Checkpoint Inhibitors for Mesothelioma

What Are Checkpoint Inhibitors for Mesothelioma?

Immune checkpoint inhibitors for mesothelioma are cancer drugs that belong to a class of treatment called immunotherapy. They have shown promise in treating mesothelioma, a rare and aggressive cancer caused by asbestos exposure.

Mesothelioma cancer cells can hide from T cells (which your immune system makes to fight cancer) by using substances called checkpoint proteins. Checkpoint inhibitors keep cancer cells from hiding so they can be destroyed by the immune system.

Checkpoint inhibitors for mesothelioma include:

• Atezolizumab (Tecentriq®)
• Avelumab (Bavencio®)
• Durvalumab (Imfinzi®)
• Ipilimumab (Yervoy®)
• Nivolumab (Opdivo®)
• Pembrolizumab (Keytruda®)
• Tremelimumab (Imjudo®)

Key Facts on Immunotherapy Checkpoint Inhibitors for Mesothelioma

• Types of mesothelioma treated: Pleural mesothelioma (which develops in the lung lining) and peritoneal mesothelioma (which forms in the abdominal lining)
• How they’re used: Administered through intravenous (IV) injections as part of a larger treatment plan with therapies like surgery, chemotherapy, or other inhibitors
• Most common side effects: Fatigue, nausea, diarrhea, constipation, skin rash, and cough
• When they’re used: As a first-line (initial) treatment or second-line treatment (which can help patients if first treatments don’t)

Download our Free Immunotherapy Guide to see how cancer immunotherapy checkpoint inhibitors could improve your life span after a mesothelioma diagnosis.

How Do Checkpoint Inhibitors for Mesothelioma Work?

Checkpoint inhibitors for mesothelioma improve the body’s immune response to cancer.

Your immune system naturally wants to destroy mesothelioma cells while not hurting healthy cells. To do this, it uses checkpoint proteins.

These proteins tell your body to make T cells if it detects an illness like cancer, and also help the T cells know which cells are healthy and which ones are harmful.

However, mesothelioma cells can produce proteins of their own that allow them to avoid being destroyed by T cells, according to the American Cancer Society (ACS).

“Our immune systems are dormant until there is a need to fight foreign bodies, like an infection. Because cancer hides from the immune system, it doesn’t know it needs to go to work.”
— Dr. Stephen Lemon, medical oncologist (cancer doctor)

Using different immunotherapy checkpoint inhibitors, doctors can ensure that your body’s T cells can find and destroy mesothelioma.

Types of Immunotherapy Checkpoint Inhibitor Drugs

There are several types of checkpoint inhibitor medications that can treat mesothelioma. Each drug falls into a different category depending on which immune checkpoint protein it targets. Learn about each below.

CTLA-4 Inhibitors

T cells use a protein called CTLA-4 to find cancer cells. However, mesothelioma cells can bind proteins they make to the CTLA-4 receptors of T cells and avoid destruction. CTLA-4 inhibitors prevent this.

Two anti-CTLA-4 medications for mesothelioma are Yervoy and Imjudo.

Ipilimumab (Yervoy®)

Yervoy is currently used alongside another immunotherapy called nivolumab (Opdivo®) to treat malignant pleural mesothelioma.

The breakthrough Checkmate 743 trial found that Opdivo and Yervoy helped patients live for over 18 months on average. This was four months longer than patients who received the first-line chemotherapy drugs pemetrexed (Alimta®) and cisplatin.

The partial response rate was 38% in this study, meaning cancer tumors partly shrank in roughly 4 out of 10 patients.

Tremelimumab (Imjudo®)

In 2023, Baylor College of Medicine released the results of a study that compared the use of tremelimumab (Imjudo) and durvalumab (Imfinzi®) to just Imfinzi when treating pleural mesothelioma. These immunotherapies were given prior to thoracic (chest) surgery.

Patients who received both Imjudo and Imfinzi lived longer than those who just received Imfinzi.

PD-1 Inhibitors

A protein called PD-1 found on T cells can bind to another protein called PD-L1 on cancer cells. When this happens, the T cells won’t kill cancer. Anti-PD-1 immunotherapies block this and stimulate the immune system so the T cells can destroy more of the cancer.

Keytruda and Opdivo are examples of PD-1 inhibitors that can treat mesothelioma.

Nivolumab (Opdivo®)

Opdivo is an immunotherapy drug approved by the U.S. Food and Drug Administration (FDA) as a first-line treatment for pleural mesothelioma. It’s administered in combination with Yervoy to help patients who aren’t eligible for mesothelioma surgery.

“Opdivo and Yervoy yields durable survival, and we can see about a quarter of our patients are still alive and doing well at 3 years.”
— Dr. Hedy Lee Kindler, mesothelioma specialist

Since Opdivo targets PD-1 and Yervoy blocks CTLA-4, the overall immune response rate is greater than if either drug were used alone, helping to improve patient life expectancy in the process.

Pembrolizumab (Keytruda®)

Keytruda has been shown to help pleural and peritoneal mesothelioma patients live longer. It was approved by the FDA for use as a second-line treatment in select cases of mesothelioma in 2020.

Pleural mesothelioma patients who received Keytruda and chemotherapy lived for 17.3 months — over a month longer than those treated with just chemotherapy — according to a December 2023 report published in The Lancet.

Peritoneal mesothelioma patients treated with Keytruda had a median overall survival of 20.9 months in a March 2023 study published in Oncology.

PD-L1 Inhibitors

PD-L1 inhibitors work very similarly to PD-1 inhibitors. Instead of blocking the PD-1 protein from T cells, though, PD-L1 produced by the mesothelioma cells is targeted. PD-L1 is a tumor-specific antigen, meaning it’s a substance found on mesothelioma cells but not on healthy ones.

Tecentriq, Bavencio, and Imfinzi are the three most notable anti-PD-L1 drugs being studied to treat mesothelioma.

Atezolizumab (Tecentriq®)

A 2021 study published in Cancer Discovery found that 85% of peritoneal mesothelioma patients were still alive a year after being treated with Tecentriq and another medication called bevacizumab (Avastin®).

The 1-year progression-free survival rate was 61%, meaning the cancer stopped spreading in more than 6 out of 10 patients.

Avelumab (Bavencio®)

Pleural mesothelioma patients treated with Bavencio and radiation therapy lived for over 1 year on average, according to a 2023 study from JTO Clinical and Research Reports.

All of the patients in the study were previously treated with chemotherapy, but their cancer had started to come back.

Durvalumab (Imfinzi®)

Imfinzi is another type of immunotherapy checkpoint inhibitor made by the company AstraZeneca. The 2021 PrE0505 trial tested how Imfinzi could help pleural mesothelioma patients live longer.

This study combined Imfinzi with chemotherapy, and patients had an average mesothelioma life expectancy of 20.4 months.

Another 2021 study, the NIBIT-MESO-1 trial, showed that Imfinzi worked to treat both pleural and peritoneal mesothelioma patients. Patients who received both Imfinzi and Imjudo lived for 16.6 months.

The patients in this study had already received other treatments, but their cancer had started spreading again.

Get our Free Immunotherapy Guide to see how checkpoint inhibitors for mesothelioma can help you or a loved one.

How Are Immune Checkpoint Inhibitors for Mesothelioma Used?

Immune checkpoint inhibitors can fit into many different mesothelioma treatment plans.

Checkpoint inhibitors for mesothelioma can be used:

• By themselves in what’s known as monotherapy
• With each other
• With other treatments like surgery or chemotherapy

Most mesothelioma doctors use immune checkpoint inhibitors with other treatments. Numerous clinical trials have shown that using checkpoint inhibitors as part of a larger mesothelioma treatment plan can help improve overall survival.

As of May 2024, Opdivo and Yervoy are the only checkpoint inhibitors approved as first-line treatments, with Keytruda being used as a second-line treatment in some cases. However, you or a loved one may qualify to access other types of immune checkpoint inhibitors through clinical trials.

Clinical Trials Testing Checkpoint Inhibitors and Mesothelioma

Many mesothelioma clinical trials focus on immune checkpoint inhibitors and other immunotherapies. These trials study how checkpoint inhibitors for mesothelioma could help patients live longer, better lives.

Notable ongoing clinical trials for mesothelioma checkpoint inhibitors include:

• Alliance A092001 trial: This phase II trial will determine if using Tecentriq, Avastin, and chemotherapy will help patients live longer than if they received just chemotherapy and Avastin. It is sponsored by the National Cancer Institute (NCI).
• DREAM3R trial: This phase III trial is studying if Imfinzi and chemotherapy will improve the life expectancy of pleural mesothelioma patients compared to those treated with just chemotherapy or Opdivo and Yervoy. It is slated to be completed in 2025.
• SMARTEST trial: Here, doctors will use radiation and a medication called cyclophosphamide (Cytoxan®) followed by surgery, Imjudo, and Imfinzi to try and help patients live longer.

Use our Free Doctor Match service to find specialists who can recommend clinical trials for mesothelioma checkpoint inhibitors.

Side Effects of Checkpoint Inhibitors for Mesothelioma

Checkpoint inhibitors for mesothelioma may cause side effects and toxicity (harm to patients) since T cells destroy both healthy and cancer cells.

Common side effects of checkpoint inhibitors for mesothelioma include:

• Constipation
• Diarrhea
• Dizziness
• Fatigue
• Fever
• Joint or muscle pain
• Loss of appetite
• Nausea
• Shortness of breath
• Skin rashes, ulcers, or sores
• Vision changes
• Worsening cough

Side effects of checkpoint inhibitors can vary depending on the specific drug and factors like mesothelioma stage, cell type, and overall health.

In general, however, checkpoint inhibitors for mesothelioma tend to cause fewer and milder side effects than chemotherapy.

Patients should contact their mesothelioma doctor right away if they experience severe side effects or adverse events.

What to Expect During Checkpoint Inhibitor Treatment Sessions

While each immune checkpoint inhibitor for mesothelioma is different, the process for each session is pretty similar. Learn what you can expect when being treated with checkpoint inhibitors below.

1. Receive a Checkpoint Inhibitor Infusion

Immunotherapy checkpoint inhibitors are given through an IV infusion that takes about 30-60 minutes. These infusions are usually given in cycles every 2-6 weeks.

“With immunotherapy, you take a rest period after treatment. The break gives your body time to produce healthy cells.”
— Cleveland Clinic

You can get checkpoint inhibitor infusions for up to 2 years in some cases if your cancer responds well to it.

2. Report Any Side Effects

While you receive immunotherapy, make sure to let your doctor know about any side effects that you experience.

Doctors can recommend follow-up care like pain relievers and anti-nausea medications to help manage side effects if they cause too much discomfort.

3. Monitor Your Cancer and Adjust Your Treatment Plan

Doctors will monitor how your mesothelioma responds to checkpoint inhibitors through imaging tests or blood tests. These show any signs that your cancer has stayed the same or gotten smaller.

If your cancer doesn’t respond or starts progressing after receiving checkpoint inhibitors, your doctor may be able to use other therapies to help improve your survival time.

How Much Does Checkpoint Inhibitor Treatment Cost?

As of 2024, many immune checkpoint inhibitors for mesothelioma are free to access if you join a clinical trial.

However, you must meet the trial’s criteria to join. Some checkpoint inhibitor trials may only accept patients who need first-line therapy, while others want patients whose cancer has started to spread despite initial treatments like chemotherapy.

Opdivo and Yervoy are the only two mesothelioma immunotherapy drugs available outside of clinical trials as of May 2024. However, these medications are very expensive without insurance.

Bristol Myers Squibb notes that it costs $28,292 per each Opdivo and Yervoy infusion for mesothelioma, and you’ll likely need multiple infusions.

Learn if Checkpoint Inhibitors for Mesothelioma Are Right for You

Mesothelioma checkpoint inhibitors are some of the most important therapies for this cancer.

Clinical trials continue to show that checkpoint inhibitors and other types of immunotherapy can improve survival, giving mesothelioma patients more reasons to stay hopeful.

A specialist can determine if checkpoint inhibitors for mesothelioma could help you or a loved one.

Use our Free Doctor Match for help finding specialists near you with expertise in immunotherapy checkpoint inhibitors.