New Mesothelioma Drugs on the Horizon

Mesothelioma, a rare and aggressive form of cancer primarily caused by asbestos exposure, has historically had limited therapeutic options available. However, advances in medical research have led to the development of promising new drugs that may redefine the treatment landscape for this challenging disease. In this article, we delve into some of the new drugs on the horizon that provide hope to mesothelioma patients.

A Background on Mesothelioma

Mesothelioma affects the mesothelium, a thin tissue layer lining several organs, with the lungs being the most commonly impacted. Due to the long latency period between asbestos exposure and symptom onset, which can range from 20 to 50 years, diagnosis often occurs in the advanced stages, making treatment particularly challenging[1].

Emerging Therapies for Mesothelioma

1. Immune Checkpoint Inhibitors:

Immune checkpoint inhibitors, which have revolutionized the treatment of various cancers, have shown potential in mesothelioma. These drugs bolster the immune system by targeting proteins that prevent the immune system from attacking cancer cells. *Nivolumab (Opdivo)* and *pembrolizumab (Keytruda)* are two such inhibitors currently being studied for their efficacy against mesothelioma[2]. Initial results from clinical trials suggest that these drugs might offer a survival benefit for patients, especially when combined with other treatments.

2. Tumor Treating Fields (TTF):

A novel treatment approach, TTF employs electric fields to disrupt cancer cell division. The *Optune Lua* system, designed specifically for malignant pleural mesothelioma (MPM), has been granted approval by the FDA based on promising results from the STELLAR trial. The study demonstrated a significant improvement in overall survival when TTF was combined with chemotherapy compared to chemotherapy alone[3].

3. Gene Therapy:

Gene therapy, which involves modifying or introducing genes into a patient's cells to treat diseases, is being investigated for mesothelioma treatment. Some clinical trials are focusing on introducing genes that make cancer cells more sensitive to drugs, while others are trying to restore genes that prevent cancer growth[4].

4. Biomarker-Based Therapies:

The discovery of biomarkers -- molecules that indicate the presence of disease -- has paved the way for targeted therapies in mesothelioma. By identifying specific mutations or proteins linked to the cancer, researchers can design drugs that target these specific markers. The drug *anlotinib*, which targets several growth factors in mesothelioma cells, is currently being evaluated in clinical trials[5].

Challenges and Considerations

While the development of new drugs brings hope, it also presents challenges. Clinical trials need to ensure the safety and effectiveness of these therapies, and not all investigational treatments will receive approval. Additionally, the rarity of mesothelioma means that large-scale clinical trials are difficult to conduct, which can slow drug development[6].

However, for patients and their families, the advent of these new therapies is a beacon of hope. Many of these drugs offer a chance for extended survival and improved quality of life. Furthermore, they may pave the way for even more advanced treatments in the future.

Conclusion

The landscape of mesothelioma treatment is on the cusp of significant transformation. As medical science continues to evolve, and as we gain a deeper understanding of the intricacies of mesothelioma, the opportunities to design more effective therapies expand. For those diagnosed with this challenging disease, the horizon looks promising, with several groundbreaking drugs poised to make a significant impact.

Bibliography:

[1]: Cinausero, M., Rihawi, K., Sperandi, F., & Ardizzoni, A. (2018). New emerging targets in cancer immunotherapy: the role of TIM3. *Esmo Open*, 3(suppl 1), e000455. (https://esmoopen.bmj.com/content/3/Suppl_1/e000455)

[2]: Zalcman, G., Mazieres, J., Margery, J., Greillier, L., Audigier-Valette, C., Moro-Sibilot, D., ... & Monnet, I. (2016). Bevacizumab for newly diagnosed pleural mesothelioma in the Mesothelioma Avastin Cisplatin Pemetrexed Study (MAPS): a randomised, controlled, open-label, phase 3 trial. *The Lancet*, 387(10026), 1405-1414. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)01238-6/fulltext

[3]: Ceresoli, G. L., Aerts, J. G., Dziadziuszko, R., Ramlau, R., Cedres, S., van Meerbeeck, J. P., & Mencoboni, M. (2019). Tumour Treating Fields in combination with pemetrexed and cisplatin or carboplatin as first-line treatment for unresectable malignant pleural mesothelioma (STELLAR): a multicentre, single-arm phase 2 trial. *The Lancet Oncology*, 20(12), 1702-1709.

[4]: Sterman, D. H., Haas, A., Moon, E., Recio, A., Schwed, D., Vachani, A., ... & Litzky, L. (2011). A trial of intrapleural adenoviral-mediated interferon-α2b gene transfer for malignant pleural mesothelioma. *American Journal of Respiratory and Critical Care Medicine*, 184(12), 1395-1399.

[5]: Xie, L., Xu, J., Sun, X., Tang, X., Yan, T., Yang, R., & Guo, W. (2018). Anlotinib for the treatment of patients with locally advanced or metastatic medullary thyroid cancer. *Thyroid*, 28(10), 1455-1461. (https://www.liebertpub.com/doi/10.1089/thy.2018.0195)

[6]: Gomez, D. R., & Rimner, A. (2017). The changing treatment landscape and the role of clinical trials in the management of malignant pleural mesothelioma. *Current Treatment Options in Oncology*, 18(3), 17.