Vaishnavi Gullapally June 8, 2015 Mesothelioma: Standard of care treatment for malignant pleural mesothelioma may be changing soon, based on discussions last week at the American Society of Clinical Oncology (ASCO) annual meeting in Chicago.
New Treatment for Mesothelioma:
Bevacizumab, a drug that restricts the growth of new blood vessels within tumors, should be added to the standard pemetrexed and cisplatin chemotherapy regimen, according to multiple doctors who attended the conference.
The drug, also known by its brand name Avastin and manufactured by Genentech, Inc., already is used regularly for colorectal cancers and some types of lung cancer. Its first FDA approval was in 2004 for metastatic colon cancer.
“It provides a significantly longer survival in patients with MPM, with acceptable toxicity, making this triplet a new treatment paradigm,” wrote Dr. Gerald Zalcman, of the French Cooperative Thoracic Intergroup, in the abstract he presented at the 2015 ASCO meeting.
The median overall survival for those getting the bevacizumab was 18.6 months, compared to 16.1 months for those without it. The median progression-free survival was 9.6 months for the bevacizumab group, but only 7.5 months for the group without it.
Of those getting the bevacizumab, 45 patients lived longer than 30 months. Only 36 with just the standard chemotherapy survived as long.
Dr. Natasha Leighi, from Prince Margaret Cancer Centre in Toronto, called the study’s results “practice-changing” during a discussion at ASCO.
“Demand for a new standard of care will exist irrespective of the cost,” said Dr. Anna Nowak, of Sir Charles Gairdner Hospital in Perth, Australia. “It may be a new standard of care for some, and not for others.”
Leigh said it could “cause financial toxicity.”
The current use of bevacizumab with other cancers is restricted by cost-benefit calculations used by some health insurance plans and by countries with national health care systems. Estimated monthly costs are $8,000-$10,000.
Dr. Raffit Hassan, mesothelioma specialist from the National Cancer Institute, detailed results of a phase I trial involving immunotherapy drug CRS-207 in combination with standard chemotherapy.
Disease control was obtained in 30 of the 32 trial participants. There was a partial response in 19 patients and stable disease in 11. CRS-207 is given by vaccination. The median duration of response was 5 months and median progression-free survival was 7.4 months.
Dr. Diego Cortinovis, San Gerardo Hospital in Monza, Italy, reported impressive results for the anti-tumor drug Trabectedin in a phase II study involving second-line treatment for sarcomatoid/biphasic mesothelioma. Trabectedin has been used effectively in soft-tissue sarcomas and for relapsed ovarian cancers.