Mesothelioma Clinical Trials: Improving Survival and Access to Novel Treatments

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• Common Patient Questions in Mesothelioma
• Prognosis and Survival Expectations
• Molecular Tumor Sequencing Benefits
• Clinical Trial Participation Importance
• UK Clinical Trial Recruitment Rates
• Patient Initiated Treatment Discussions
• Full Transcript

Common Patient Questions in Mesothelioma

Dr. Dean Fennell, MD, identifies the most frequent questions mesothelioma patients ask their oncologists. Patients typically want to know about their prognosis and available treatment options. These questions reflect fundamental concerns about survival and quality of life. Dr. Fennell acknowledges the difficulty in providing definitive answers to these emotionally charged questions.

Prognosis and Survival Expectations

Mesothelioma survival varies significantly among patients despite similar diagnoses. Dr. Dean Fennell, MD, explains that some patients defy statistical odds through various factors. Clinical trial participation often leads to better outcomes and extended survival. Current licensed therapies typically provide approximately six months of survival benefit. Dr. Dean Fennell, MD, emphasizes that while mesothelioma isn't curable, multiple treatments can stabilize the disease. This approach helps patients maintain quality of life for extended periods.

Molecular Tumor Sequencing Benefits

Molecular profiling provides crucial information for mesothelioma treatment planning. Dr. Dean Fennell, MD, discusses how tumor sequencing helps identify specific genetic mutations. These include BAP-1 and CDKN2A mutations that influence treatment response. Immunohistochemistry often provides sufficient protein-level information for clinical decisions. Molecular information helps oncologists provide more accurate prognostic information to patients. This personalized approach represents the future of mesothelioma treatment optimization.

Clinical Trial Participation Importance

Clinical trial access represents a critical opportunity for mesothelioma patients. Dr. Dean Fennell, MD, stresses that patients should proactively ask about available trials. Not all physicians are involved in clinical research, making patient initiative essential. Finding specialized Centers of Excellence can provide access to innovative treatments. Clinical trials offer patients opportunities to benefit from new cancer drugs before widespread availability. Dr. Anton Titov, MD emphasizes that this proactive approach applies across multiple disease areas.

UK Clinical Trial Recruitment Rates

The United Kingdom demonstrates exceptional mesothelioma clinical trial recruitment capabilities. Dr. Dean Fennell, MD, notes that approximately 80% of patients come from outside his immediate area. This referral pattern enables rapid trial completion, sometimes a year ahead of schedule. Fit patients without second malignancies typically qualify for clinical trial participation. The UK's efficient referral system accelerates answers from clinical studies. This model benefits both current patients and future mesothelioma treatment development.

Patient Initiated Treatment Discussions

Patient engagement significantly influences mesothelioma treatment outcomes. Dr. Dean Fennell, MD, encourages patients to research available clinical trials independently. Family members often play crucial roles in identifying treatment opportunities. Patients should specifically ask their physicians about nearby clinical trial options. Even when local trials aren't available, the question prompts important discussions about treatment alternatives. Dr. Anton Titov, MD confirms that multiple experts across specialties emphasize this proactive patient approach.

Full Transcript

Dr. Anton Titov, MD: Professor Fennell, you're a world-renowned expert in mesothelioma treatment. What are the top three questions that patients with mesothelioma ask you? And also, what are the top questions that patients do not ask you, but you think they should?

Dr. Dean Fennell, MD: Well, gosh, the second one is quite difficult. I have to think about that. But I'm not asked any question that is unique to any oncologist. Actually, I suppose two questions: how long have I got, and what can you do about it?

The answer to the question of "how long have I got?" is obviously an impossibly difficult question. Some patients do well, despite the fact that they have BAP-1 or CDKN2A mutation, sarcomatoid or non-sarcomatoid mesothelioma. We have examples, not in huge numbers, but examples where patients have defied the odds one way or the other.

Usually patients do better with clinical trials. We know that with more treatments, and provided that patients can remain fit and enter into clinical trials where they have opportunities to get the benefit of therapy, survival will be longer in mesothelioma. But we have to still quote the survival figures that we get from the licensed therapies, a little bit longer for the reasons I've given you.

The time benefit that patients are going to get from the treatment is in the order of about six months, whether it's immunotherapy or chemotherapy. So I think addressing that question, how long have I got, is the difficult one. We cannot cure mesothelioma. We cannot ever speak about that reliably.

But we can do our very best to offer as many positive treatments that can stabilize cancer and keep people well for as long as possible. And thankfully, we've had some patients in our clinics who have relapsed many times but have remained thankfully well because they have had treatments that can control their mesothelioma.

Another question that has arisen is, "do you want to sequence my tumor?" And I think it's sort of early days there. Really we have sequenced a number of tumors. Some of the information that we've gained has been extremely beneficial.

Because of the very nature of mesothelioma, you can get most of the important information you need about the genes probably from immunohistochemistry, from looking at the proteins. When you think about how these genes become disrupted, actually knowing whether the protein is there or not is probably the most useful bit of information you can get.

So we are doing more molecular information. And that helps us get prognostic information to patients.

The question that perhaps patients could always ask more of their doctors is, "is there a clinical trial available near me that I can take part in?" Not all doctors will be involved in clinical trials. But it is important.

I think that if there are clinical trials out there, in order to move this field forward, it's going to be critical for patients to be referred. And very often, when it's with the patient themselves to perhaps do the reading, or the patient's family to sort of finding out about a Center of Excellence nearby, it may be running a particular clinical trial.

That may often come down to the patient actually having to ask the doctor, is there a clinical trial near me? Patients get referred to that, and hopefully then benefit from receiving that new cancer drug. So that's the question that patients perhaps don't ask enough. Maybe they do ask it! And in some instances, the answer is "no" because there aren't any trials. So I think that's a very important question.

Dr. Anton Titov, MD: What percentage of mesothelioma patients actually do participate in clinical trials, in the Leicester area or in the UK?

Dr. Dean Fennell, MD: Yeah, so we're in a bit of an unusual situation. I think most big clinical trial centers will basically ever find themselves in this situation. For a rare disease, your population per head of capita in your neighboring environment is not going to be huge.

So I think something like 80% of my patients come from outside of Leicester. I guess that's going to be the case for other areas of my country as well, where the patients will be referred to those key centers.

I would say actually, any patient, certainly for the clinical trials that we design, any patient who is fit enough to receive chemotherapy and doesn't have a second malignancy is probably good to go with a clinical trial. And therefore, all patients really who are looking for therapy should be considered.

We have in the past, as I mentioned, we've been able to recruit trials very, very quickly, a phase three a year before time. Precisely because in the UK, I think we've had a very good referring policy. And hopefully, it's that referring to trials we see elsewhere in Europe and the US as well.

It's that ability to refer quickly that we can get answers quicker as well from the clinical studies.

Dr. Anton Titov, MD: Thank you for this clarification. I think patient initiative is very important and seeking both the best treatment as well as being involved in clinical trials. And this is something that we hear from multiple experts on multiple diseases. Patients must be proactive in bringing up questions to their physicians.