Mesothelioma Help Cancer News
Two-Drug Combination Found Effective in Lung Cancer May Increase Survival in Mesothelioma Patients
It has been over two years since Mesothelioma Help reported on the start of a clinical trial that used a combination of immunotherapy drugs to treat lung cancer. The trial was designed to determine whether the two drugs would work better than one in the treatment of cancer patients. Now, researchers say early results of the trial show the pair of drugs are “surprisingly effective” at controlling the progression of lung cancer.
Immunologist John Wrangle, M.D. and his colleague Mark Rubinstein, Ph.D., both from the Hollins Cancer Center at The Medical College of South Carolina (MUSC), are so excited with the results that they are “flirting with the idea” of using the word “cure” on some of the non-small cell lung cancer patients treated with the novel therapy, according to an April 5 press release.
“People don’t talk about ‘curing’ patients with metastatic lung cancer,” said Wrangle. “We now get to flirt with the idea for certain patients using immunotherapy. And at the very least we have a significant proportion of patients enjoying prolonged survival even if we can’t call them ‘cured’.”
The researchers report that nearly every lung cancer patient will relapse after chemotherapy, and with the advent of immunotherapy, some of them will turn to it as their next mode of treatment. But still, they say, less than 20 percent of NSCLC patients will respond to immunotherapy, and it too will eventually stop working. Pleural mesothelioma is an equally stubborn cancer and treatment for the asbestos-caused cancer is very similar to NSCLC treatments. Mesothelioma patients are anxious to find a new treatment that will increase their survival beyond the typical prognosis of less than one year.
Hoping to break that poor response record, the two researchers turned to nivolumab (Opdivo), an FDA-approved immunotherapy, and ALT-803, an experimental immuno-oncology treatment. In the initial test of 21 patients, nine previously had either become resistant to their previous treatment or had stable disease at the time of the trial. Looking specifically at those nine patients, the researchers report that “100 percent either had stable disease or had a partial response to the treatment used in this study.”
Opdivo, developed by Bristol-Myers Squibb, works by blocking the PD-L1 protein and activating the immune system, leading it to attack and kill cancer cells. ALT-803, being developed by Altor BioScience Corporation, is an immune stimulation drug.
“There are very few people in human history who get the privilege of developing a new therapy for any human disease, much less cancer,” said Wrangle. “That’s such an amazing privilege to be able to do that.”
The two admit there is still a long way to go “before the new combination of drugs can be used outside of a clinical trial.” They hope to treat hundreds of patients in a trial to better understand the proper mix of the drugs.
Ongoing research into lung cancer, mesothelioma and other aggressive cancers is vital to continue to break ground in treatments previously not considered. Mesothelioma patients should continue to work with their medical team to assess how they can participate in this critical research.
Read more about the study in the April 4 issue of The Lancet Oncology.
https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(18)30148-7/fulltext
For more information about the trial see ClinicalTrials.gov.
https://clinicaltrials.gov/ct2/show/NCT02523469
“Lung Decision Precision” Screening Tool May Lead to Early Detection of Mesothelioma
The key to increased life expectancy when battling lung cancer, and other extremely aggressive cancers such as mesothelioma, is early detection. Unfortunately, while there are standard screening tests and guidelines for breast cancer, colon, and prostate cancer, lung cancer screening tests are limited to high risk patients, defined as life-long heavy smokers. Now, researchers have developed a personalized lung cancer screening decision tool which incorporates past asbestos exposure as a criteria to guide individuals and physicians in determining their lung cancer screening options.
Researchers from the University of Michigan have unveiled a lung cancer screening Q&A tool that can be used by medical professionals to identify people who may benefit from a low-dose computed tomography (LDCT) screening. For people who do not have any symptoms often associated with lung cancer or pleural mesothelioma, such as difficulty breathing, coughing or fatigue, there is seemingly no reason to screen for lung cancer.
That is why the personalized Lung Decision Precision tool for physicians, which presents a series of questions targeting the person’s smoking history and asbestos exposure, is important. The tool is designed to open discussion between the physician and patient to determine whether a lung screening is appropriate.
“This allows us to identify which patients are in the preference-sensitive zone for the decision about screening, and which ones have a very clear potential benefit to them,” said Tanner Caverly, M.D., M.P.H., an assistant professor in the Division of General Medicine and Department of Learning Health Sciences at the U-M Medical School.
The Lung Decision Precision Tool asks the critical question: “Has the patient been exposed to asbestos at work?” Based on a “yes” answer, the patient is asked to confirm the following:
- You worked in one or more of the following occupations: asbestos worker, insulator, lagger, plasterboard worker, dry waller, plasterer, ship scaler, ship fitter, rigger, shipyard boilermaker, shipyard welder, shipyard machinist, shipyard coppersmith, shipyard electrician, plumber/pipefitter, steamfitter, or sheet metal worker.
- You worked in this job for at least 5 years.
- You began working in this job at least 15 years ago.
Asbestos is a human carcinogen, known to cause lung cancer and pleural mesothelioma, a cancer of the lining of the lungs diagnosed in nearly 3,000 Americans each year. The U.S. Environmental Protection Agency warns that there is no safe level of exposure. In addition, the Occupational Safety and Health Administration reports, “every occupational exposure to asbestos contributes to the risk of getting an asbestos related disease.”
While no longer used in new buildings in the U.S., asbestos was added to a variety of products including insulation, steam pipes, furnace ducts, floor tiles and roofing shingles, in buildings and homes built prior to EPA regulations were put in place in the 1970’s. People who worked in construction, ship-building, plumbing and in the military are at a higher risk than others of developing mesothelioma.
The only recommended screening test for lung cancer is LDCT, according to the Centers for Disease Control and Prevention. During an LDCT an X-ray machine scans the body and uses low doses of radiation to make detailed pictures of the lungs to help find abnormal areas that may be cancer. The American Cancer Society reports that in a study of 50,000 smokers or former smokers aged 55 to 74 researchers found that people who got LDCT had a 20% lower chance of dying from lung cancer than those who got chest x-rays.
Mesothelioma is often not diagnosed until symptoms are present, and the cancer is in its late stages. At this point, prognosis is often less than one-year. Stopping tumor growth and preventing metastasis is especially critical for mesothelioma and lung cancer where the diseases are highly aggressive. This can only be achieved if the mesothelioma cancer is detected early.
“As a clinician I’d like to have this [tool] for many of the things I do, where it would be meaningful to know how beneficial something could be for the individual patient, and we could talk about whether it’s indicated for them,” said Caverly.
The research team also launched a companion website, “Should I get screened”, for patients that includes easy-to-understand information about the pros and cons of lung cancer screening, and includes a “lung cancer risk calculator.”
If you have been exposed to asbestos in the past, talk to your doctor about the Lung Decision Precision tool.
Find out more about the tool in the May 29 issue of Annals of Internal Medicine.
Sources:
- University of Michigan
http://ihpi.umich.edu/news/scan-or-not-scan-research-shows-how-personalize-lung-cancer-screening-decisions - Annals of Internal Medicine
http://annals.org/aim/article-abstract/2682684/identifying-patients-whom-lung-cancer-screening-preference-sensitive-microsimulation-study - Lung Decision Precision tool
https://share.lungdecisionprecision.com/ - Should I get screened
http://www.shouldiscreen.com/ - The American Cancer Society
https://www.cancer.org/cancer/lung-cancer/prevention-and-early-detection/early-detection.html - Occupational Safety and Health Administration
https://www.osha.gov/SLTC/asbestos/
Defining Your Personal Space During Your Mesothelioma Journey
Mesothelioma patients often face a busy schedule when initially diagnosed, and when they begin undergoing treatments. There are a lot of tests and consultations, and decisions to be made. There is a sense of urgency in getting treatment under way as soon as possible. During this phase of the disease, family and friends are frequently rallying around and trying to provide as much support as possible. There are other patients also offering support if needed. Support groups, friendships, and new relationships are formed.
At the end of the journey, when a person has exhausted his clinical options and has shifted to hospice or comfort care, the path is not as clear. We recently had a mesothelioma patient whose journey was at its end. During his battle with mesothelioma, he conducted extensive research and was willing to try anything. But now, he had no more options, and he decided to stay home with his wife and keep things as “normal” as possible. His sons were not living at home, and he elected to have them come home a weekend after he had made the decision to enter hospice. Over this weekend they talked, reminisced, and acknowledged that he was dying. The sons went back to their lives until the final weekend of his life. During this time his wife was caring for him.
We were surprised at the couple’s reluctance to ask for help from their large, extended family and network of friends. Up until the last weekend his wife was taking total care of him and the house.
The last weekend was a different story – they had called home their sons, and let family members in to be with them. He died peacefully at home surrounded by his loved ones.
Everyone’s journey is different, as is everyone’s response to it. We are all unique individuals, and we have the right to decide when to let people in.
Sometimes space, both physical and mental, is needed for people to process and decide how they want to move forward. To allow a person and their loved one that space is sometimes the best support you can offer.
Holding My Father’s Music Close to My Heart
My father never claimed to be a musician. He said he just “played at” the guitar but loved singing and playing with his band. Dad began singing at Church when I was little, and he practiced constantly, his latest choice of song would be stuck in my head for days. Many Saturday mornings were spent with him at the Christian book store, listening to new music, carefully choosing one. He had specific criteria that he looked for when he decided on which song to pick. He loved songs that were a bit country, classic, and told a story.
I remember many times, listening to him sing, so full of pride that my eyes would fill with tears. It happened often, but always on Easter when he sang a song called “The Hammer.” It never failed that I would have to look away from him so that I wouldn’t sob. The powerful message of the music, coupled with the humility of the man singing it, were almost too much for me. Now, every time I think of that song, I instantly feel sad.
When I was little, Dad always sang “You Are My Sunshine” to me. It kind of became our song. On my wedding day, before he walked me down the aisle, he handed me a gold box containing a necklace with the lyric engraved on it. It is something that I will treasure forever.
Music means a lot to me, in that I find a lot of comfort in its message; it seems like, I too, enjoy a song with a story… another trait that I inherited from my father. It makes me smile, hearing ones that I would sing with Dad, or that he thought were funny or made no sense! It seemed like Dad always had a song in his heart, and that song exuded from him like a beautiful beam of sunshine.
I love having musical memories of someone who I loved, and still love, so very much. These are some of my favorite memories that I will always hold close to my heart.
Combination of Electric Fields and Chemotherapy May Be A New Treatment Option for Pleural Mesothelioma Patients
The key to increasing survival for mesothelioma patients is to kill the cancer cells before they can spread to other organs. Treatment options, including surgery, chemotherapy and radiation, all contribute to a patient’s survival, but many times the prognosis remains unchanged. Now, one company has turned to experimenting with delivering electromagnetic waves to the chest of pleural mesothelioma patients and reports improvements in overall survival when combined with chemotherapy.
Novocure, a UK-based medical device company that develops and markets Tumor Treating Fields delivery systems, developed the novel devices as an alternative way to destroy tumor cells while sparing healthy tissue. Already approved by the U.S. Food and Drug Administration for the treatment of brain cancer, the device is now in a Phase II clinical trial for pleural mesothelioma patients.
In April, researchers gave an interim review of the STELLAR clinical trial reporting that the first 42 pleural mesothelioma patients treated with the combination of Tumor Treating Fields (TTF) and pemetrexed and cisplatin or carboplatin had a one-year survival rate of 80 percent, compared to 50 percent in the chemotherapy only patients. Median progression free survival was 7.3 months versus just 5.7 months in the chemotherapy controlled group.
“We are extremely pleased with these top-line results, which bring us one step closer to realizing the potential for a new treatment for mesothelioma patients in desperate need,” said Dr. Eilon Kirson, Novocure’s Chief Science Officer and Head of Research and Development, in an April 17 press release.
The NovoTTF-100L device used in the clinical trial provides mesothelioma patients with a round-the-clock treatment option that allows them to maintain an active lifestyle without interference to activities such as walking outdoors, shopping, and cleaning. Connected to the patient via insulated electrode arrays placed on the upper torso, the device delivers low-intensity alternating electric fields to the region near the mesothelioma tumors. The TTF is inconspicuous and light enough to carry to most functions and activities. The device needs to be active approximately 18 hours a day. According to the company’s website there are no limiting side effects.
“Mesothelioma is the first torso indication for which Novocure will pursue FDA approval,” said Dr. Kirson.
Novocure previously received a Humanitarian Use Device (HUD) designation for the use of TTF for pleural mesothelioma. The next step is to submit a Humanitarian Device Exemption (HDE) application to the FDA. For medical devices, an HDE exempts the businesses from proving effectiveness of the device. However, the company must show that the HUD “will not expose patients to an unreasonable or significant risk of illness or injury and the probable benefit to health from use of the device outweighs the risk of injury or illness from its use, ” according to the HDE application requirements.
Pleural mesothelioma, a rare form of cancer affecting the lining of the lungs, is highly aggressive and is resistant to many cancer treatments. Most often diagnoses are not made until symptoms appear and the disease has progressed to an advanced stage leaving the patient with life-threatening complications. 3,000 Americans are diagnosed with mesothelioma each year.
Sources :
- STELLAR clinical trial
https://clinicaltrials.gov/ct2/show/NCT02397928 - Novocure’s Chief Science Officer and Head of Research and Development
https://www.novocure.com/novocure-reports-positive-top-line-results-from-stellar-phase-2-pilot-trial-in-mesothelioma/ - NovoTTF-100L
https://www.novocuretrial.com/stellar-mesothelioma/living-with-ttfields/ - Humanitarian Device Exemption
https://www.fda.gov/medicaldevices/deviceregulationandguidance/howtomarketyourdevice/premarketsubmissions/humanitariandeviceexemption/default.htm - HDE application requirements
https://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/HowtoMarketYourDevice/PremarketSubmissions/HumanitarianDeviceExemption/ucm563286.htm
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