Targeted cancer treatment could provide new hope for mesothelioma patients

Southampton researchers are leading a new clinical trial to see if a targeted treatment improves survival for a rare type of cancer.

The NERO trial aims to improve treatment options for patients with mesothelioma - a rare and aggressive form of cancer linked to breathing in asbestos.

The trial is now open to patients at University Hospital Southampton (UHS). It will also recruit patients from Queen Alexandra Hospital in Portsmouth, referred to UHS by the local research team.

Urgent need for more treatments

Dr Judith Cave, medical oncologist at UHS, and the Southampton Clinical Trials Unit are part of the team launching the trial.

“Mesothelioma is a challenging cancer,” says Dr Cave. “Unfortunately, there are currently very few treatment options for patients when their cancer stops responding to chemotherapy. We therefore urgently need to explore more effective approaches to treating this disease.”

Mesothelioma develops in the lining of the lungs or abdomen. Currently only five percent of people survive five years after diagnosis.

Building on previous work

Researchers from UHS were recently involved in the University of Leicester-led MiST1 study. This showed a class of targeted cancer drugs called PARP inhibitors were effective against mesothelioma.

PARP inhibitors have already been shown to improve the survival of patients with breast and ovarian cancers that carry specific mutations. They work by blocking a protein which helps repair damaged DNA in cancer cells. This causes the cancer cells to die.

Building on the results of MiST1, Dr Cave is now part of the leadership team for the NERO trial. She is working with chief investigators Professor Dean Fennell at the University of Leicester, and Professor Gareth Griffiths and his team at the Southampton Clinical Trials Unit.

“The MiST1 trial gave us positive data showing that mesothelioma does respond to this type of drug, but further investigation is needed," says Judith.

"We hope that the NERO trial can provide clear evidence that PARP inhibitors could be a new treatment option for patients and potentially give them more time with their loved ones.”

Dr Cave and the team behind NERO also recently published the results of the CONFIRM trial. This was the first study of its kind to show an immunotherapy treatment improved survival for patients with mesothelioma.

The NERO trial was developed in collaboration with Mesothelioma UK, a national charity working to support mesothelioma patients and research into the disease. It is funded by Asthma and Lung UK, with additional support from Cancer Research UK core funding at the Southampton Clinical Trials Unit.

Taking part in the NERO trial

Mesothelioma patients whose tumours have continued to grow following chemotherapy are more likely to be susceptible to a PARP inhibitor. The NERO trial will recruit 84 of these patients at hospitals across the UK.

They will be randomly allocated into one of two groups, with a 2:1 chance of receiving the PARP inhibitor niraparib. This will allow the researchers to compare the effect of the drug on the tumour.

Those patients who do not receive niraparib will be closely monitored for signs of early tumour growth, so they can receive an alternative treatment if necessary.

‘A huge shock’

Helen Wilangowski, 70, received a prognosis of just 18 months when she diagnosed with mesothelioma in April 2016 after experiencing changes in her breathing.

“It was a huge shock to find out I had this disease, and it hit me badly,” says Helen. “I didn’t even tell my children for the first few months as my daughter was doing her finals at university and I just didn’t want to worry them.”

Helen had surgery and chemotherapy. This kept her disease stable for several years, but then doctors discovered that the cancer had spread to her lymph nodes.

“I was offered the chance to take part in a clinical trial, which I jumped at,” says Helen. “Thankfully, the drugs have been successful in keeping my cancer stable, but for how long no one knows. It means a great deal to know that more trials, like the NERO trial, are now being carried out to help find better treatments for the future.”