Mesothelioma Help Cancer News

The Latest Developments in Treatment of Mesothelioma

• Nancy Meredith
• Featured News

by Jennifer Schnalzer

Mesothelioma is an aggressive cancer that affects the membrane lining of the lungs and abdomen and is the most serious of all asbestos-related diseases. Asbestos refers to a set of six naturally occurring fibrous minerals that are extremely durable and resistant to fire and most chemical reactions and breakdowns (MCA, 2014). Most products today do not contain asbestos. However, asbestos was used in many building products and insulation materials in homes until about the 1970’s (CPSC, 2014) Therefore, asbestos still plays a major role in today’s society and more and more people are being diagnosed with mesothelioma due to asbestos exposure.

Studies show that people breathing high levels of asbestos fibers can lead to an increased risk of mesothelioma. Mesothelioma is a cancer that usually affects the thin, protective membrane of the chest surrounding the lungs, heart or abdominal cavity (Selby, 2014). In the United States, doctors diagnose between 2,000 and 3,000 new cases a year. Worldwide approximately 14,200 people are diagnosed a year and 43,000 people die from the disease annually (Selby, 2014).

Mesothelioma is a difficult cancer to treat and doctors are constantly trying to improve on current approaches. The three standard treatments used are surgery, radiation therapy and chemotherapy. Currently, the leading therapeutic approach for mesothelioma is called multimodal treatment, involving a combination of surgery, chemotherapy and radiation therapy (Selby, 2014). While each treatment option has their own benefits by itself, cancer specialists are opting for a more effective approach of combining treatments. Some patients are given chemotherapy and/or radiation therapies after surgery to kill any cancer cells that are left.

Since standard treatments often have limited usefulness against mesothelioma, researchers and doctors are studying new types of treatment. The research and treatments being performed in clinical trials and facilities across the world are leading doctors to more effective procedures for current and future mesothelioma patients (American Cancer Society, 2014). There may be tremendous potential with biologic therapy, gene therapy and photodynamic therapy. Even though these treatments are still in the clinical trial phase they could very well be the standard treatment in the future.

Biologic therapy, also known as, immunotherapy is a treatment that uses the patient’s immune system to fight cancer (NCI, 2013). When combines with the other anticancer treatments like chemotherapy, biologic therapy can improve survival rates and reduce symptoms for people with mesotheliomma. Even though it has not been able to cure the cancer, it can enhance the immune system response to mesothelioma cancer. Researchers have discovered a direct correlation between penetrating lymphocytes and mesothelioma prognosis, indicating that enhanced immune response may improve patient outcome (Selby, 2014). Some types of biologic therapy are referred to as vaccination therapy. One approach is to remove the immune cells from the patient’s blood and treat them in a lab to get them to react to tumor cells, the immune cells are then given back to the patients as blood transfusion, where it is hoped they will cause the body’s immune cell system to attack the cancer (American Cancer Society, 2014).

Other approaches of biologic therapy are the studies of drugs such as tremelimumab, ganetespib, and defactinib. The objective for these drugs is to help kill the cancers cells and prevent them from spreading. Tremelimumab is an antibody that blocks Cytotoxic T lymphocyte antigen4. CTLA4 is a protein found on the cells of the immune system, which may prevent immune cells from attacking cancer cells by slowing the immune response, allowing the cancer to grow and spread. Tremelimumab blocks the lymphocyte CTLA4 from slowing the immune system which enhances the immune response against mesothelioma (MSKCC, 2014). Ganetespib is a drug that is currently being tested to prevent mesothelioma tumors. Ganetespib inhibits heat shock protein 90, which is a protein in cells that is required in order for a tumor growth to occur. Tests have indicated that ganetespib is extremely active in mesothelioma and doctors seem to think that combined with chemotherapy this treatment could shrink cancers down and improve symptoms for patients (Leicester, 2013). Defactinib is another biological therapy drug being tested in clinicals. The clinical trial that is testing Defactinib is called COMMAND (Giulianotti, 2014). Defactinib is an oral drug that targets cancer stem cells by inhibitin the process of the protein focal adhesion kinase, which is needed for cancer stem cells to grow and survive. Defactinib is designed to stop the signals that the cancer cells use to divide and grow (Giulianotti, 2014). Defactinib is less toxic than chemotherapy and has fewer side effecting allowing it to be used for long periods of time to compat tumor stem cells and for maintenance (Povtak, 2013). Defactinib is proving to be a very promising treatment for mesothelioma and has been approved by the Food and Drug Administration in the treatment of mesothelioma (Povtak, 2013).

Researchers are exploring a newer type of treatment involving gene therapy to treat patients with mesothelioma. Gene therapy attempts to add new genes to cancer cells to make them easier to kill (American Cancer Society, 2014). One type of gene therapy targets cancer cells and auses them to die; this is called suicide gene therapy and is one of the most promising forms of gene therapy for treatment of mesothelioma (Selby, 2014). With the help of a virus, doctors introduce a protein-producing gene that converts a non-toxic drug into one that can kill cancer cells (Selby, 2014). Another type of gene therapy uses modified viruses to deliver immune system molecules called cytokines. Cytokines can help the immune system mount an attack against cancer cells (Selby, 2014). Early studies of gene therapy have found that it may shrink or slow the growth of mesothelioma in some people. However, because gene therapy is still in its infancy, the long-term side effects of the treatment remain unknown and more research is needed to determine if this treatment will truly work.

A newer therapy being used to treat mesothelioma is Photodynamic therapy, which uses light energy to kill cancer cells. First, a photosensitizer drug is injected into the patient. The main photosensitizer used for pleural mesothelioma treatment is porfimer sodium, usually called Photofrin (Selby, 2014). This drug is absorbed by cells and happens to remain in cancer cells longer. Therefore, after a few days when the photosensitizer has left many of the healthy cells, a special light is applied to the area, usually via laser, to activate the drug. The activated drug produces a highly reactive form of oxygen which affects all nearby cancer cells causing a reaction that kills the cancer cells (Selby, 2014). Photodynamic therapy has demonstrated positive results and is developing into a viable treatment option. Not only is photodynamic therapy less invasive with fewer side effects but it can also be used safely with other treatments to be more effective in increasing life expectancy (Mesothelioma Guide, 2014).

Even though there is still no cure for mesothelioma, advances in treatment offer hope for those affected by mesothelioma. Mesothelioma patients are living longer than ever before, benefiting from the advancement in treatment and the personalized care they receive at specialty centers across the country. More accurate diagnostic tools, better chemotherapy drug combinations and improved surgical techniques all play a role in the treatment progress. As research and experiments continue, the newer forms of treatment involving biologic therapy, gene therapy, and photodynamic therapy may become the first line of treatment for mesothelioma in conjunction with the standard treatments. With the developments of the new treatments, many doctors hope to give patients with mesothelioma a better quality of life and increase life expectancy and to maybe one day actually find a cure.

REFERENCES

• American Cancer Society (2014) What’s New in Malignant Mesothelioma Research and Treatment?
  http://www.cancer.org/cancer/malignantmesothelioma/detailedguide/malignant-mesothelioma-new-research
• Consumer Product Safety Comission: CPSC (2014). Asbestos In The Home
  http://www.cpsc.gov/en/Safety-Education/Safety-Guides/Home/Asbestos-In-The-Home/
• Dr Giulianotti, Dan (2014). Will Mesothelioma Finally Meet Its Match?
  http://www.mesocare.org/verastem-mesothelioma-treatment/
• MSKCC: Memorial Sloan Kettering Cancer Center (2014). Phase II Study of Tremelimumab versus Placebo for Previously Treated Inoperable Mesothelioma
  http://www.mskcc.org/cancer-care/clinical-trials
• NCI: National Cancer Institute: (2013). Malignant Mesothelioma Treatment
  http://www.cancer.gov/cancertopics/pdq/treatment/malignantmesothelioma/patient/
• Povtak, Tim (2013). New Clinical Trial Tests Drug to Control Cancer Stem Cells.
• Selby, Karen (2014). Mesothelioma. The Mesothelioma Center
• University of Leicester (2013). Mesothelioma: Two groundbreaking trials into treatments for asbestos-related cancer. Science Daily
  https://www.sciencedaily.com/releases/2013/09/130923092748.htm

Scholarship Essay by Kristyn Albert

• Nancy Meredith
• Featured News

“We aren’t exactly sure what is causing this discomfort Kathy, but we know it’s not cancer.” Those are the words she heard multiple times as she visited different doctors trying to pin point the cause of the back pain she was experiencing. No one ever expects it to be them, their family, their loved ones. Kathy was a wife, mother, sister, daughter, teacher and friend. While she had a heart bigger than Texas, with her humble, graceful spirit, she was the very best at everything she did. My personal favorite thing being, she was my mom.

And while some would say that those doctor visits are where the story began, I would fast forward a couple months and say our journey really began on March 25, 2008. Mom was teaching in her third grade classroom on the morning of March 25th when she reached over to take a drink of her Diet Coke, where she then had a stroke and fell over. That morning is when our lives changed forever. After being rushed to the hospital and having multiple tests done, the doctors came back and told my mom she had Mesothelioma, a rare form of cancer in the lining of the lungs.

When my mom and dad sat my older sister and I down to tell us what the doctors had shared with them, I felt as if I was in a nightmare, one I wanted to quickly come out of. Sadly it wasn’t the type of nightmare I could just wake up from. In the weeks to follow, we found out more and more about this awful cancer and the numbers did not seem to be on our side. It was a fast growing, very aggressive cancer, one that is ultimately incurable. There are three types of mesothelioma, the most common type being pleural, which is what my mom had.

Unfortunately it is a type of cancer that is very difficult for doctors to detect early on, which lead to my mom reaching stage four when they finally found it. With being stage four, even at the young age of 45, the survival rate was very small. But that statistic didn’t scare my mom and she never once gave up the fight. The only known cause of mesothelioma found today is by exposure to asbestos, which was commonly used as an acoustic insulator and in thermal insulation in homes built before the 1980s. Research shows it being linked to mesothelioma, when one breathes in the asbestos fibers which then settle in the thin membranes of the lining of the lungs.

They believe my mom most likely acquired this while growing up, for most patients have it at least 10-15 years before it is ever found. After learning the symptoms of mesothelioma, Mom had been experiencing a good bit of them for some time, sadly we just didn’t know it. She had a persistent dry cough, unusual pain or discomfort and at times shortness of breath. While it affects the organs in the chest, it is most commonly found in the tissue surrounding the lungs. When Mom was diagnosed with stage four, the doctors told her she was looking at around 9 months to live. At this stage, Mom’s cancer wasn’t constricted to one side of her chest but had spread to both of her lungs which made surgery no longer an option. Fluid was starting to build up in the lining of her lungs which resulted in making breathing very difficult.

When faced with cancer, it ultimately gives you two choices; to run and hide or to face it head on. Mom told us she would fight until she could not fight anymore, and she did just that. She started going down to MD Anderson in Houston, TX to receive treatment from some of the most experienced doctors in the world. Mom went back and forth from Fort Worth, where we lived, to Houston weekly to receive different treatments. With being stage four, the doctors were most focused on keeping her comfortable. She went through chemotherapy and more medications than one can count. All the while she never complained, never questioned why her, was so hopeful and so full of life.

The thing with cancer is, it does not just affect you, your family or your loved ones. It affects everyone surrounding you. While Mom loved being a teacher in the classroom, her illness quickly grew to a point that caused her not be able to teach anymore due to her health. This was one of the hardest things for her to give up. What my mom didn’t realize was that her teaching skills weren’t just impacting children in the classroom, but she quickly became a teacher outside the classroom to people in the community. Every Saturday morning for 18 months, approximately 80 Saturdays during Mom’s illness, people met at a near by park in honor of my mom, which quickly grew to be known as “Prayer in the Park”.

Whether it was 10 people or 100, we prayed, laughed, cried, shared stories, memories and poured love over Mom. While we all thought we were the ones supporting and helping her, it quickly became evident that even outside the classroom, Mom was still the teacher and we were her students. She taught us so much about life through her illness. I think my dad said it best when he said, “The response to her illness was now turning into a fellowship and ministry and the lesson theme for this class centered around faith. Kathy was faithful to her school and profession, faithful to her friends, faithful to her family and ultimately lovingly faithful to our God. Never have I seen someone more exemplify the meaning of “livestrong”.

Through this illness, Kathy touched the hearts of so many … young and old… near and far … friends and strangers. She had enough courage, faith and hope for all of us who rallied around her. So many people (almost 2300 to date) have left messages about Kathy being an inspiration … a model of faith and a beacon of hope. How ironic it was to learn that we thought we were carrying Kathy through this journey, only to realize that she had actually been leading us the entire time. She taught us to: Love our God, love our family, share our treasures and talents, openly pray, put others before yourself, always believe in yourself, and never give up hope.”

While I watched my mom go from being active, to using a walker, wheel chair, oxygen machine and having a hospice bed in our house, the one thing I never watched was her give up. While this rapidly, aggressive cancer took over my moms body and ultimately took her life on December 6, 2009, she fought until the very end. Her passing gave me the desire to impact and help improve people’s quality of life, which is why I want to pursue my dreams of being a nurse. Her untimely decline taught me what it truly means to live, and her death placed a new value on life. In the wake of my families own personal tragedies and realizations, studying nursing will allow me to answer my life’s ultimate calling to serve others.

To this date, mesothelioma does not have a cure and only 5-10% of people with this heart wrenching cancer live five years after being diagnosed. This is such a short period of time in the world we live in today, considering the technology we have. I want to change that. I never want someone to experience what I did feeling so helpless, knowing there was nothing I could do to save my mom. Not enough people know about this awful cancer and I hope with becoming a nurse, more people will. My mom might not have been a survivor to mesothelioma, but she sure was a fighter.

John Dreier Essay

• Nancy Meredith
• Scholarship

By: John Dreier

“What are all the symptoms you have had due to LAM?” Over six hundred people have answered me, and their shortness of breath, their collapsed lungs, their cysts, their tumors, all of it- fit neatly into a column of a spreadsheet. I have graphed their pain and analyzed their suffering. However, no Cartesian coordinate system that can convey what it is like to listen to the belabored pauses between the answers as these women struggle to supply their bodies with sufficient oxygen. Yet the patients I talk to never sound dispirited. Their ragged breaths never hint at a despair one might assume would be omnipresent. To face cancer is to acknowledge the death within life- your body’s own tissue transforming into a terrible sickness. Lymphangioleiomyomatosis, or LAM, the lung disease my lab studies, occurs primarily through genetic events. You cannot prevent your genes any more than you can prevent the weather.

Mesothelioma, however, is a much more terrible, destructive lung disease (though it can affect other organs) and does not typically arise from genetic events. Asbestos, a seemingly innocuous fibrous silicate, which is the primary cause and risk factor for mesothelioma. While prevention and awareness are essential to keep people from becoming afflicted by mesothelioma, the reality is that each year 3,000 Americans are diagnosed with this frighteningly aggressive cancer. Each year 3,000 mothers, fathers, daughters and sons are forced to acknowledge the death within their lives. If we are to address mesothelioma head-on, we must not only focus on prevention and awareness, but also on treatment and, ultimately, a cure. We must endeavor to do more than merely attempt to ameliorate this disease. We must eradicate mesothelioma from the lungs of loved ones so they can take a deep, full breath of life, and acknowledge that death but visited, and his stay was just a reminder of our own mortality.

My grandmother, a spry 95 year-old, remembers when asbestos was casually mixed in with all manner of building materials. Similarly, my mother can recall playing hop-scotch on spare asbestos-laced roof shingles. While the matrons of my family are thankfully mesothelioma-free, their stories are not uncommon for many people their age. Furthermore, the buildings constructed during that time still exist – many of which may secretly harbor asbestos in their walls and ceilings. While asbestos is only harmful in an aerosolized form, asbestos materials are a lurking danger. What can we do about this danger, given its omnipresence? Counterintuitively, the safest thing is to do nothing. Keeping asbestos-laden materials in good upkeep prevents the fibers from making their way into lungs and airways. If we demolished every building with asbestos, not only would the cost be exorbitant, but it would also increase the risk of releasing the deadly fibers into the air. On the other hand, if older buildings are allowed to fall into disrepair, their deterioration too could aerosolize asbestos. Thus, many states have enacted standard policies of asbestos testing for many large building demolitions and remodeling contracts. However, anyone and everyone who has a home-improvement project in mind, or is involved in the upkeep or custodial duties of older buildings, should be aware of the dangers of asbestos. Tearing down that wall between your kitchen and your living room may give your home a modern, open-style look, but it may also release a deadly agent into the air. Spreading this knowledge is the first step in creating a mesothelioma-free world.

While prevention and awareness are a necessary step in eradicating mesothelioma, research into treatment and a cure is absolutely critical for those already afflicted with this deadly disease. Scientists are actively trying to discover new ways of combating mesothelioma. There are currently 96 open clinical trials related to mesothelioma, 57 of which are in the United States and 43 pursuing interventional strategies. Unfortunately, the road between the discovery of a drug that has cancer-inhibiting potential to FDA approval is a long one. Take everolimus, for instance, the primary drug used to treat tuberous sclerosis complex (TSC), another disorder my lab studies. In 2009 Memorial Sloan Kettering Cancer Institute began exploring the potential of everolimus to treat a certain subset of patients with malignant pleural mesothelioma (MPM). This Phase II trial (remember, a drug must pass Phase III to make it onto the market) lasted 6 years. Iin April 2015, the study concluded “Everolimus has limited clinical activity in advanced MPM patients. Additional studies of single-agent everolimus in advanced MPM are not warranted.” To put that time-frame into context, I began college in 2009 and graduated in 2013. It takes longer for a drug to be deemed ineffective than it does to get a bachelor’s degree. Consider also that less than 10 percent of patients diagnosed with mesothelioma will live past five years. With a cancer as aggressive as mesothelioma, national interest, financial support, and intense, fast-paced research are necessary for the very survival of these patients.

Having worked in a translational medicine laboratory for the last two and half years, I am more than familiar with the obstacles confronting the scientific community attempting to treat these debilitating cancers. It is not an easy process. Each step must be scrutinized carefully, because any flaw may only waste time of researchers and patients alike. Even so, I would tell a family member of someone afflicted with mesothelioma that there is hope. Personalized (sometimes referred to as targeted) medicine is the future of healthcare, and cancers will be the most susceptible to this approach. With lowered costs of genetic sequencing as well as faster and more robust algorithms combining proteomic, metabolomic, and genetic profiling – we are rapidly pushing the boundaries of not only detection of biological targets, but also therapies specifically designed for those targets. My hope as a scientist, and as a future clinician, is that increased awareness of mesothelioma will garner public attention and support for directed therapies. For now, all we can do is spread the word, and provide the resources to dedicated scientists and physicians fighting to end this deadly disease.

We cannot change the past. Asbestos is all around us – in our homes, our schools, our offices – it surrounds us. However, we can build a new future. A future in which families are aware of the dangers of older buildings and take precautions; a future in which support and funding for mesothelioma enter the national spotlight; a future in which a patient diagnosed with mesothelioma has hope for a cure, because personalized medicine has a solution specifically for them. We can build that future, but it has to start today.

References

• Alexander HR, Burke AP. Diagnosis and management of patients with malignant peritoneal mesothelioma. Journal of Gastrointestinal Oncology. 2016;7(1):79-86. doi:10.3978/j.issn.2078-6891.2015.134.
• Calabrò, Luana, Aldo Morra, Ester Fonsatti, Ornella Cutaia, Carolina Fazio, Diego Annesi, Marica Lenoci, Giovanni Amato, Riccardo Danielli, Maresa Altomonte, Diana Giannarelli, Anna Maria Di Giacomo, and Michele Maio. “Efficacy and Safety of an Intensified Schedule of Tremelimumab for Chemotherapy-resistant Malignant Mesothelioma: An Open-label, Single-arm, Phase 2 Study.” The Lancet Respiratory Medicine 3, no. 4 (2015): 301-09.
• ClinicalTrials.gov, U.S. National Institutes of Health, Web. March 20, 2016
• Mass.gov, Massachusetts Energy and Environmental Affairs, “Answers to Common Asbestos Questions,” Web. March 15, 2016

Essay Contest: Win an Apple iPad Mini

• Nancy Meredith
• Scholarship

Contestants in the MesotheliomaHelp Scholarship Essay Contest sponsored by Belluck & Fox, LLP, have an additional chance to win a iPad-mini.

Share the essay contest with friends and family on Twitter and Facebook for a chance to win an Apple iPad Mini. The more you tweet the more opportunities you have. Please remember that to be eligible to win you should submit your essay in the annual essay scholarship contest. One lucky ipad-mini winner will be selected at random!

Every year, as an incentive to get people participating in our scholarship contest, we provide a chance for students to win an iPad Mini by sharing their essays with friends, family and all readers of MesotheliomaHelp.

The History of Asbestos Use in America

• Nancy Meredith
• Scholarship