Aaron S. Mansfield, MD, associate professor of oncology, medical oncologist, consultant, Division of Medical Oncology, Department of Oncology, Mayo Clinic, discusses ongoing trials with chemoimmunotherapy in mesothelioma.

Clinical trials evaluating chemoimmunotherapy strategies for patients with mesothelioma are likely to read out in the next few years, Mansfield says. Nonrandomized phase 2 data evaluating these regimens have yielded promising data.

However, it will be important to compare the efficacy of these combinations against standard options to determine whether chemoimmunotherapy will emerge as the standard of care for patients with mesothelioma. Currently, some of the ongoing trials are utilizing platinum-based doublet chemotherapy in the control arm, but that approach is no longer appropriate for many patients with mesothelioma, including those with non-epithelioid disease. As such, when the data read out, cross-trial comparisons may be necessary to determine whether patients should receive chemoimmunotherapy, Mansfield concludes. 

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Aaron S. Mansfield, MD, discusses ongoing trials with chemoimmunotherapy in mesothelioma.  



Dr. Mansfield Discusses Ongoing Trials With Chemoimmunotherapy in Mesothelioma 

Aaron S. Mansfield, MD, associate professor of oncology, consultant in the Division of Medical Oncology, Mayo Clinic, discusses the current treatment paradigm for patients with extensive-stage small cell lung cancer (SCLC) and highlights ongoing research in the field.

For decades, the standard of care has been a platinum doublet, either cisplatin or carboplatin with etoposide. However, progress has not moved much beyond that, explains Mansfield. Although these regimens are fairly effective in terms of tumor shrinkage, the responses have not been durable. After initial response, the tumor tends to progress quickly thereafter. Patients with a diagnosis of SCLC have poor survival, averages of which have yet to surpass 1 year.

However, there are several ongoing trials in which investigators are examining different therapeutic approaches. At the 2019 AACR Annual Meeting, Mansfield and colleagues presented an update on a chemoimmunotherapy combination comprised of atezolizumab (Tecentriq), carboplatin, and etoposide. Other studies have looked at temozolomide (Temodar) plus PARP inhibitors, says Mansfield. There are also proteins expressed in SCLC that researchers are trying to target with antibody-drug conjugates. Most of these trials have been negative, although not due to a lack of effort, Mansfield concludes.

Dr. Mansfield on the Current Treatment Paradigm in SCLC

Aaron S. Mansfield, MD, associate professor of oncology, consultant in the Division of Medical Oncology, Mayo Clinic, discusses challenges in the treatment of patients with small cell lung cancer (SCLC).

Despite recent advances, there are a number of challenges that still exist in developing effective therapies for these patients, Mansfield says. One of them is the lack of tissue to study. Most of the time, patients are diagnosed with SCLC from cytology or from a pleural effusion because they present with advanced, symptomatic disease. These patients are often hospitalized or come through the emergency department, so oncologists don’t have the time to obtain sufficient tissue samples, Mansfield notes.

Moreover, it is very rare for a patient with SCLC to be eligible for surgery, whereas in the non—small cell lung cancer (NSCLC) space, many patients have resectable disease. There are also tissue repositories for NSCLC tissue samples, allowing researchers to study them more rigorously. As such, NSCLC has had a proliferation of targeted therapies, while SCLC has lagged in that area.

Aaron S. Mansfield, MD, associate professor of oncology, consultant in the Division of Medical Oncology, Mayo Clinic, discusses challenges in the treatment of patients with small cell lung cancer.

Aaron S. Mansfield, MD

Articles

Dr. Mansfield Discusses Ongoing Trials With Chemoimmunotherapy in Mesothelioma

Dr. Mansfield on the Current Treatment Paradigm in SCLC

Dr. Mansfield Discusses Challenges in SCLC