GRACE :: Lung Cancer

malignant pleural mesothelioma

Denise Brock

ASCO 2017 – Lung Cancer – Emerging Options for Malignant Pleural Mesothelioma

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H. Jack West, MD
Medical Director
Thoracic Oncology Program Swedish Cancer Institute
President & CEO, GRACE
Matthew Gubens, MD
Thoracic Oncologist
Thoracic Surgery and Oncology Clinic
UCSF Helen Diller Family Comprehensive Cancer Center
Jyoti D. Patel, MD
Director Thoracic Oncology
University of Chicago Medicine

 

Drs. H. Jack West, Medical Director of the Thoracic Oncology Program at Swedish Cancer Institute in Seattle, Washington and President and CEO of GRACE, Matthew Gubens, Thoracic Oncologist at the Thoracic Surgery and Oncology Clinic of the UCSF Helen Diller Family Comprehensive Center in San Francisco, California, and Jyoti Patel, Director of Thoracic Oncology at University of Chicago Medicine gathered post meeting to discuss new information from ASCO 2017 regarding lung cancer.   In this roundtable video, the doctors discuss Emerging Options for Malignant Pleural Mesothelioma.



 

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GRACE Video

Promising Early Results with Immunotherapy for Mesothelioma

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WCLC_2015_03_Mesothelioma_Immunotherapy_Promising_Early_Results

 

Drs. Leora Horn, Ben Solomon, & Jack West review early promising data on the potential activity of immune checkpoint inhibitors in the treatment of malignant pleural mesothelioma.

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Transcript

Dr. West:  Turning to the issues of what’s emerging in mesothelioma, it seems that there’s a lot of interest in immunotherapies in this setting. Any sense of early data in that, how hopeful you are?

Dr. Solomon:  So, it was with pembrolizumab, and again, a small study, and a response rate of about 29%, and I think that’s encouraging, and I think this is in patients who had prior platinum pemetrexed, and this is a setting where there isn’t a standard second-line treatment, so I think that sort of response rate, again, is a meaningful response rate, and there are a number of other studies that are going with the other different PD-1 or PD-L1 inhibitors, alone or in combination with CTLA-4 inhibitors.

Dr. Horn:  The pembrolizumab study, from what I remember, was only in PD-L1-positive patients.

Dr. Solomon:  I think that’s right, and we may talk about PD-L1 as a biomarker later, but I think an interesting observation was that the didn’t find that the degree of PD-L1 scoring correlated with the likelihood of response, in mesothelioma.


GRACE Video

Is the Survival Benefit with Avastin Added to Chemotherapy Enough to Change the Standard of Care in Mesothelioma?

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WCLC_2015_Avastin_Chemotherapy_Mesothelioma_Survival_Benefit_Enough

 

Drs. Ben Solomon, Leora Horn, & Jack West discuss highlights of a French randomized trial that demonstrated a significant survival benefit from addition of Avastin (bevacizumab) to cisplatin/Alimta in patients with malignant pleural mesothelioma.

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Transcript

Dr. West:  So, one of the other topics that’s covered in this broad thoracic malignancies conference is mesothelioma, where one of the biggest bits of news that we got this year actually came at ASCO, earlier this year, in a French trial that showed that adding Avastin (bevacizumab) to standard chemotherapy, in this case, cisplatin and Alimta (pemetrexed), seemed to improve survival in a clinically significant way. What do you think of these data — is this changing practice for you or around you, Ben?

Dr. Solomon:  Sure, look, I think it’s an important study — the initial study that showed benefit of cisplatin and pemetrexed, over cisplatin alone, was the first phase three study that showed a survival benefit in mesothelioma. This is the second study, and I think the benefits are meaningful. There was an improvement in progression-free survival of about two months — the improvement in overall survival was a bit more than that. So, I do think that that difference is meaningful, and I think it’s likely that bevacizumab, in that context, will get incorporated into standard practice.

Dr. West:  What do you say?

Dr. Horn:  I think that is possible — what I worry is that pemetrexed and bevacizumab together is a more toxic combination, and it is not as easy and as tolerable as pemetrexed alone, but for those patients who can tolerate it, it is a good, new treatment option for them.

Dr. West:  So it’s not something you’re uniformly inclined to incorporate for most or all of your patients with mesothelioma?

Dr. Horn:  It’s such a rare disease, so not right now. What I also worry about is a lot of the mesothelioma patients are older, and, so, that same worry about tolerability.


Dr West

The Challenge of Assessing Response in Malignant Pleural Mesothelioma (and Some Lung Cancers)

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Malignant pleural mesothelioma (MPM) is a challenging cancer to treat for many reasons, one of which being the difficulty in assessing whether there has been any meaningful change in the volume of a cancer that doesn’t tend to appear as a discrete mass, but most commonly as thickening of the pleura, the lining around the lung that is normally a thin, onion skin, but can thicken to be more like an orange rind or even thicker.  We can often see this pattern in some people with lung cancer who happen to have a form of the disease that also primarily appears as pleural-based deposits of cancer.

   Here’s a post I did for another site about this issue of imaging to assess response in MPM.  I hope it’s helpful to those of you with pleural-based disease.


Dr West

First ASCO Highlights Podcast: Dr. Pinder on Small Cell, Early Stage NSCLC, and Mesothelioma

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Several weeks ago, we were fortunate enough to have Dr. Mary Pinder (alternately referred to as Pinder-Schenck) from the H. Lee Moffitt Cancer Center in Tampa join as the first of two speakers reviewing highlights in thoracic oncology from ASCO. She covered several key presentations in small cell lung cancer, early stage non-small cell lung cancer, and mesothelioma. Here’s the audio and video versions of the podcast, along with the transcript and figures (a zip file to decompress, since it was too big in unzipped form to upload) for this program:

pinder-asco-2011-highlights-sclc-early-stage-nsclc-and-meso-audio-podcast

pinder-asco-2011-highlights-sclc-early-stage-nsclc-and-meso-transcript

pinder-asco-2011-highlights-sclc-early-stage-nsclc-and-meso-figures

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