University of Southampton: Scientists in Southampton have made a major breakthrough that could help patients with mesothelioma survive for longer.

People diagnosed with the aggressive form of cancer, linked to breathing in asbestos fibres, could have more time with their loved ones when prescribed an immunotherapy drug currently used to treat several other types of cancer, new research has found.

The Checkpoint Blockade for Inhibition of Relapsed Mesothelioma (CONFIRM) trial was led by researchers in the University’s clinical trials unit, which is funded by Cancer Research UK, alongside their colleagues in Leicester.

Funded by Stand Up To Cancer – a joint fundraising campaign by Cancer Research UK and Channel 4 – the trial found that an immunotherapy called nivolumab increased survival and made the disease more stable for patients who relapsed following standard treatment.

A total of 332 patients whose tumours were still growing after receiving chemotherapy and who were not able to have surgery, took part in the randomised trial.

A total of 221 of those patients were given nivolumab and the remaining 111 given a placebo once every fortnight for up to 12 months. Twenty-one of the patients who took part in the trial were treated at University Hospital Southampton.

It’s the first study to show that a treatment has been able to improve survival in patients with mesothelioma that has come back after chemotherapy. Until now, no treatment had been found that could significantly improve outcomes for patients.

The impressive findings, which saw those who had nivolumab survive an average of 9.2 months compared to those in the placebo group who survived 6.6 months, were presented to oncologists and researchers around the world at the World Conference on Lung Cancer at the weekend.

Patients who received nivolumab also had more stable disease. The risk of their cancer progressing was reduced by 39%, with people not seeing their cancer worsening for 3.0 months compared with 1.8 months in the placebo group.

Mesothelioma develops in the lining of the lungs or abdomen, with most cases caused by exposure to the now outlawed industrial material, asbestos. Currently seven per cent of people survive their disease for five years or more.

Each year, around 90 people are diagnosed with mesothelioma in Hampshire. Cases of mesothelioma in the UK have increased by 61% since the early 1990s. It is particularly high in areas where shipping and mining industries formerly thrived.

Patients are usually treated with chemotherapy, surgery or radiotherapy. But treatment options start to become limited once people stop responding to their treatment.

During the COVID-19 pandemic, NHS England endorsed nivolumab for use in some people with malignant mesothelioma as an alternative to chemotherapy because it has less of a suppressive effect on the immune system and may reduce the risk of someone becoming seriously ill during the pandemic. This decision is currently in place until the end of March but the data from the CONFIRM trial could help to make this option permanently available to patients.

Professor Gareth Griffiths, Director of the Cancer Research UK Southampton Clinical Trials Unit at the University of Southampton, said: “This trial shows clear evidence of benefit and marks a major breakthrough in the treatment of mesothelioma, a disease where there are currently very few options for patients when first-line chemotherapy has stopped working and prognosis is often very poor.

“This is the first study ever to show improved survival and we therefore believe that nivolumab could be a game-changer for treating mesothelioma patients in the future.”

Michelle Mitchell, Cancer Research UK’s chief executive, said: “Nearly half a century ago, Cancer Research UK scientists added to the understanding of just how dangerous asbestos could be. This research helped change regulations, reducing workers exposure to this deadly substance. But mesothelioma can take over 40 years to develop, and the long and painful legacy of asbestos use is still sadly being felt today.

“It’s wonderful news to hear that we may have found a new treatment for people with mesothelioma who have run out of options, when there has been so little progress over the years. We hope that NICE considers nivolumab as a treatment option, which will give people with mesothelioma precious extra time with their loved ones.”