Drug repurposing in malignant pleural mesothelioma: a breath of fresh air?

Drug repurposing is the use of known drugs for new indications. Malignant pleural mesothelioma (MPM) is a rare cancer with a poor prognosis. So far, few treatments have been approved in this disease. However, its incidence is expected to increase significantly, particularly in developing countries. Consequently, drug repurposing appears as an attractive strategy for drug development in MPM, since the known pharmacology and safety profile based on previous approvals of repurposed drugs allows for faster time-to-market for patients and lower treatment cost. This is critical in low- and middle-income countries where access to expensive drugs is limited. This review assesses the published preclinical and clinical data about drug repurposing in MPM.In this review, we identified 11 therapeutic classes that could be repositioned in mesothelioma. Most of these treatments have been evaluated in vitro , half have been evaluated in vivo in animal models of MPM and only three ( i.e. valproate, thalidomide and zoledronic acid) have been investigated in clinical trials, with limited benefits so far. Efforts could be coordinated to pursue further investigations and test promising drugs identified in preclinical experiments in appropriately designed clinical trials.
Competing Interests: Conflict of interest: E. Pasquier reports personal fees for consultancy from Pierre Fabre Oncology, outside the submitted work. Conflict of interest: J. Ciccolini reports personal fees from Pierre Fabre (who commercialised a drug used in mesothelium patients), outside the submitted work. Conflict of interest: L. Greillier reports grants, personal fees and non-financial support from Roche and Novartis. He also reports personal fees and non-financial support from Lilly, Boehringer Ingelheim, AstraZeneca and Pfizer, and personal fees from Bristol-Myers Squibb, outside the submitted work. Conflict of interest: N. Andre reports personal fees and non-financial support from Bristol-Myers Squibb and Pierre Fabre for drug trials. Conflict of interest: F. Barlesi reports personal fees from AstraZeneca, Bristol-Myers Squibb, Boehringer Ingelheim, Clovis Oncology, Eli Lilly Oncology, F. Hoffmann–La Roche Ltd, Novartis, Merck, MSD, Pierre Fabre and Pfizer, outside the submitted work. Conflict of interest: C. Mascaux reports board member and speakers fees from Roche and Kephren, and speakers fees from Bristol-Myers Squibb, Lilly, Roche, AstraZeneca and Boerhingher Ingelheim, outside the submitted work.
(Copyright ©ERS 2018.)