Immunotherapy for Mesothelioma

Immunotherapy is the use of drugs to help a person’s own immune system better recognize and destroy cancer cells. It can sometimes be helpful in treating mesothelioma.

Immune checkpoint inhibitors

Just as it’s important that immune cells get activated to fight infections and cancer, it’s also important that they turn off when they are no longer needed. Checkpoint proteins on immune cells act as brakes to slow down immune attacks.

Cancer cells sometimes use these checkpoints to keep from being attacked by the immune system.

Drugs that target these checkpoint proteins, called checkpoint inhibitors, can help restore the immune response against the cancer cells.

PD-1 inhibitors

Pembrolizumab (Keytruda and Keytruda Qlex) and nivolumab (Opdivo) are drugs that target PD-1, a protein on immune system cells called T cells. By blocking PD-1, these drugs boost the immune response against cancer cells. This can shrink some tumors or slow their growth.

• Nivolumab can be used along with another checkpoint inhibitor, ipilimumab (see below), as the first treatment in people with mesothelioma that can't be removed with surgery.
• Pembrolizumab can be used along with chemotherapy as the first treatment in people with mesothelioma that can't be removed with surgery.
• Either of these drugs can be used in people whose mesothelioma is still growing after initial treatment.

These drugs are given either as an intravenous (IV) infusion or as an injection under the skin, typically every 2 to 6 weeks.

CTLA-4 inhibitor

Ipilimumab (Yervoy) targets CTLA-4, another protein on T cells that normally helps keep them in check.

This drug can be used along with nivolumab to treat advanced mesothelioma, but it’s not used alone.

It's given as an IV infusion, usually once every 6 weeks.

Possible side effects of checkpoint inhibitors

Side effects of these drugs tend to be mild and can include:

• Fatigue
• Cough
• Nausea
• Itching
• Skin rash
• Loss of appetite
• Diarrhea
• Joint pain

Other, more serious side effects occur less often:

Infusion reactions: Some people might have an infusion reaction while getting these drugs. This is like an allergic reaction and can include fever, chills, flushing of the face, rash, itchy skin, feeling dizzy, wheezing, and trouble breathing. It’s important to tell your doctor or nurse right away if you have any of these symptoms while getting one of these drugs.

Autoimmune reactions: These drugs work by removing one of the safeguards from the body’s immune system. Sometimes the immune system then starts attacking other parts of the body, which can cause serious or even life-threatening problems in the lungs, intestines, liver, hormone-making glands, kidneys, or other organs. These types of side effects seem to happen more often with ipilimumab than with the PD-1 inhibitors.