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CTLA-4 and Mesothelioma

CTLA-4 inhibitors are a type of immunotherapy drug that can help your body fight cancers like mesothelioma. The two main CTLA-4 drugs for mesothelioma are ipilimumab (Yervoy®) and tremelimumab (Imjudo®). Doctors can combine CTLA-4 immunotherapies with other mesothelioma treatments to improve survival. We can connect you with specialists for immunotherapy and other treatments today.

Fact-Checked and Updated by: Jenna Tozzi, RN

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What Is CTLA-4 Immunotherapy for Mesothelioma?

CTLA-4 inhibitors for mesothelioma, also called anti-CTLA-4 drugs or CTLA-4 antibodies, are a type of immunotherapy that may help you live longer.

These inhibitors target a protein called cytotoxic T lymphocyte antigen-4 (CTLA-4) found on regulatory T cells, which your immune system makes to fight cancer.

T cells use CTLA-4 to identify cancer cells to kill while sparing normal cells. However, mesothelioma can hijack CTLA-4 to create an immunosuppressive effect. In other words, mesothelioma prevents the immune system from killing cancer cells. CTLA-4 inhibitors stop this from happening so more of the cancer can be destroyed.

Key Facts on CTLA-4 and Mesothelioma

  • Types of mesothelioma treated: Pleural mesothelioma and peritoneal mesothelioma
  • How they’re administered: Intravenous (IV) injection
  • When they’re used: Typically with other mesothelioma treatments like surgery, chemotherapy, and different cancer immunotherapies
  • Most common side effects: Fever, nausea, vomiting, and loss of appetite

Download our Free Immunotherapy Guide to learn more about CTLA-4 inhibitors and other immunotherapy drugs that could increase your life expectancy.

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  • When it’s used
  • Types of therapies
  • What to expect

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How Does CTLA-4 for Mesothelioma Work?

CTLA-4 inhibitor drugs help your body’s natural immune response to destroy mesothelioma cancer cells.

They belong to a class of medications called immune checkpoint inhibitors. These medications target specific checkpoint proteins like CTLA-4 found on T cells.

Function of Cytotoxic T Lymphocytes

Cytotoxic T lymphocyte is the medical term for a T cell that kills cancer. These cells use CTLA-4 to determine which cells should be killed.

However, mesothelioma cells make a protein called B7, which can bind to CTLA-4 on T cells. This makes T cells think mesothelioma cells don’t need to be killed.

CTLA-4 inhibitors prevent mesothelioma cells from binding, which releases the “brakes” on your immune system and boosts T cell activation.

Types of CTLA-4 Inhibitors for Mesothelioma

As of 2024, ipilimumab (Yervoy) is the most commonly used CTLA-4 inhibitor for mesothelioma. Researchers are also studying another anti-CTLA-4 medication called tremelimumab (Imjudo).

Learn about both types of mesothelioma CTLA-4 inhibitors below.

Ipilimumab (Yervoy®)

Yervoy is the only CTLA-4 inhibitor approved by the U.S. Food and Drug Administration (FDA) to treat malignant pleural mesothelioma (which develops in the lining of the lungs).

The FDA approved Yervoy in combination with nivolumab (Opdivo®), another immunotherapy that targets different proteins on T cells, in 2020 following the results of the CheckMate 743 clinical trial.

Did You Know?

This trial revealed that combining Opdivo and Yervoy helped pleural mesothelioma patients live over 18 months on average when used as a first-line (initial) treatment. Their life expectancy was 4 months longer than the group that received the chemotherapy drugs pemetrexed and cisplatin.

A 2021 study from researchers at the MD Anderson Cancer Center found that Opdivo and Yervoy may also help patients with peritoneal mesothelioma (which develops in the abdominal lining).

The patients in this study had an average life expectancy of 19.1 months and a progression-free survival of 5.5 months (where the cancer wasn’t worsening). There was also a strong objective response rate (number of patients whose cancer shrank), with 25% of cases still responding to the treatment at the end of the study.

We can help you access Yervoy and Opdivo. Contact us now to connect with a Patient Advocate.

Tremelimumab (Imjudo®)

Imjudo is currently available through clinical trials that test new mesothelioma treatments. Many of these trials have shown that Imjudo can extend patient survival.

In 2023, a phase II trial conducted by the Baylor College of Medicine found that surgery, Imjudo, and another immunotherapy called durvalumab (Imfinzi®) helped pleural mesothelioma patients live longer than those who only received surgery and Imfinzi.

In addition, the 2021 NIBIT-MESO-1 trial found that Imfinzi and Imjudo helped pleural and peritoneal mesothelioma patients who needed second-line treatment (used if initial therapies stop working). The patients had an average overall survival of 16.5 months.

CTLA-4 and Mesothelioma Treatment Plans

Anti-CTLA-4 immunotherapies can be used alone as a monotherapy. More commonly, though, doctors typically use them with other mesothelioma treatments in combination therapy to destroy as much of the cancer as possible.

CTLA-4 may be used with the following mesothelioma treatments:

  • Chemotherapy: The in-progress phase III DREAM3R study is comparing the use of Opdivo, Yervoy, and chemotherapy to Imfinzi and chemotherapy in treating pleural mesothelioma.
  • Other immunotherapy drugs: Doctors can combine multiple immunotherapies to improve survival.
  • Surgery: In the previously mentioned Baylor College of Medicine study, patients received surgery after getting Imjudo to shrink solid tumors.

Get our Free Immunotherapy Guide to learn more about CTLA-4 inhibitors and how they may help as part of your larger mesothelioma treatment plan.

Get Your Free Immunotherapy Guide
  • When it’s used
  • Types of therapies
  • What to expect

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Side Effects of CTLA-4 Inhibitors for Mesothelioma

You may develop side effects while receiving CTLA-4 inhibitors, since they turn off the T cell’s ability to distinguish between healthy cells and cancerous ones.

Common side effects of mesothelioma CTLA-4 inhibitors include:

  • Black or bloody stools
  • Coughing
  • Diarrhea
  • Fever
  • Headaches
  • Itchy skin or rash
  • Loss of appetite
  • Nausea
  • Pain in the legs, arms, or bones
  • Severe cramping or stomach pain
  • Sneezing
  • Vomiting

In some cases, more serious long-term symptoms may develop, such as arthritis, hepatitis (liver inflammation), and neuropathy (numbness and tingling in limbs).

Your mesothelioma doctor can explain these in more detail and prescribe medications to address any pain, nausea, or other side effects.

What to Expect During CTLA-4 Treatment Sessions

Mesothelioma CTLA-4 treatment sessions may vary slightly depending on the hospital or cancer center, but below is a general overview of what to expect.

1. Receive CTLA-4 Infusions

A patient receives a CTLA-4 infusion through an IV

You will receive a CTLA-4 medication through an IV drip into your bloodstream every 3-6 weeks. Each infusion takes between 30-90 minutes.

If you’re getting multiple treatments through an IV, such as different immunotherapy drugs or chemotherapy, your doctors will tell you which treatments you’re receiving and when.

2. Monitor CTLA-4 and Mesothelioma Response

Your doctors will closely monitor how your mesothelioma tumors respond to CTLA-4 antibodies and any other treatments you receive. They’ll also promptly address side effects or toxicity (harm from a medication).

3. Recover and Adjust Mesothelioma Treatment Plan

Following CTLA-4 treatments, your cancer care team will conduct a follow-up medical review to see how your cancer has responded. Hopefully, the mesothelioma tumors will have shrunk and your symptoms will start to lessen.

If your cancer doesn’t respond to CTLA-4 inhibitors or starts to grow back, your doctors can recommend other treatments that may improve your life expectancy.

Clinical Trials Studying CTLA-4 and Mesothelioma

Besides those mentioned above, many other mesothelioma clinical trials are looking into how CTLA-4 immunotherapies can help patients with this cancer.

Trials studying CTLA-4 and mesothelioma include:

  • Imjudo, Imfinzi, and Chemotherapy: This Baylor College of Medicine trial is studying whether combining chemotherapy with Imjudo and Imfinzi before surgery helps patients live longer than immunotherapy alone.
  • Opdivo, Yervoy, and Surgery: Researchers at Sidney Kimmel Comprehensive Cancer Center are investigating whether Opdivo with or without Yervoy given prior to surgery will improve overall survival.
  • Oral 7HP349 (Alintegimod), Opdivo, and Yervoy: Patients with mesothelioma and other cancers will receive an experimental drug called Alintegimod, followed by Yervoy and then Opdivo.

Use our Free Doctor Match to find specialists who can help you determine if you’re a good fit for clinical trials on CTLA-4 and mesothelioma.

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How Much Does CTLA-4 Mesothelioma Treatment Cost?

The cost of mesothelioma CTLA-4 inhibitors depends on which ones you receive.

Here is a breakdown of CTLA-4 costs by type:

  • Imjudo. This mesothelioma CTLA-4 medication is only available in clinical trials, which cost nothing to join. However, you must meet the criteria outlined in the study in order to receive Imjudo.
  • Yervoy. While Yervoy is more easily available than Imjudo, you’ll need to pay out of pocket or use insurance to help cover the cost. According to Bristol Myers Squibb, a single Yervoy and Opdivo infusion costs $28,292. However, you may be able to access financial assistance that can help pay for your treatment.

Call our team at (866) 608-8933 now to get help pursuing financial assistance for mesothelioma.

Get Help Accessing CTLA-4 Inhibitors for Mesothelioma

CTLA-4 inhibitors like Yervoy and Imjudo have helped many other mesothelioma patients live longer, giving them precious time with family and friends. These immunotherapy medications could help you or a loved one as well.

Yervoy is already widely available for many pleural mesothelioma patients, and Imjudo continues to show encouraging results in ongoing trials. Both medications have given hope to those facing a mesothelioma diagnosis.

Use our Free Doctor Match service to connect with mesothelioma specialists near you who are experienced with CTLA-4 drugs and other immunotherapies.

CTLA-4 and Mesothelioma FAQs

How does cancer use CTLA-4?

Mesothelioma cells use proteins that they create to bind to a protein called CTLA-4 on T cells. This binding tells the T cells not to kill the cancer, allowing it to spread.

Mesothelioma CTLA-4 inhibitors prevent mesothelioma cells from binding so the T cells can destroy them.

What is the new immunotherapy for mesothelioma?

Tremelimumab (Imjudo®) is a new immunotherapy for mesothelioma. Imjudo blocks the CTLA-4 protein on T cells so they can more easily kill cancer, creating what is known as an antitumor response.

Recent studies like the NIBIT-MESO-1 trial show that Imjudo can help both pleural and peritoneal mesothelioma patients live longer. Doctors continue to study Imjudo in clinical trials to get a better idea of how it can improve survival times.

What is the difference between PD-1 and CTLA-4?

PD-1 and CTLA-4 are two different proteins found on T cells. They act in a very similar way as they help T cells know which cells are healthy and which ones are cancerous.

The PD-1 and CTLA-4 responses can be turned off by different proteins that mesothelioma cells create. Fortunately, doctors can use both anti-PD-1 drugs and CTLA-4 inhibitors so T cells can fight mesothelioma.

Call (866) 608-8933 for help accessing top mesothelioma immunotherapy drugs like PD-1 and CTLA-4 inhibitors.

What is the most common side effect of CTLA-4 inhibitors?

According to City of Hope, the most common side effect of CTLA-4 inhibitors is a rash or itchy skin. Other notable side effects include fatigue, nausea and vomiting, and loss of appetite.

Your mesothelioma doctor can help manage any mesothelioma CTLA-4 side effects as they arise.

What do cytotoxic T lymphocytes do?

Cytotoxic T lymphocytes is the medical term for T cells that fight cancer and other diseases, according to the National Cancer Institute (NCI).

Cytotoxic T cells use proteins like CTLA-4 to tell cancer cells apart from healthy cells. However, mesothelioma cells make the B7 protein that binds to CTLA-4, preventing cytotoxic T lymphocyte activation (meaning the T cells won’t kill the cancer).

CTLA-4 inhibitors can block CTLA-4 from binding so the T cells can find and destroy mesothelioma tumor cells.

What cancers can CTLA-4 inhibitors treat?

CTLA-4 inhibitors like Yervoy and Imjudo can help treat mesothelioma, a rare cancer that develops in the linings of major organs decades after asbestos exposure.

These medications can also treat non-small cell lung cancer, carcinoma, and advanced melanoma.

Jenna TozziWritten by:

Director of Patient Advocacy

Jenna Tozzi, RN, is the Director of Patient Advocacy at Mesothelioma Hope. With more than 15 years of experience as an adult and pediatric oncology nurse navigator, Jenna provides exceptional guidance and support to mesothelioma patients and their loved ones. Jenna has been featured in Oncology Nursing News and is a member of the Academy of Oncology Nurse & Patient Navigators & the American Nurses Association.

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References
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