Mesothelioma remains a very difficult “big killer” to cure, but researchers continue to test new therapeutic solutions, as also shown by some studies presented in recent days during the annual congress of the American Society of Clinical Oncology (Asco), the results of which open perspectives on a possible use of immuno-oncology in the first line and on improvements obtained from chemotherapy with vinorelbine in progression-free survival in relapses.
In Italy 2 thousand new cases in 2020
Mesothelioma is a particularly aggressive neoplasm affecting the mesothelium, a fibrous membrane that lines various organs and structures including the lungs and the inner part of the rib cage (pleura), heart (pericardium), intestines (peritoneum) and testes. It is a rare and very aggressive cancer, closely linked to exposure to asbestos or asbestos. Diagnosis is often late, with the majority of patients presenting with advanced or metastatic disease, and the prognosis is generally poor, with an average survival of less than one year. «Mesothelioma has a very strong link with occupational exposure to asbestos fibers – he explains Rossana Berardi, professor of medical oncology at the Polytechnic University of Marche and director of the oncology clinic Ospedali Riuniti of Ancona -. It is a tumor that arises in over 90% of cases from the pleura and, to date, remains a difficult pathology, so there is no effective curative therapy. Unlike other solid tumors, even in the case of early diagnosis, surgical treatment, which is moreover burdened by great complexity, does not have a significant impact on survival due to the high rate of local relapses ». In Italy, in 2020, almost 2,000 new cases were estimated, which are constantly growing (there were 1,800 in 2019) and on average, unfortunately, only 9% of patients are alive five years after diagnosis.
The studies presented at the US conference
In most patients, the first therapeutic approach is pharmacological and, since 2004, combination chemotherapy has been considered the first-line standard of care with palliative intent. «They were presented at the Asco congress data from a study on immunotherapy with check point inhibitors who documented how, in mesothelioma patients, developing treatment-related side effects can be a factor capable of predicting the response and efficacy of immunotherapy – says Berardi, who is also coordinator of the Italian Association of Medical Oncology ( Aiom) for the Marche region -. In the study, conducted on 61 patients with mesothelioma treated in the first line with immunotherapy, 28% had developed side effects related to early treatment, with an improvement both in terms of activity, or in terms of clinical benefit linked to the disease, and in terms of terms of efficacy, that is, of impact on survival ». Notably, overall survival was higher in patients with immune-related side effects (21.1 months compared to 4.7 months), as well as progression-free survival (6.8 months compared to 1.7 months) and with a significant increase in clinical benefit (65% compared to 27%). «Another study conducted by British colleagues demonstrated the effectiveness of chemotherapy treatment with a drug, vinorelbine, traditionally used in oncology in other pathologies, even as a second line in mesothelioma – continues the expert -. To date, randomized clinical trials on the role of vinorelbine in relapse were lacking, despite its wide use off label. 154 patients were enrolled, with relapse after first-line chemotherapy. Progression-free survival reached 4.2 months with vinorelbine combined with supportive therapy compared with 2.8 months with supportive therapy alone.
Supervise workers at risk
Although in Italy the use of asbestos (production, processing and sale) has been banned since 1992, the peak incidence of mesothelioma has not yet been reached because the latency period between exposure to possible risk factors and the appearance of the tumor is about 20-40 years. The incidence is particularly high in some regions, including Piedmont and especially the area of ​​Casale Monferrato (in the province of Alessandria), sadly famous for Eternit process. Other high-risk areas are found in Friuli Venezia Giulia, in the area of ​​Monfalcone and Trieste, and in Bari due to the presence of shipyards and factories where asbestos was used. In Italy this mineral is still present in large quantities and in various forms in factories and buildings, public and private, and it is essential to speed up the time for remediation of contaminated sites, which can only be performed by specialized personnel. Mesothelioma generally occurs around 70 years of age: it is essential to monitor the people most at risk of getting sick, that is, the former workers of the factories that produced or treated asbestos. The most commonly affected professional figures are: workers in shipyard and construction sites, workers in companies of car mechanics, insulating materials, pipes and installation of heating systems.
June 22, 2021 (change June 23, 2021 | 15:54)
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