Category: Featured 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.

Breakthrough Blood Test May Extend Mesothelioma Survival

• Nancy Meredith
• Cancer, Diagnosis, Featured News, Pleural Mesothelioma

Just last week, MesotheliomaHelp reported on a corporate partnership for blood test tools that will bring improved results in the detection of key lung cancer mutations. Blood biopsies are shown to be fast and accurate, as well as less stressful on the patients. Now, in another breakthrough using liquid biopsies, researchers report success in the early detection of mesothelioma and screening for multiple cancers using one tool.

Researchers from Johns Hopkins University have developed the CancerSeek blood test that is able to screen for eight different types of cancers and can help pinpoint the location of the tumor. In a recent study of 1,005 cancer patients, the results had a “greater than 99 percent specificity for cancer,” according to a Jan. 19 press release from Johns Hopkins University.

Although there are screening options for some cancers, such as breast and prostate,  mesothelioma, and many other cancers, are diagnosed after the patient goes to a doctor exhibiting some of the signature symptoms of cancer: unexplained weight loss, extreme fatigue and a persistent cough. CancerSeek results had a sensitivity ranging from 69 percent to 98 percent in five cancers that do not currently have any screening test availables, including ovarian, pancreatic, and esophageal cancers.

The test, according to the researchers, looks at eight common cancer proteins and the presence of cancer gene mutations from DNA circulating in the blood. The team developed a “small yet robust panel” that could detect at least one mutation and not lead to false-positives. The test is used for cancer detection only, and does not detect specific biomarkers to drive treatment.

“The use of a combination of selected biomarkers for early detection has the potential to change the way we screen for cancer…,” says Nickolas Papadopoulos, senior author and professor of oncology and pathology at Johns Hopkins.

Pleural mesothelioma, a deadly cancer of the lungs caused by past exposure to asbestos, has a long incubation period where patients may not exhibit symptoms for decades after exposure. By then the disease is already at an advanced, incurable stage.

Early detection of cancer through screening reduces mortality from many cancers, including lung and colon, according to the National Cancer Society. When treating mesothelioma patients, the best outcome is achieved with early detection of the disease by increasing treatment options and improving the patients’ quality of life while battling the cancer.

The  tests are still in the early stages of research and are not yet available; however, they may be helpful in diagnosing mesothelioma in the future. In fact, the team anticipates a relatively inexpensive test that may be conducted by a primary care provider.

Read the results of the study in the Jan. 18 issue of the journal Science.

http://science.sciencemag.org/content/357/6349/378

Turning Off Certain Enzymes Could Stop Mesothelioma Growth

• Nancy Meredith
• Cancer, Featured News, Research

Researchers realize that one of the best ways to fight cancer is to stop it from growing and metastasizing in the first place. However, finding the right way to do that is not easy. Now, researchers believe that by turning off certain enzymes they can stop cancer cells from dividing. This discovery may stop cancer in its tracks, and bring new treatments that could extend the lives of mesothelioma patients.

Researchers from Uppsala University, Karolinska Institutet, and the University of Oxford, began to look deeper into finding a way to switch off enzymes as a promising strategy to fight cancer. Tailored drugs are needed to shut down an individual enzyme, but before they could look at new therapies, they needed to better understand how cancer-fighting drugs get to their targets.

The team of scientists turned their focus deep into the cells to a cell membrane protein dehydroorotate dehydrogenase (DHODH), a key anticancer target known to play a role in cell proliferation, according to a Jan. 19 press release from Uppsala University. They conducted a series of tests to determine how lipids, or building blocks of the cell membrane, and drugs bind to the DHODH enzyme. By better understanding this mechanism, they can better understand how to drive drugs directly to the disease.

“To our surprise, we saw that one drug seemed to bind better to the enzyme when lipid-like molecules were present,” says assistant professor Michael Landreh, Karolinska Institutet. In addition, they found that a lipid present in the mitochondrial respiratory chain complex, or the cell’s energy source, binds to the enzyme. The researchers concluded that DHODH may “use special lipids to find its correct place on the membrane.”

Research suggests that tumor metastases are responsible for approximately 90% of all cancer-related deaths. Funding research to find ways to have drugs home in directly on the disease brings hope to every cancer patient. In the case of mesothelioma, an incurable, asbestos-caused cancer, that quickly spreads to other organs leaving patients with few treatment options, halting cancer growth could lead to extended survival. Survival is typically about one year.

“By studying the native structures and mechanisms for cancer targets, it may become possible to exploit their most distinct features to design new, more selective therapeutics,” says Sir David Lane, Karolinska Institutet.

To find out more about this research, read the full study in the Jan. 18 issue of Cell Chemical Biology.

http://www.cell.com/cell-chemical-biology/fulltext/S2451-9456(17)30461-0

Chemical in Alaskan Sea Sponge May Kill Mesothelioma Cancer Cells

• Nancy Meredith
• Asbestos Exposure, Family, Featured News

Another sea-dwelling plant is making headlines in oncology research. Over a year ago MesotheliomaHelp reported that the active agent, trabectedin, found in the Caribbean sea cucumber showed promise in fighting mesothelioma. Now, researchers believe the unique chemical composition in the deep-water Alaska green sponge could kill cancer cells. This discovery could lead to treatments for pancreatic cancer, and other aggressive cancers such as mesothelioma.

Found by National Oceanic and Atmospheric Administration (NOAA) scientist Bob Stone in 2005 during a fishery mission, the sponge has researchers from around the U.S., and the globe, clamoring to find out more about it, according to a July article in NOAA Fisheries. A researcher from the Medical University of South Carolina, who has been turning to marine life as a potential drug ingredient for nearly 20 years, is particularly excited by the discovery and is now working with Stone, a team in New Zealand, and with other cancer centers in the U.S.

Identifying the sponge as Latrunculia austini, Mark Hamann, the Charles and Carol Cooper SmartState Endowed Chair at MUSC, said that the plant, “covers unique and unprecedented chemical space.”

Samples of the sponge are now in the hands of researchers at the Henry Ford Cancer Institute where a team is testing sponge extracts against pancreatic cancer cells. The researchers found the green sponge extracts effective in killing pancreatic cancer cells in the lab.

“You’d never look at this sponge and think this is a miracle sponge, but it could be,” said Stone.

Although pancreatic cancer and mesothelioma are very different cancers, the two diseases both lack treatments that can effectively combat the tumors. Chemotherapy is a standard treatment option for both mesothelioma and pancreatic cancer, but eventually the cancer cells build up a resistance to the treatment. Survival is low for both cancers.

The cancer-fighting capability of the sponge is driven by its inability to flee from predators. As a result, it builds up powerful chemicals to ward off its enemies. For that reason, Hamann and the other researchers turn to these marine creatures to develop life-saving drugs. They note that “Of the eight most frequently prescribed products to treat cancer, half are natural products.”

The sponge is at a depth that makes it difficult to harvest bringing a significant obstacle to the research, albeit one worth trying to overcome. “For pancreatic cancer this is absolutely the best lead that we have,” Hamann said.

Mesothelioma, caused by asbestos exposure, is diagnosed in close to 3,000 Americans each year. Currently, there is no cure for the disease, but research into treatments of other cancers is followed closely by the mesothelioma community in hopes the results are transferrable.

“Given the lack of current effective drug treatments available for pancreatic cancer, this study finding offers hope for the future of cancer care,” said Fred Valeriote, senior researcher with the Henry Ford Cancer Institute.

This research is in early stages and significant, additional research is still needed.

Photo Credit: NOAA Fisheries