Surviving Mesothelioma According to the American Cancer Society, up to about 10 percent of people with malignant mesothelioma live at least five years after the disease is diagnosed. While that leaves miles of room for improvement, the statistic nevertheless means that a substantial fraction of patients are surviving mesothelioma—a fraction that is likely to grow with each passing year. That’s because survival figures for mesothelioma, as well as for other cancers, are based on outcomes of patients in the past, whoreceived whatever treatment was available back when they first learned of theirmesothelioma diagnosis. Even minor innovations in surgery or postoperative care, as well asmore substantial advances in chemotherapy or other medicines, can immediately benefitindividual patients. That impact, though, can take years to begin to show up in averagesurvival statistics. For instance, the mesothelioma treatment pemetrexed disodium (Alimta),which is given with another chemotherapy drug to patients who aren’t candidates forsurgery, received U.S. government approval just seven years go, meaning that any abilityto nudge up survival statistics is only beginning to appear.In the broader war on cancer, there is even more reason for hope. In the war on cancer,many powerful weapons are in development, and in some cases, already on the battlefield.Consider a rare cancer of the white blood cells known as chronic myeloid leukemia (CML).Until the introduction of a new drug, called imatinib (Gleevec), in the United States in 2001,less than one-third of patients with CML survived for five years. The new medicine, clinicaltrials show, boosted that survival rate to around 90 percent or more—and is now thestandard of care for that disease.Also, knowledge from the development of one such weapon—even if it isn’t designed tospecifically attack malignant mesothelioma—can yield insights that will help in the battleagainst asbestos-caused disease. Every day scientists are learning more about how toattack specific tumors, how a tumor’s environment in the body can help or hinder itsgrowth, and what special tricks tumors use to thrive and spread. A multitude of researchstudies are under way to translate that knowledge into action.Meanwhile, the medical literature on mesothelioma reflects how individual miracles happen.A report in January 2011 in the Journal of Medical Case Reports described a woman in her40s who is alive and well seven years after diagnosis with peritoneal mesothelioma, acancer of the lining of the abdomen. Her physicians attribute her good fortune to thecontained nature of the disease, her successful surgery and chemotherapy, and specificcharacteristics of her tumor tissue. Another case report, appearing just a month earlier inthe journal Diagnostic Pathology, describes a patient who developed pleural mesothelioma,a cancer of the lining of the lungs, after asbestos exposure and was healthy 14 years aftersymptoms appeared, and a dozen years after surgery and chemotherapy. And a report from2007, appearing in the journal The Annals of Thoracic Surgery, recounts a surgical patientwhose pleural mesothelioma spontaneously regressed. The patient experienced just a singlerecurrence six years into a 12-year follow-up period, and that tumor in the chest wassuccessfully removed.In short, as oncologists and other experts will readily acknowledge, statistics reflect thehistory of a group—not the future of an individual.
Taking a Shot at MesotheliomaResearchers at Memorial Sloan-Kettering Cancer Center in New York City are recruitingpatients for a clinical trial to test a ―vaccine‖ under development for the mesotheliomatreatment.Unlike many well known vaccines—such as a shot to protect against onset of illnesses suchas the flu or the mumps—this vaccine is intended to be given to people who already havemalignant pleural mesothelioma, a cancer of the lining of the lung. Very preliminary testshave suggested that the experimental vaccine can mobilize a patient’s own immune systemto attack mesothelioma cells.Specifically, the vaccine appears to target WT1, a type of protein that binds to a specificpart of the DNA code, affecting the transfer of genetic information and impacting how cellsfunction. WT1 is especially abundant in cells from many people’s mesothelioma tumors.The preliminary tests, whose results were published in fall 2010 the journal CancerImmunology, Immunotherapy, found that the vaccine worked to mobilize two differenttypes of immune cells known as T cells, and those T cells were able to kill the cancer cellswith abundant WT1. Also, the vaccine was well tolerated, causing minimal problems withside effects among test patients, the researchers noted.Participants in the preliminary trial, which included both malignant mesothelioma patientsand those with non-small-cell lung cancer, received six doses of the vaccine, injected underthe skin, along with an immune-boosting substance. Injections were given at the start ofthe study, and four, six, eight, 10 and 12 weeks later. People whose tumors respondedreceived additional injections once a month.While only a handful of patients received the vaccine in this early trial, a majority of themshowed an immune response to the treatment, setting the stage for the current, Phase IIrandomized clinical trial. The new trial is for adult patients who have had their pleuralmesothelioma tumors surgically resected and have received chemotherapy or radiation. Halfthe participants will receive a series of shots over 10 weeks containing the WT1-targetedvaccine, along with some general immune-boosting medicines, while the other half willreceive those general immune boosters alone. Neither the patients nor the researchers willknow who received which treatment.The research team, which hopes to enroll 78 participants whose tumors test positive for theWT1 protein, will evaluate whether or when their mesothelioma recurs for a period of oneyear after the vaccine treatment is completed. The principal investigator conducting thestudy is thoracic oncologist Dr. Lee Krug, director of the Mesothelioma Program at MemorialSloan-Kettering. Dr. Krug can be contacted at 212-639-8420 or 646-888-4201.The identifier number for the new mesothelioma clinical trial is NCT01265433. Researchersexpect the trial to be completed in December 2014.
Study of New Medicine for Mesothelioma Treatment The National Cancer Institute is sponsoring a clinical trial of a new medicine in hopes that it will help mesothelioma patients whose cancers have been unresponsive to chemotherapy. The trial is being conducted at the National Institutes of Health’s Clinical Center in Bethesda, Md., and is led by Dr. Raffit Hassan. The experimental medicine that is being tested - IMC-A12 -is a human antibody. The trial is a Phase II study, meaning the medicine has already shownpromise in preclinical testing in the laboratory and has been tested in people to assesssafety and proper dosage. The current research will continue to investigate safety andevaluate IMC-A12′s effectiveness against mesothelioma tumors.The medicine, also called cixutumumab, is given intravenously in the trial once every 21days to patients with pleural mesothelioma (cancer in the thin layer of tissue that surroundsthe lungs and lines the chest cavity) or peritoneal mesothelioma (cancer in the lining of theabdomen). The study is open to adults whose tumors can’t be fully removed with surgery,and whose cancer has not responded to chemotherapy with drugs known as platinum-basedagents, such as cisplatin, which is commonly used to treat mesothelioma. Patients mightalso be admitted if they have refused previous chemotherapy as part of their mesotheliomatreatment.Treatment will be ongoing unless patients develop severe side effects or their mesotheliomaprogresses. The primary goal is to see whether mesothelioma tumors partially or completelyrespond to the medicine.The antibody works somewhat in the way that glue gums up the works of a lock andprevents a key from opening a door. IMC-A12 (the ―glue‖) stops up certain receptors(―locks‖) that sit on the surface of a mesothelioma cell. That way, a protein called Type Iinsulin-like growth factor, or IGF-1R—the normal ―key‖ that would open the door to thecancer’s growth and survival - no longer works. This particular type of ―lock‖ and ―key‖ isalso being studied in other cancers.All participants in the IMC-A12 trial must have acceptable kidney and liver function as wellas the adequate ability to form blood cells, and must not have had any major surgery,radiation treatment, chemotherapy or biologic therapy within 28 days of the start of thenew mesothelioma treatment. Potential participants will be given a complete physical examto assess their mesothelioma and overall health.Patients must cover their own travel expenses to be screened for possible enrollment in thetrial, but those selected to participate will receive payment for out-of-town transportationcosts for study treatment and follow-up. All medical care related to the trial will be providedfor free at the NIH Clinical Center, but patients should maintain any current health carecoverage to pay for other medical expenses.Additional information about the mesothelioma study and its requirements can be obtainedfrom the cancer institute’s referral office, at 1-888-NCI-1937. The study’s identifying tag atClinicalTrials.gov is NCT01160458.
Mesothelioma and GemcitabineNew research from Europe suggests that a drug known as gemcitabine, given along with one thatis now commonly used for mesothelioma, might someday serve as another weapon in doctors’arsenals against the cancer.Gemcitabine (marketed as Gemzar) is a chemotherapy drug currently in use to treat lung, breast,pancreatic and ovarian cancers. In the recent, Phase II study—designed to test whether the drugis effective and to measure side effects and other risks—investigators in Slovenia gave patientswith malignant pleural mesothelioma a prolonged, low-dose infusion of gemcitabine incombination with cisplatin (marketed as Platinol).The researchers decided to test this course of therapy against malignant pleural mesothelioma—acancer in a layer of specialized cells, called mesothelial cells, that line the chest and are adjacentto the lungs—after noting that the treatment appeared to be effective in advanced cases of themost common type of lung cancer, non-small-cell lung cancer.Patients in the mesothelioma study were eligible if they had not previously received anychemotherapy, and other than the mesothelioma, were in fair to good health with normal liverand kidney function. The treatment entailed six three-week cycles of therapy. For the first fourcycles, patients received six-hour infusions of gemcitabine on the first and eighth days, pluscisplatin on the second day; the last two cycles included the gemcitabine but not the cisplatin. Atotal of 78 patients—58 men and 20 women, ages 33 to 82 years old—participated. More than 70percent of the patients had mesothelioma tumors of the most common subtype, known asepitheloid, a categorization based on certain characteristics of the cancer cells.Four of the patients, or 5 percent, showed a complete response—meaning their cancer wasundetectable—after the therapy. Thirty-five had a partial response—meaning the size of theirtumors was reduced substantially. Another 35 patients had tumors that either respondedminimally or remained stable, while only four patients experienced tumor progression during thetreatment.Sixty-seven percent of the mesothelioma patients survived one year after therapy; almost 33percent survived two years, and about 20 percent survived three years. Patients who hadepitheloid tumors were more likely to survive longer without their tumor progressing, and tosurvive longer overall, compared with patients who had other tumor subtypes.Most of the patients experienced an improvement in mesothelioma symptoms, and a quality oflife that either remained the same or improved, the researchers reported. Notable side effectsincluded neutropenia (a shortage in a type of white blood cells, which can impair the immunesystem), anemia (a shortage of red blood cells, which can cause fatigue) and hair loss, as well asthrombocytosis (an excess of blood platelets, which cause clotting). Because the therapyappeared to slow down the mesothelioma’s progress and didn’t prove to be too toxic, thescientists advised that this mesothelioma treatment approach warranted further research.
Photodynamic therapy for pleural mesothelioma A combination therapy might hold promise for extending the lives and preserving more lung function of patients with malignant pleural mesothelioma, a cancer of the lining inside the chest. Patients in mesothelioma treatment often undergo an extensive surgery known as a modified extrapleural pneumonectomy, which involves removal of the lung and surrounding tissue and is usually accompanied by radiation of the whole chest area. But the new combination approach for mesothelioma patients adds a treatment called photodynamic therapy to a more conservative,lung-sparing surgery called a pleurectomy.Photodynamic therapy is a light-based treatment that is designed to eliminate any microscopic bits ofresidual cancer that surgeons are unable to remove. The therapy, which penetrates just a fewmillimeters into tissue, has three components that are administered: a nontoxic compound thatsensitizes cancer cells to light; then oxygen; then specially tailored light. While the therapy is federallyapproved for treatment of several cancers, it remains experimental for malignant pleuralmesothelioma.Researchers at the University of Pennsylvania in Philadelphia set out to determine whether the lung-sparing surgery could be used instead of an extrapleural pneumonectomy, and whether the use ofphotodynamic therapy would extend patients’ survival time, compared with typical survival times inmesothelioma patients.Nine women and 19 men with malignant pleural mesothelioma, ranging in age from 27 to 81,participated in the Phase II study from 2004 to 2008. Half received the more extensive surgery alongwith photodynamic therapy, while the other half had the lung-sparing surgery along with the light-based therapy.Twelve patients in each group had stage III/IV mesothelioma—and researchers noted that many ofthe research subjects, due to the advanced stage of their mesothelioma or to their advanced age,would not be candidates for surgical treatment. In all, 22 patients also had chemotherapy. The twogroups were comprised of mesothelioma patients with similar demographic traits such as age, sex anddisease characteristics.Among the patients who had the more extensive surgery and photodynamic therapy, the medianoverall survival—the point in time after treatment was completed at which half the patients were stillalive—was 8.4 months. For the patients receiving the lung-sparing surgery plus the light therapy, thatmedian point had not been reached yet, after more than two years of follow-up.The surgeon who performed the procedures in the study, Dr. Joseph Friedberg of the PennMesothelioma and Pleural Program, said researchers had hoped that preservation of patients’ lungswould improve their quality of life, and that the extended survival time of those patients was acomplete surprise. The scientists are continuing to investigate exactly how the photodynamic therapymight be helping to fight mesothelioma—possibly by creating a ―vaccine‖ effect with residual diseasethat sparks the immune system to fight any remaining cancer. Or, the photodynamic therapy mighthave made any residual cancer more vulnerable to other follow-up treatments.
SIDE EFFECTS OF CHEMOTHERAPY ON MESOTHELIOMA PATIENTS While doctors might choose from an assortment of available medicines to care for malignant mesothelioma patients, a combination treatment with two chemotherapy drugs—pemetrexed disodium (marketed as Alimta) and cisplatin (marketed as Platinol)—is a mainstay. The two drugs are typically used in patients when surgery is not an option. Pemetrexed received approval from the federal Food and Drug Administration (FDA) in 2004 for the treatment of malignant pleural mesothelioma, a cancer of the chest cavity lining, after a randomized clinical trial showed that the drug, given with cisplatin, extended patients’ average survival time longer than cisplatin alone. As the first drug shown to be effective against pleural mesothelioma,pemetrexed received priority review from the FDA.As with most chemotherapy treatments, mesothelioma patients are vulnerable to experiencing sideeffects from the combination of pemextrexed and cisplatin. In more than half the patients in theclinical trial, the treatment suppressed bone marrow function, which might lead to low counts of whiteblood cells, the body’s infection fighters. It’s important that mesothelioma patients on pemetrexed andcisplatin tell their doctors immediately about any signs of infection, such as fever or chills or mouthulcers. Vitamin B-12 and folic acid are administered with pemetrexed to reduce the risk of a low whitecell count, as well as the likelihood of other side effects.Cisplatin and pemetrexed also lowered red blood cell counts in about one-quarter of the mesotheliomapatients in the clinical trial. This condition, known as anemia, can cause fatigue. Medicines areavailable to treat both low white and low red blood cell counts. Also, research has shown thatmoderate exercise can help reduce cancer patients’ fatigue, and perhaps lessen pain.Mesothelioma patients on pemetrexed could also experience a drop in their platelet count. Plateletshelp the blood to clot, and patients with reduced levels of platelets should report any signs ofbleeding. These patients also might be asked to take precautions to avoid even minor injuries thatmight cause bleeding, such as using a soft toothbrush to prevent gum bleeding.Nausea and vomiting are very common side effects of the pemetrexed-cisplatin combination;fortunately, effective anti-nausea medicines can be prescribed. Patients should promptly tell theirdoctors about those symptoms—as well as rash, diarrhea, constipation, sore or gritty eyes and otherhealth concerns. It’s important that mesothelioma patients keep their health care teams fully informedof side effects and avoid choosing over-the-counter treatments without medical consultation.To learn more about the symptoms, diagnosis, treatment options, and resources for dealing with thelung cancer or mesothelioma, call at 1.866.855.1229 or visit www.mesotheliomanews.com .And if you, a family member or friend have been diagnosed with mesothelioma and believe it has beencaused by asbestos exposure, visit http://baronandbudd.com. Baron & Budd has been protecting therights of people with mesothelioma for nearly 30 years. Baron & Budd can help you seek thecompensation you deserve.
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