Immunotherapy Over Chemotherapy for Mesothelioma
With advancements in mesothelioma treatment, patients have more options for treatment than ever before. For a long time, mesothelioma was treated with the combination of surgery, chemotherapy, and radiation. This standard of care multimodal approach has helped improve survival compared to no treatment at all, but there is still no cure for the cancer. Immunotherapy, while not a cure, has advanced mesothelioma treatment and improved survival in select groups of patients. Immunotherapy utilizes the immune system to help fight and treat cancer. The immune system typically defends the body against harmful invaders like bacteria and viruses, but cancer cells can hide or disguise themselves to avoid detection. Immunotherapy makes it easier for the immune system to identify and target cancer cells.
To understand immunotherapy, we first must understand cancer and its typical treatments. Cancer is part of a wide variety of diseases that involve unregulated cell growth. The body’s cells grow uncontrollably and spread to other parts of the body. It can start almost anywhere in the human body. Usually human cells grow and multiply (through a process called cell division) to form new cells, as the body needs them. When cells grow old or become damaged, they die, and new cells take their place. Sometimes this regulated process breaks down, and abnormal or damaged cells grow and multiply when they shouldn’t. These cells can then form lumps of tissue known as tumors. Cancerous tumors spread into, or invade, nearby tissues and can travel to distant places in the body to form new tumors. Most cancers usually create solid tumors, except for cancers of the blood. Cancer usually develops due to changes in genes that control the way our cells function, especially how they grow and divide. The body usually eliminates cells with damaged DNA before they turn cancerous, but the body’s ability to do so goes down when we age.
Chemotherapy typically works by blocking a tumor’s ability to grow and spread. Most chemotherapy drugs damage cancer cells as they divide and multiply. They prevent the synthesis of DNA and other molecules. These are vital for cell division and survival. Cancer cells grow and divide faster than most healthy cells. This makes them an ideal target for chemotherapy drugs. Immunotherapy works differently than chemotherapy. Immunotherapy can help someone’s immune system spot cancer cells. Cancer cells are just abnormal cells, so the immune system does not always recognize them as a threat. Boosting the immune system helps the body fight cancer cells.
Immunotherapy has multiple benefits that might make someone choose it over standard chemotherapy. Immunotherapy harnesses the body’s immune system to fight cancer more effectively. It helps the immune system recognize and target mesothelioma cells. Certain types of immunotherapy may even train the body to recognize cancer cells for a long time. Immunotherapy responses can have a long-lasting response. The benefits can be seen from months to even years after treatment. Immunotherapy is beneficial for patients with advanced or inoperable mesothelioma when conventional treatments may be less effective. It can help improve survival and quality of life. Immunotherapy also can have less serious side effects. Side effects for immunotherapy can include abnormal blood pressure, dizziness, injection site reaction, weakness, fatigue, fever and chills, pain and headaches, and weight loss. Immunotherapy is more effective in the first line of treatment in advanced cases. Doctors may choose immunotherapy or chemo as the first treatment. The decision is based on the patient’s health and tumor statistics.
Eligibility for immunotherapy can depend on multiple factors, including previous mesothelioma treatments, overall health, and specific tumor characteristics. Each patient is unique, and specialists evaluate these factors individually. Even when a patient has not responded well to earlier treatments, the patient may benefit from immunotherapy. Patients with nonepithelioid mesothelioma (sarcomatoid or biphasic) usually respond better to immunotherapy than chemotherapy. Patients in overall good health are also better candidates for immunotherapy compared to unhealthy candidates. Doctors use the Eastern Cooperative Oncology Group status to assess whether a patient is healthy enough for immunotherapy. Patients also might be good candidates if they have high PD-L1 levels, but patients with low PD-L1 levels can also benefit from immunotherapy. The stage and operability also affect the ability to receive immunotherapy. Patients with advanced, metastatic, or unresectable mesothelioma are usually prime candidates for immunotherapy.
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