Dr. Zauderer on Emerging Treatment Strategies in Mesothelioma

Marjorie G. Zauderer, MD, medical oncologist, co-director, MSK Mesothelioma Program, Memorial Sloan Kettering Cancer Center, discusses emerging treatment strategies in mesothelioma.

Following the 2004 FDA approval of pemetrexed in combination with cisplatin for patients with malignant pleural mesothelioma, therapeutic advancement was stagnant in this disease, Zauderer says. However, in October 2020, the FDA approved the frontline combination of nivolumab (Opdivo) and ipilimumab (Yervoy) for patients with malignant pleural mesothelioma.

Although nivolumab/ipilimumab has improved survival for many patients with mesothelioma, novel therapies are needed to continue advancing the field forward, Zauderer explains. Research efforts are under way to determine which patients are best suited for immunotherapy, chemotherapy, or chemoimmunotherapy, as well as to evaluate novel ways to activate the immune system. For example, clinical trials are ongoing to evaluate CAR T-cell therapies targeting mesothelin.

Although targeted therapy has been game changing in non–small cell lung cancer (NSCLC) management, the therapeutic modality has not had the same degree of success in mesothelioma, Zauderer says. In part, this is because mesothelioma is characterized by tumor suppressor genes instead of oncogenic-activating genes that are associated with NSCLC. As such, therapies targeted against NF2, BAF1, and PIK3CA alterations are being evaluated in mesothelioma, Zauderer concludes.