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.
FIND AN OPDIVO CLINICAL TRIAL
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:
- Diarrhea
- Nausea or low appetite
- Fever and achiness
- Itchiness or rash
- Headaches
- 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.