Bevacizumab as a First-Line Chemotherapy Treatment for Pleural Mesothelioma

Treatment // November 8, 2016

After receiving a diagnosis of mesothelioma, patients are usually given treatment options that are based upon a number of different things such as their age, their general health, and how far their disease has progressed. For most people with unresectable mesothelioma, the treatment option is usually chemotherapy. Although mesothelioma is not curable, chemotherapy is used because it can help to accomplish several goals including destroying cancer cells, stopping them from spreading to other parts of the body and to help relieve symptoms that patients might be suffering from.

Right now the gold standard in chemotherapy treatment is the use of two drugs – cisplatin and pemetrexed (Alimta). Used in combination, they have long been considered the benchmark for treating mesothelioma.

Pemetrexed belongs to a group of drugs known as anti-metabolites and it works by stopping cells in the body (including cancer cells) from making and repairing the DNA so that cells cannot multiply at a rapid pace. The second drug, cisplatin, contains platinum and works by promoting DNA damage, which causes cancer cells to die. Both pemetrexed and cisplatin have been the mainstay of chemotherapy treatment for mesothelioma for many years but just recently another drug known as Bevacizumab has been introduced into the mix.

What is Bevacizumab (Avastin)?

Bevacizumab is a cancer drug that has been around for over a decade. It was first approved by the Food and Drug administration (FDA) in 2004 and has been used for the treatment of colorectal cancer, glioblastomas, non-small cell lung cancer, and renal cell cancer.

Recently, however, researchers started testing bevacizumab to see if it could also be used to treat mesothelioma and the results have been very promising. One study carried out in 2016 showed that when added to pemetrexed and cisplatin, bevacizumab “significantly improved overall survival in patients with malignant pleural mesothelioma.”

Interestingly, although bevacizumab is sometimes classified as a chemotherapy drug, it does not fight cancer in the usual way. One of the reason cancer cells grow so quickly is they are able to grow more blood vessels than other cells in the body which allows them to attract more nutrients and grow at a very fast rate. Bevacizumab works by slowing the growth of these blood vessels which deprives the cancer cells of their blood supply. So while bevacizumab is not a classic chemotherapy drug, it is being used alongside pemetrexed and cisplatin to fight cancer cells using a non-conventional attack method.

Learn more about experimental treatments like bevacizumab.

The Effectiveness of Bevacizumab

In a popular study that was carried out in France in early 2016, researchers looked at over 400 patients with unresectable (that is, non-operable) mesothelioma and randomly assigned half the group to receive cisplatin and pemetrexed, while the other half received cisplatin, pemetrexed, and bevacizumab. At the end of the study, researchers found that patients who were given bevacizumab had an overall increased survival (18.8 months) compared to those that were not (16.1 months). Not unsurprisingly, the authors of the study came to the conclusion that bevacizumab should be “considered as a suitable treatment” for malignant pleural mesothelioma.

Following on from this, in July 2016 the National Comprehensive Cancer Network (NCCN) changed its first-line treatment recommendation for unresectable pleural mesothelioma to include the addition of bevacizumab in combination with cisplatin/pemetrexed. The NCCN includes dozens of the biggest cancer centers in the world, and is often a leader in the recommendation of new and emerging cancer therapies.

Where Will Research Go Next?

Using triplet drug combinations to treat cancer is not a new idea, but it is something that is now being looked at once again. It also gives us a glimpse into where research may go next and instead of focusing on traditional chemotherapy drugs, researchers may start considering other medications that can be added to existing regimens. Fighting cancer cells on a number of different fronts like these three drugs are doing may be the future of cancer treatments and although progress can seem slow at times, it is still progress in the right direction.