Professor Dean Fennell discusses mesothelioma research and clinical trials

Dean Fennell, Professor of thoracic medical oncology and President of the International Mesothelioma Interest Group, attended the House of Commons on 22 March 2016 to update the Asbestos Sub-Committee on current mesothelioma research trials being conducted across the world and, importantly, within the UK.

Professor Fennell described the current theme of clinical research as attempting to “harness the immune system by way of stratified therapy”.

In discussing this theme Professor Fennell explained that sadly there have been no major break-through’s in mesothelioma related treatment for some 10 years or so.

Professor Fennell went on to state that there have been no key advancements in treatment for mesothelioma victims suffering a relapse after chemotherapy.

Research centres across the world are now agreed that each mesothelioma patient is different and as such their mesothelioma grows differently and the patient will react in varying ways to treatment.  With this in mind it is important to customise the treatment being offered to each patient as opposed to having a “one size fits all policy”.

Professor Fennell reminded the committee that the UK is at the forefront of mesothelioma research and went on to explain the three main methods of treating mesothelioma being studied.

Mesothelioma research – targeting the immune system

The first method being trialled involves taking fluid and tissue samples from mesothelioma patients for analysis.  Genetically modified organisms are then created which are introduced to the mesothelioma in an attempt to create a direct immune response to the tumour.  In effect this is a case of assisting the bodies own immune system to create bacteria to fight the disease.  Trials of this treatment, known as “CRS207” are currently showing promising results with most mesotheliomas either shrinking or stabilising.

Another method of targeting the immune system being trialled is by re-programming dendritic cells to attack the mesothelioma.  This treatment involves the removal of cells from the patient’s body which are then re-programmed and re-inserted in to the patient.  The cells then purposely target the mesothelioma.  Professor Fennell in very simple terms described this treatment as “giving a sniffer dog a scent to follow”.  Once the cells are aware of the mesothelioma due to the re-programming process they will then automatically attack the tumour within the body.  Again this is a case of using the bodies own immune system to fight the disease.

The final immune system approach being trialled is by using drugs “to remove the camouflage that mesothelioma produces”.  Professor Fennell stated that mesothelioma is able to camouflage itself from the bodies immune system making it hard for the patients own auto immune system to combat the disease.  A combination of the chemical trials known as FAK+PD1 are being used to remove the camouflage of mesothelioma so the immune system, assisted by drugs can actually target the mesothelioma.

Mesothelioma research – the magic bullet approach

Professor Fennell next stated that “a magic bullet” approach is being used to target mesothelioma.  In essence a drug called anetumab ravtansine is being introduced to the patients immune system which is intended to have a fast acting and powerful effect on the tumour.  To date the approach has had a 90% success rate in pre-chemotherapy patients and a 50% success rate for chemotherapy patients that have had a relapse.  The success is measured by way of the mesothelioma either stabilising or shrinking.

Professor Fennell has described the results as being very exciting.

Mesothelioma research – stratified therapy

The final key approach to mesothelioma treatment is by way of mapping the most common genes affected by mesothelioma mutations and targeting efforts on assisting those genes to produce an immunity to the disease.

A hierarchy of most affected genes has now been produced and as well as being used to assist the bodies immune system in fighting mesothelioma, scientists are also using this to guide them in mesothelioma research and tissue sampling trials.

Professor Fennell acknowledges that the fight to successfully treat or even find a cure to mesothelioma is a long way off, but with continued clinical research and the promising results being produced by current research he is confident that one day there will be either a positive treatment or even a cure.