What's the place of immunotherapy in malignant mesothelioma treatments?

Abstract

Malignant pleural mesothelioma (MPM) is a rare malignancy of the pleura with a very poor prognosis. Treatments evaluated for malignant mesothelioma, including chemotherapy, radiotherapy and surgery are of limited efficacy. However, the fact that the tumors of some patients with MPM regress spontaneously or respond to immunotherapy suggests that the immune system may respond to MPM under some circumstances. In this respect, animal studies have demonstrated immunoreactivity of MPM to different immunotherapies. In the case of MPM, several clinical studies have demonstrated a correlation between the presence of a lymphocyte infiltrate and a better prognosis and humoral response directed against specific antigens related to tumor. Thus, MPM immunotherapy is undoubtedly a highly promising but also very challenging approach to the treatment of this disease that has slipped through the defense lines of the immune system. This article reviews past and recent developments of the clinical strategies that concern immunotherapy of mesothelioma.

Stem Cells and Mesothelioma

“…Thirdly, mesothelioma in part is such an aggressive tumor secondary to its successful immunosuppressive strategies. Similar to the mechanisms of immunomodulation demonstrated by MSCs, mesothelioma is characterized by inhibition of NK cells, dendritic cells, cytotoxic T cells; while showing upregulation of regulatory T cells, and secretion of the immunosuppressive cytokine TGF (Gregoire, 2010). These findings correlate with clinical presentation, where a high lymphocytic infiltration is associated with a better prognosis in patients.…”

A 5-aza-2′-deoxycytidine/valproate combination induces cytotoxic T-cell response against mesothelioma

“…As spontaneous regression has been observed in mesothelioma patients with infiltration of tumour-specific lymphocytes [15], immunotherapy strategies for the treatment of MPM should be considered [16]. However, the candidate antigens that can be targeted in MPM are poorly defined.…”

Malignant pleural mesothelioma treated as pulmonary tuberculosis

“…Treatment regimens involving immunotherapy have yielded variable results (Gregoire, 2010). Trials involving interferon alpha have proved encouraging with 20% of patients experiencing a greater than 50% reduction in tumour mass with minimal side effects (Gregoire, 2010). This was not contemplated due to the cost implication as this patient could not even commence chemotherapy until after 2 months, which is much cheaper than immunotherapy.…”

“…The index case had this combination therapy and his response was satisfactory before he was lost to follow-up. Treatment regimens involving immunotherapy have yielded variable results (Gregoire, 2010). Trials involving interferon alpha have proved encouraging with 20% of patients experiencing a greater than 50% reduction in tumour mass with minimal side effects (Gregoire, 2010).…”