A summary of information from Lesley Shears (AVA) sourced from Asbestos: New Frontiers in Management, Science and Care (2024 NCARD Public Lecture)
The treatments now available for mesothelioma have improved considerably in the last ten years, when the standard treatment for most patients was chemotherapy. At that time, of the one in three patients who benefited, the average gain was an extension of life up to six months.
The first major breakthrough was the use of immunotherapy. At first, it was offered in conjunction with chemotherapy, but soon trials led to the use of immunotherapy alone. It was evident that generally patients were living for longer and having a better quality of life, and the statistics are beginning to reflect this. A larger study currently being conducted by Dr Nicola Principe of NCARD is based on chemotherapy + immunotherapy versus chemotherapy alone. The results will be available early in 2025.
The research journey is long, involved and expensive. It includes preclinical studies, safety trials, proof of concept, regulatory review and translation into practice.
Personalisation has become an important factor, and it is now possible to test a patient’s tissue and blood samples, and consider other relevant information before deciding on a course of treatment. Researchers are using new technologies and logarithms to enhance the process.
NCARD (the National Centre for Asbestos Related Disease) in Western Australia and the Peter McCallum Centre in Melbourne are two of the organisations taking part in this exciting work.
The research, published in Cell Reports Medicine, was led by Dr Melvin Chin, who said “These results represent an important step forward in mesothelioma treatment. While we still need to validate these findings in larger trials, identifying these biological markers could help us move closer to personalised treatment approaches for mesothelioma patients.” The team analysed blood and tumour samples from 54 participants in the DREAM clinical trial, which tested a combination of standard chemotherapy drugs–cisplatin and pemetrexed–with the immunotherapy drug durvalumab.
The results revealed that patients who responded well to this treatment had higher levels of specific immune cells, which were able to self-renew and persist during therapy, potentially playing a critical role in driving positive outcomes.
By linking changes in peripheral blood with immune activity in tumour samples, the researchers found that combining insights from both sources offered the most reliable way to predict treatment responses. This integrated approach could help doctors tailor treatments to individual patients, enhancing care quality and effectiveness.
Participants for the DREAM trial were recruited from 12 hospitals across Australia, highlighting the nationwide scope of this research effort. By uncovering how combination chemo-immunotherapy works, this study opens pathways to more personalised and effective treatment strategies for people with mesothelioma, offering renewed hope for improved care.
