Mesothelioma Keytruda®

Early studies show promise for the treatment of mesothelioma, non-small cell lung cancer (NSCLC), and melanoma.

Mesothelioma

Each year in the United States, approximately 3,000 mesothelioma cases are diagnosed, and more men develop it than women. Most cases are due to on-the-job asbestos exposure. Pleural mesothelioma forms on the lining of your lungs and is what most mesothelioma patients have. This condition may also show up on the lining of your abdomen or heart.

Non-Small Cell Lung Cancer (NSCLC)

NSCLC is one of two primary lung cancer types that affect both smokers and nonsmokers. It’s a group of lung cancers that have similar behaviors such as adenocarcinoma and squamous cell carcinoma. Around 85 percent of all lung cancer cases are NSCLC.

Keytruda® – A Newer Treatment for Both Mesothelioma and NSCLC

Keytruda® (Pembrolizumab) is a new drug that fights cancer and is increasingly gaining attention for treating both Mesothelioma and Non-small cell lung cancer, in addition to melanoma skin cancer.

Physicians use Keytruda® for immunotherapy treatment. It’s a new monoclonal antibody medication that interferes with the growth and spreading of cancer cells and is specifically made for targeting and treating various types of solid tumors.

Monoclonal antibody medications, also known as anti-PD-L1 and anti-PD-1, target specific areas or proteins in cancer cells and is therefore considered targeted therapies. They have a philosophical leverage of binding to cancer cells and killing them, while not causing much damage to your normal cells.

Doctors use Keytruda® pembrolizumab to treat a particular type of NSCLC with a specific genetic marker and advanced stage melanoma. Now, it’s also effective at treating mesothelioma. Studies show the drug partially or completely shrinks tumors and the FDA approved the drug for treating an “accelerated” basis case lung cancer.

How Does Keytruda® (Pembrolizumab) Work?

You have white blood cells (T cells) in your body that “watch” for infection or signs of disease. They also attack cancer cells. Certain proteins (programmed cell death receptors or PD-1) are on the surface of your white blood cells. And, your T cells use PD-1 to communicate and bind with PD-L1 and PD-L2 (proteins that keep your cells from being attacked by your body’s immune system) so they don’t damage your healthy cells.

What this means is that once the PD-1 protein that’s on your T cells touch the PD-L1 and PD-L2 proteins, they’re signaled to let that cell live and spread. But, there are specific cancer cells that contain too much of these two proteins, which basically fool your immune system into thinking they’re healthy cells, keeping your T cells from destroying them.

Keytruda® blocks this signal and ensures the PD-L1 and PD-L2 proteins don’t mislead your T cells. And, this allows your immune system to attack the cancer cells. This whole process is a certain therapy referred to as immune checkpoint blockade where this T cells and PD-L1 protein encounter on tumor cells are the “checkpoint.”

Treating Mesothelioma, Non-Small Cell Lung Cancer and Melanoma with Keytruda®

As of today, the Keytruda® treatment is showing success in these three types of cancers: mesothelioma, non-small cell lung cancer and melanoma.  According to clinical trials, Keytruda® increases the response rate and duration of this response in PD-L1 positive NSCLC patients who didn’t respond to chemotherapy.

The FDA approved Keytruda® for these types of cancer-based on the safety, efficacy, and tolerability of the intravenous treatment.

Early Clinical Trial for Mesothelioma Treatment Keytruda®

Around 20 to 40 percent of patient who has malignant mesothelioma also have PD-L1 on their cancer cells’ surfaces. And, the cancer cells in many of these tumors that are PD-L1 positive have a large amount of this protein on their surface.

During an early clinical trial, patients who were afflicted with advanced pleural mesothelioma that previous therapy didn’t control and whose tumors had PD-L1 on the cell surface that was at high levels received Keytruda® every couple weeks at 10mg a dose. This treatment during the trial was to continue for around 2 years or until the patients had unmanageable side effects or growth of their tumors. Doctors evaluated tumor responses in the first six months to this treatment every 8 weeks and every 12 weeks thereafter.

Encouraging Results of Keytruda®

In around 76 percent of patients treated, Keytruda® was effective with promising results. Of the other 25 patients who received treatment:

  • Tumors shrank in 28 percent (partial response).
  • Disease stabilized in 48 percent with no increase in the magnitude of tumors.

Some patients experienced a positive response to Keytruda® for more than 24 weeks. In addition, Keytruda® appeared to improve other treatment’s effectiveness which meant that doctors could include the drug as part of several different modes of treatment.

Even though the survival advantages of the drug are too early to determine in mesothelioma, after six months of treatment, 50 percent of people who had mesothelioma experienced what doctors refer to as progression-free survival (PFS). It’s also known as survival where tumors didn’t increase in size or became smaller.

Patients with mesothelioma appeared to tolerate Keytruda® well. No mesothelioma patients in the trial stopped therapy because of side effects related to the drug, as of April 2015.

In the early human studies, the effectiveness of Keytruda® for malignant mesothelioma is encouraging news and gives patients hope, even though there still needs to be more research conducted. To date, however, Keytruda® continues to be an investigational mesothelioma and Non-small cell lung cancer.

There’s another trial (phase II) of Keytruda® in malignant mesothelioma, including peritoneal and pleural and patients are being recruited.

Possible Side Effects of Keytruda®

As mentioned, most patients tolerate Keytruda® well. Studies show common side effects of Keytruda® include:

  • Fatigue
  • Anemia
  • Itching
  • Nausea
  • Cough
  • High blood glucose levels
  • Abnormally low albumin in the serum
  • Abnormally low sodium in the blood

Studies also show less common side effects in patients for the drug which include:

  • Decrease in appetite
  • Rash
  • Diarrhea and constipation
  • Abnormally high level of liver enzymes
  • Abnormally high levels of triglycerides in the blood
  • Abnormally low level of calcium in the blood
  • Vomiting
  • Headache
  • Chills
  • Shortness of breath
  • Muscle and joint pain
  • Pain in limbs
  • Pain in back or abdomen
  • Dizziness
  • Difficulty sleeping
  • Fever
  • Infection of the upper respiratory tract

During months of Keytruda® treatment (or after), a serious immune reaction (rare) could be a possible side effect. Your symptoms of this may be pain in the nerves, rash and diarrhea. An immune reaction may affect some organs like your skin, liver, lungs, bowels, kidneys and endocrine system (organs that produce hormones).

If you’re receiving Keytruda®, you should consult with your doctor if you’re experiencing any new or more severe side effects.

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