What can independent research for mesothelioma achieve to treat this orphan disease?

ABSTRACT

Introduction: Malignant pleural mesothelioma (MPM) is a rare neoplasm with a poor prognosis, as current therapies are ineffective. Despite the increased understanding of the molecular biology of mesothelioma, there is still a lack of drugs that dramatically enhance patient survival.

Area Covered: This review discusses recent and complete clinical trials supported by the NIH, other U.S. Federal agencies, universities and organizations found on clinicaltrials.gov. Firstly, chemotherapy-based trials are described, followed by immunotherapy and multitargeted therapy. Then we introduce drug repositioning and the use of drug docking as tools to find new interesting molecules. Finally, we highlight potential molecular pathways that may play a role in mesothelioma biology and therapy.

Expert Opinion: Numerous biases are present in the clinical trials due to a restricted number of cases, inappropriate endpoints and inaccurate stratification of patients which delay the finding of a treatment for MPM. The most crucial issue of independent research for MPM is the lack of more substantive funding to translate these findings to the clinical setting. However, this approach is not necessarily scientific given the low mutational load of mesothelioma relative to other cancers, and therefore patients need a more solid rationale to have a good chance of successful treatment

KEYWORDS:

• Chemotherapy
• drug repositioning
• immunotherapy
• independent research
• malignant pleural mesothelioma
• small molecules
• targeted therapy

Article Highlights

• Mesothelioma clinical trials rarely met the principal parameters for the design of high-quality trials mainly due to the size of the population investigated.

• Although targeted therapy and immunotherapy, in particular immune checkpoint inhibitors, has been approved by the FDA for the treatment of cancers such as melanoma, these therapies have shown low clinical benefit for MPM patients.

• The approach of drug repositioning is based on a solid scientific rationale, combined with a good clinical trial design and effective endpoints may increase the chance to identify promising treatments for MPM.

• MPM is a heterogenous tumour, many molecular mechanisms including hypoxia, metabolism, microRNAs and gene-environment interaction should be the main areas for designing new promising therapeutic agents.

• The lack of appropriate interest and funding for research into MPM has most certainly affected the opportunity to achieve dramatic progress in the treatment of this neoplasm.

• The approach of adopting drugs that have shown benefit in other tumours is of low clinical benefit, and therefore investment into new ideas leading to new therapies for this ‘niche’ tumour would be beneficial, particularly with targeted drug repositioning that is based on a solid scientific rationale, complemented by good clinical trial design and effective endpoints such as overall survival.

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Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper is not funded.