The Changing Face of Mesothelioma Treatment
For many years, mesothelioma treatment options consisted mostly of a regimen of chemotherapy, some radiation treatments, and perhaps surgery…if you were one of the lucky ones. Sometimes, the recommendation for treatment was just to take the patient home and let them live out the rest of their life among love ones. “There’s nothing much we can do,” the doctor would say, and the mesothelioma patient would go home to die.
Thankfully, that scenario changed a bit in 2004 with the development and approval of the drug Alimta® – pemetrexed – developed by Eli Lilly and the first drug specifically recommended by the Food and Drug Administration for the treatment of malignant pleural mesothelioma, the most common form of the disease.
At that point, victims of the disease began receiving a combination of pemetrexed and the platinum-based chemotherapy drug known as cisplatin. Finally, doctors could see some improvement in life expectancy and even the few extra months it was giving patients were enough for many to rejoice over this new drug.
Sadly, however, nothing much has happened in the drugs vs. mesothelioma realm for the past twelve years, but – finally – a new first-line treatment is being recommended for those with unresectable pleural mesothelioma. (Unresectable means that the patient is not a candidate for surgery.)
The drug bevacizumab – brand name Avastin® – is the newest success on the market. Perhaps you’ve seen the commercials for it on television, with the company ending the ad by thanking those who participated in their clinical trials.
Just recently, the National Comprehensive Cancer Network (NCCN), a non-profit alliance of 27 of the nation’s leading cancer hospitals – chose to recommend that Avastin – a monoclonal antibody – be added to the regimen of pemetrexed and cisplatin for more successful treatment of malignant pleural mesothelioma. So far, it shows promise.
What is bevacizumab?
Bevacizumab can work to stop the formation of new blood vessels in tumors, therefore greatly slowing the growth of deadly cancer cells. A drug such as this is known as an angiogenesis inhibitor.
It was developed after years of research and after a set of successful clinical trials, first with animals and then, eventually, with human volunteers. It has actually been around for more than a decade, first approved by the FDA for metastatic colon cancer and later for renal cancers, ovarian cancers, some forms of brain cancer, and some lung cancers, namely advanced non-squamous non-small cell lung cancers.
It had also once been approved for breast cancer treatment but was later found to be non-effective. It has also been used to treat certain eye diseases that are caused by blood vessels that grow abnormally around the retina.
Though bevacizumab’s recommended use for meso treatment is only recent, it is indeed significant to make note of this NCCN endorsement as it is likely that a recommendation by the FDA will follow in the near future.
Improved survival time
Ask any patient what they’d like to know about any new chemotherapy drug and they’ll no doubt ask whether or not the drug will prolong their life and if taking it is worth the side effects that it causes. In the case of bevacizumab, the answer to the first part of the question is a cautious “yes”. In a randomized Phase III clinical trial conducted in France, the average improved survival time was not quite 3 months.
The trial involved 448 patients, all receiving treatment with pemetrexed and cisplatin. About half of the trial participants also received bevacizumab. Results showed an overall survival time of 18.8 months for those who received the Avastin as compared to 16.1 months for those who only received the two standard drugs.
The trial also showed that the cancer did not progress for an average of about 10 months for those given the Avastin, as compared to 7.5 months for those who did not receive it as part of their chemotherapy regimen.
Side effects among patients who were given Avastin were more severe, though study authors note that most patients described them as manageable.
However, the makers of Avastin – Genentech – indeed describe some potential side effects as severe, including serious bleeding, wounds that don’t heal, and GI perforations (holes that develop in the intestines or stomach).
Less serious side effects include fistulas, severe hypertension (high blood pressure), high protein levels in the kidneys, stroke or heart problems, vision issues, and adverse reactions at the time of infusion.
“There was no significant difference in overall Grade 3/4 adverse events [in the clinical trial],” wrote Katherine Eakle, PharmD, of Genentech. “However, there were significantly more Grade 1/2 adverse events for the Avastin group. This did not lead to a significant difference in quality of life between the two groups,” she explained.
What is the NCCN and why do they make recommendations?
As was previously mentioned, the NCCN is a collection of the best cancer hospitals in the United States and the best minds working at those locations. The organization is “devoted to patient care, research, and education, is dedicated to improving the quality, effectiveness, and efficiency of cancer care so that patients can live better lives.”
The member institutions offer resources that provide important information to all in the field of cancer care, making them a go-to place for the latest in treatment information. In particular, the member hospitals of the NCCN are known for treating rare, complex, and aggressive cancers such as mesothelioma, which strikes about 2,500 Americans each year and about 10,000 individuals worldwide.
Simply put, they are the leading experts in cancer care and in mesothelioma care, specifically.
Some of the member institutions include:
Memorial Sloan-Kettering Cancer Center, New York, NY
Fox Chase Cancer Center, Philadelphia, PA
Case Comprehensive Cancer Center, Cleveland, OH
Ohio State University Comprehensive Cancer Center, Columbus, OH
Sidney Kimmel Cancer Center at Johns Hopkins, Baltimore, MD
Yale Cancer Center, New Haven, CT
Duke Cancer Institute, Durham, NC
Roswell Park Cancer Institute, Buffalo, NY
UC San Diego Moores Cancer Center, San Diego, CA
Stanford Cancer Institute, Stanford, CA
University of Colorado Cancer Center, Denver, CO
And several others
Many of these institutions boast specialists that are long-time experts in treating individuals with mesothelioma. They’ve been on the cutting edge of research and treatments and will undoubtedly be among the first to use Avastin in their treatment protocols when and where appropriate.
Treatment Centers and the Cost of Treatment
All mesothelioma patients are intent on getting the best treatment available and NCCN institutions certainly provide that. However, victims of the disease may find that none of the centers with specialists in mesothelioma are close to their homes.
For that reason, many individuals travel outside of their local area to receive treatment, whether it’s a surgery such as an extrapleural pneumonectomy, performed by a top thoracic surgeon, or other kinds of treatment, including chemotherapy or radiation.
Sadly, the expense of treatment continues to be an issue. According to the manufacturers of Avastin, for example, the cost of treatment with that drug averages about $10,000 per month for however many months it’s recommended.
That’s a substantial amount of money and some patients will find that their healthcare insurance will not cover it or that they have exceeded the cap on their insurance. Add to that the cost of traveling to a hospital outside of the patient’s general vicinity and the costs continue to escalate and often become unaffordable.
This is one of the prime reasons victims of asbestos exposure continue to pursue litigation against those who were responsible for their disease. Many have received settlements through both out-of-court settlements and in courts of law throughout the United States while others have applied for payments through asbestos trusts, set up by more than 50 U.S. companies responsible for exposing employees and others to the toxin.