Transcript

My name is Dr Claire Verschraegen. I'm a professor at the Ohio State Comprehensive Cancer Center. I'm the chief of the medical oncology division. My specialty is really rare tumors and drug development.

So I'm going now to discuss an abstract presented by Patrick Forday on the evaluation of chemotherapy with durvalumab for pleural mesothelioma.

Pleural mesothelioma is a condition that is caused by asbestos, usually, asbestos exposure in the past, and really creates a very aggressive cancer of the lining of the lung that has some challenges in treating appropriately.

The current standard of care is the combination of carboplatin or cisplatin with pemetrexed, which was presented at ASCO >15 years ago, and it has remained the standard of care for this disease.

Surgery can sometimes be helpful for early disease, but once the disease is really advanced, it's very difficult to really cure this condition. There has been a lot of studies of immunotherapy in this disease, because interestingly, in some rare cases of mesothelioma, you can see some spontaneous remission.

I've seen that a few times, I would say 3 or 4 times in my career, where the disease just regresses on its own, making us believe that there is really an immunotherapy component that could be helpful to treat mesothelioma.

So, some drugs have been tried before, pembrolizumab, avelumab, the CTLA for tremelimumab has been also studied versus placebo. Even though some responses were seen, it was really not to the extent that we see in other diseases, such as melanoma or non–small-cell lung cancer. I was a bit disappointed to see the low rate of remission related to immunotherapy in mesothelioma.

Now, this is a very small study. It's a phase 2 study of 55 patients, combining the standard of care, cisplatin and pemetrexed with durvalumab.

The response rate, especially in overall survival, seems very promising, with really a nice increase on the expected rate of survival. The expected rate of survival for all comers with mesothelioma is about a median of 12 months.

In this study, the overall survival was 70% of patients who were still alive at 12 months, which is higher than expected. Definitely, this is a phase 2 study that will ask the question, in a phase 3 randomized study, if the company wants to pursue durvalumab for mesothelioma.

There's always a caveat that the phase 2 study can sometimes look very promising, but when you run the phase 3 study, there is really no difference in the outcome. So, I would still hold my breath to make sure that these results are a reality, but I'm very interested and would like to see it go to phase 3 trial to prove the point that the combination of immunotherapy with chemotherapy is helpful to treat patients with mesothelioma.

Thank you very much.