Innovative immunotherapy drugs could offer new treatment options for patients with some asbestos related lung cancers

Lung cancer is hard to diagnose at an early stage, and advanced lung cancer – that has spread to other parts of the body – is challenging to treat. However, with advances in immunotherapy, genetic sequencing, targeted therapies and more, researchers at The Royal Marsden are continuing to find new ways to treat patients.  

“Over the last decade, the way we treat lung cancer has evolved significantly”, says Professor Sanjay Popat, Consultant Medical Oncologist at The Royal Marsden, who is leading several studies supported by The Royal Marsden Cancer Charity in this area. “We now live in an era where personalised lung cancer therapy is key. As a result, patients are living longer, and we are improving their quality of life.” 

Harnessing the immune system to attack cancer cells   

One area at the forefront of lung cancer research is immunotherapies, which are drugs that utilise a patient’s immune system to attack cancer cells. 

Following research that included important studies at The Royal Marsden, the immunotherapy drug pembrolizumab was approved in 2016 for use on the NHS to treat lung cancer patients, followed by nivolumab in 2017. In the years following, further trials at The Royal Marsden have established immunotherapies as effective treatments for lung cancer patients. The focus of current research is making them more effective for more people, for example, by combining them with other treatments. 

New ways of treating cancer linked to asbestos 

Mesothelioma, a cancer of the protective lining of the lung, is an aggressive form of cancer linked to asbestos exposure. Results from Professor Popat’s PROMISE-meso trial saw the approval of one of the first new treatment options in decades – pembrolizumab – for some patients with mesothelioma. Pembrolizumab is an immunotherapy that offers similar benefit to chemotherapy. 

Professor Popat is also the Chief Investigator for the BEAT-Meso trial, which evaluated the benefit of adding an immunotherapy drug called atezolizumab to chemotherapy and bevacizumab. Bevacizumab is a targeted cancer drug which stops new blood vessel formation in tumours and prevents cancer from growing. The results of this trial, which were recently presented at the American Society of Clinical Oncology annual meeting, demonstrate a benefit in patients with a specific subtype called non-epithelioid mesothelioma. 

Alexius John is Clinical Research Fellow in the Lung Unit at The Royal Marsden, a role funded by The Royal Marsden Cancer Charity. He explains: “We have a growing body of evidence to demonstrate that incorporating immunotherapies and targeted therapies into the first-line treatment of mesothelioma is more effective for patients than chemotherapy alone, and we hope this will lead to an expansion of options for patients with this aggressive disease.”  

Lung cancer research carried out by Professor Popat and the team is supported by the Revere Charitable Trust through The Royal Marsden Cancer Charity.  

Taking part in the BEAT-Meso trial: Kevin’s story 

Kevin is a 75-year-old retired flight simulator engineer from Worcester Park. He was diagnosed with mesothelioma at his local hospital in 2021 and went on to join the BEAT-Meso trial at The Royal Marsden under the care of Professor Popat.  

“Early in 2021, I was getting very breathless walking up the stairs in my house and any small inclines. My wife persuaded me to go and see my doctor, who arranged for me to have an x-ray scan at my local hospital. The radiographer found that my left lung had collapsed, so I was sent off to A&E. 

“This led to an appointment where they drained off 1.5 litres of fluid from my left lung cavity. I was then told I had thickening of the pleura – where scar tissue expands and thickens the thin layer covering the lungs. After a discussion about my options, I elected to go with key-hole surgery, and as part of this they performed a biopsy.” 

Following this, Kevin was told he had mesothelioma and was referred to The Royal Marsden to join the BEAT-Meso trial. Over 47 treatment cycles later, Kevin is doing well and his cancer is stable. 

“This trial is so successful for me that I managed to complete the last five stages of the 'French Camino' in October last year, walking around 15 miles a day for five days with absolutely no problems. 

“The staff at the Royal Marsden are absolutely amazing and I can't thank them enough. I have intravenous treatment every three weeks, with a CT scan every six weeks. I only have minor side effects.”