US News and World Report rank MD Anderson as America’s number one cancer hospital, with the facility holding the top spot for the past seven years. 

Now, the Houston-based MD Anderson Cancer Center is launching a phase II clinical trial that will focus on rare, advanced cancers, such as mesothelioma, in conjunction with a promising new immunotherapy drug, vudalimab.

Establishing the efficacy of vudalimab

Vudalimab, otherwise known as XmAb20717, was originally designed by Xencor, a biopharmaceutical company based in California. The clinical trial will measure the drug’s safety and efficacy, in an attempt to improve upon current immunotherapy options.

Working closely with MD Anderson’s mesothelioma specialists, Dr. Raghav and Dr. Anne Tsao, medical oncologist Dr. Arvind Dasari heads the clinical trial as the principal investigator. 

Phase II of this clinical trial aims to include 140 patients. Among these participants will be 20 patients with pleural mesothelioma, and 20 with peritoneal mesothelioma, in the hopes of establishing vudalimab’s efficacy in treating the asbestos-related cancer. Other cancers included in the trial include Hodgkin lymphoma, small cell lung cancer, cervical carcinoma, and neuroendocrine carcinomas. 

Promising phase I results support further development of vudalimab

The phase I clinical trial of vudalimab focused primarily on ensuring safety, measuring patient tolerance, and determining the optimal dosage levels for maximum efficacy. The data from this initial trial indicated that vudalimab is generally well tolerated and that multiple tumor types either wholly or partially respond to it. 

Less toxicity with single-agent vudalimab

The combination of Opdivo and Yervoy was approved by The US Food and Drug Administration as a first-line treatment for unresectable mesothelioma in 2020. 

Both drugs are classified as immune checkpoint inhibitors, with Opdivo targeting PD-1 cell surface proteins, while Yervoy targets CTLA-4. Newly developed Vudalimab has the ability to act as a ‘dual blockade agent,’ targeting both cell surface proteins, making it a promising advancement in mesothelioma treatment. 

The primary immunotherapy treatment option for mesothelioma is a combination of two drugs, Opdivo and Yervoy. According to researchers, vudalimab has the potential to improve upon the current results achieved with the current combination approach, but with fewer side effects, given that it will only require the administration of a single agent. 

Given that one of the primary outcomes of mesothelioma treatment is prolonging life and improving the overall quality of life, the introduction of a dual blockade, single-agent treatment has the potential to increase the success of these treatment goals. The more drugs administered, the more toxicities are introduced to the body, thus impeding the patient’s well-being. By treating mesothelioma with a single-agent approach, Vudalimab has the potential to offer an equal or improved efficacy with fewer side effects.

Clinical trials

As an acclaimed cancer center, MD Anderson conducts multiple clinical trials related to mesothelioma, many of which are unique to the center and cover all disease stages, from early-stage to episodes of recurrence. You can visit the center’s website for more information regarding clinical trials and eligibility requirements. 

Types of mesothelioma

Most mesothelioma cases begin in the pleura (thin tissue layer covering the lungs and interior chest wall). This type is called malignant pleural mesothelioma.

Mesothelioma can also begin in the abdomen – malignant peritoneal mesothelioma – although this is rarer. Types of mesothelioma are also categorized depending on the type of mesothelial cells in which the disease begins. These are:

  • Epithelioid – accounting for 60-70% of cases, and often with the best prognosis
  • Sarcomatoid – more aggressive than epithelioid mesothelioma and accounting for around 10-15% of cases
  • Biphasic or mixed – the most aggressive form of mesothelioma, this type involves both epithelioid and sarcomatoid cells and accounts for 10-15% of mesothelioma cases

Treating mesothelioma

  • Surgery – there are two main types of mesothelioma surgery; extrapleural pneumonectomy (removing the entire pleura) and pleurectomy/decortication (removing the affected areas of the pleura). Mesothelioma surgery rarely cures patients but is used to relieve symptoms and slow disease progression
  • Radiation therapy – using high-energy beams, radiation therapy aims to kill cancer cells, particularly those left behind after surgery. Radiation therapy is also not a cure-all but can slow disease progression and improve symptoms
  • Chemotherapy – this is the primary treatment used for inoperable cases and has been proven to prolong the life of mesothelioma patients
  • Immunotherapy – there are several types of immunotherapy that help the body’s immune system in different ways. Immune checkpoint therapy is the immunotherapy route for some mesothelioma patients. This therapy blocks checkpoint proteins from binding, thus preventing them from ‘switching off,’ allowing them to spend longer in cancer cell-killing mode

Final thoughts

The treatment of mesothelioma has always taken a combination approach for best results. However, recent research data demonstrates a compelling need for more focus on immunotherapy in mesothelioma patients, and vudalimab shows great promise in reducing the current side effects of the combination drug approach. 

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