because TECENTRIQ mesothelioma immunotherapy has not been studied yet, there is no information about side effects specific to mesothelioma. However, the side effects for patients with NSCLC give a good idea of what mesothelioma patients can expect.
With all immunotherapy drugs, there is a chance of immune reactions. Your immune system may become overactive and attack your organs. Serious potential side effects include pneumonia, colitis, neuropathy, thyroid problems, or swollen eyes. Some patients have severe reactions to the drug infusion itself and may get a rash, fever, swelling, or have trouble breathing.
More common side effects include excess fatigue, loss of appetite, nausea, constipation, muscle aches, or coughs. The side effects of mesothelioma immunotherapy can often be treated so you can continue with the treatment.