Immunotherapy for malignant mesothelioma: reality check

ABSTRACT

Introduction: Initial data of immune based therapy showed promise for improving malignant mesothelioma (MM) treatment. However, the results of such treatments have neither been predictable nor consistent and recent clinical studies of immune checkpoint inhibitors in MM have dampened initial enthusiasm.

Areas covered: We comprehensively discuss the basis, modalities and updated results of immunotherapy in MM. An online search was conducted for relevant literature and abstracts of recent meetings.

Expert commentary: Although initial studies have demonstrated proof of principle that manipulating the immune checkpoint axis holds promise in MM, results of some recent large studies using checkpoint inhibitors have been disappointing. This is not surprising given the low mutational load in MM and suggests that single agent immunotherapy has limited benefit in this disease. We believe that in order to demonstrate durable survival benefits, they will need to be used in combination approaches with other immunotherapies, vaccines or chemotherapy.

KEYWORDS:

• Mesothelioma
• immunotherapy
• check point inhibition
• therapeutic vaccines
• PD-L1

Acknowledgments

This study was supported by the Mesothelioma grant awarded by Cancer Council Victoria and Victorian Cancer Agency and in part by funds from the Operational Infrastructure Support Program provided by the Victorian Government, Australia. TJ is recipient of a NHMRC Early Career Fellowship (APP1074035) and BT is supported by an Australian Postgraduate Award post- graduate scholarship.

Declaration of interest

B Thapa is supported by an Australian Postgraduate Award post-graduate scholarship. T John has an advisory role in BMS, Pfizer, AstraZeneca and Roche, has received speakers’ bureau from BMS, Merck and AstraZeneca, has received travel, accommodation and expenses support from AstraZeneca and Roche. T John is also a recipient of a NHMRC Early Career Fellowship (APP1074035). DN Watkins has received research support (not pertaining to the submitted manuscript) from the Paranta Biosciences Contract Research Agreement 2016. The authors have no other 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 apart from those disclosed.

Additional information

Funding

This study was supported by the Mesothelioma grant awarded by Cancer Council Victoria and Victorian Cancer Agency and in part by funds from the Operational Infrastructure Support Program provided by the State Government of Victoria, Australia.