What Is Immunotherapy for Mesothelioma?

How Immunotherapy Works

Immunotherapy is a class of cancer treatment that harnesses the body’s own immune system to fight cancer. Under normal circumstances, the immune system can detect and destroy abnormal cells. However, cancer cells often develop mechanisms to evade immune detection — effectively hiding from the body’s defenses. Immunotherapy drugs work by removing these shields, allowing immune cells to recognize and attack the cancer.

The primary type of immunotherapy used for mesothelioma is checkpoint inhibitor therapy. Immune checkpoints are proteins on T cells (a type of white blood cell) that act as “brakes” to prevent the immune system from attacking healthy tissue. Cancer cells can exploit these checkpoints to avoid being destroyed. Checkpoint inhibitor drugs release these brakes, enabling T cells to mount a stronger attack against the tumor.

FDA-Approved Immunotherapy for Mesothelioma

In October 2020, the FDA approved the combination of nivolumab (Opdivo) and ipilimumab (Yervoy) for first-line treatment of unresectable malignant pleural mesothelioma. This approval was based on the CheckMate 743 clinical trial, which enrolled 605 patients and compared the immunotherapy combination to standard pemetrexed-platinum chemotherapy.

The trial demonstrated a median overall survival of 18.1 months with immunotherapy versus 14.1 months with chemotherapy. The benefit was most pronounced in patients with non-epithelioid (sarcomatoid and biphasic) cell types, where median survival was 18.1 months versus 8.8 months — a dramatic improvement for a group that historically had very poor outcomes with chemotherapy alone.

Treatment Protocol

The approved regimen consists of nivolumab (360 mg) administered intravenously every 3 weeks plus ipilimumab (1 mg/kg) every 6 weeks. Treatment continues for up to two years or until disease progression or unacceptable toxicity. Nivolumab targets the PD-1 checkpoint on T cells, while ipilimumab targets the CTLA-4 checkpoint, providing complementary immune activation.

Patients receiving immunotherapy require regular monitoring for immune-related adverse events, which differ from traditional chemotherapy side effects. Blood tests, imaging, and symptom assessments are performed at regular intervals throughout treatment.

Immunotherapy in Clinical Trials

Beyond the approved nivolumab-ipilimumab combination, numerous clinical trials are investigating other immunotherapy approaches for mesothelioma. These include pembrolizumab (Keytruda) as a single agent or in combination with chemotherapy, immunotherapy combined with surgery in multimodal protocols, cellular immunotherapy approaches including CAR-T cell therapy, and cancer vaccine strategies designed to teach the immune system to target mesothelioma-specific proteins.

Patients interested in immunotherapy clinical trials should discuss eligibility with their oncologist or contact a mesothelioma treatment center with active research programs.

Immunotherapy and Legal Resources

Immunotherapy represents a significant advance but is also costly, with treatment potentially exceeding $100,000 per year. Patients diagnosed with mesothelioma from asbestos exposure have legal options for compensation that can help cover treatment expenses. The attorneys at Danziger & De Llano can explain your options during a free, confidential consultation. Call 1-800-400-1805.