Immunotherapy for Malignant Mesothelioma

Immunotherapy is the use of drugs to stimulate a person’s own immune system so it can better recognize and destroy cancer cells.

Immune checkpoint inhibitors

An important part of the immune system is its ability to keep itself from attacking normal cells in the body. To do this, it uses “checkpoints” – molecules on immune cells that need to be turned on (or off) to start an immune response. Cancer cells sometimes use these checkpoints to keep from being attacked by the immune system. Newer drugs that target these checkpoints hold a lot of promise as cancer treatments. These drugs are called checkpoint inhibitors.

These drugs are used for people whose cancer is still growing after treatment with chemotherapy.

PD-1 inhibitors

Pembrolizumab (Keytruda) and nivolumab (Opdivo) are drugs that target PD-1, a protein on immune system cells called T cells. PD-1 helps keep the T cells from attacking other cells in the body. 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 ipilimumab (see below) as the first treatment in people with malignant mesothelioma that cannot be removed with surgery.

These drugs are given as an intravenous (IV) infusion every 2 or 3 weeks.

Side effects of these drugs can include fatigue, cough, nausea, itching, skin rash, decreased appetite, constipation, joint pain, and diarrhea.

Other, more serious side effects occur less often. These drugs work by removing the brakes 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.

CTLA-4 inhibitor

Ipilimumab (Yervoy) is another drug that boosts the immune response, but it has a different target. It blocks CTLA-4, another protein on T cells that normally helps keep them in check.

This drug can be used along with nivolumab (see above) as the first treatment for advanced mesothelioma, but it’s not used alone.

It's given as an intravenous (IV) infusion, usually once every 3 weeks.

The most common side effects from this drug include fatigue, diarrhea, skin rash, and itching.

Serious side effects seem to happen more often with this drug than with the PD-1 inhibitors. Like the PD-1 inhibitors, this drug can cause the immune system to attack other parts of the body, which can lead to serious problems in the intestines, liver, hormone-making glands, nerves, skin, eyes, or other organs. In some people these side effects can be life threatening.

Side effects

Talk to your treatment team about the side effects you should watch for. Most side effects can be treated, and some can even be prevented.

Still, it’s very important to report any new side effects during or after treatment with any of these drugs to your health care team right away. If serious side effects do occur, you may need to stop treatment and take high doses of corticosteroids to suppress your immune system.