Category: Featured News
Based on Results of Prostate Cancer Study, Specialist Centers Most Likely Offer Best Mesothelioma Care
Due to mesothelioma’s relative rarity among the general population, it is recommended that patients seek out a mesothelioma specialist center. Mesothelioma specialists are aware of the latest research and they are able to develop a more informed treatment plan than would a physician who does not specialize in the disease. Researchers at one of the most prominent mesothelioma centers in the world tested this theory on prostate cancer patients and found that those treated at a high-volume radiation center see better survival rates.
Researchers at Brigham and Women’s Hospital looked at records of nearly 20,000 high-risk prostate cancer patients who received radiation at over 1,000 facilities. The data showed that when treated at “higher-volume facilities,” i.e., the top 20 percent by prostate radiation volume, patients consistently had better survival rates than those treated at lower-volume facilities.
“Our paper shows that experience counts,” said Paul Nguyen, MD, a physician researcher in the department of Radiation Oncology at Brigham and Women’s Hospital and corresponding author of the new paper, in a March 14 press release. “For men with aggressive prostate cancer, survival is improved if they receive their radiation treatments at a high volume facility as opposed to a lower volume facility.”
In the case of mesothelioma care, a mesothelioma specialist will develop the treatment protocol and will supervise its implementation, while the patient still meets with his or her personal doctor. Mesothelioma has a unique set of treatment requirements and specialists serve a key role in interpreting and defining the best approach for caring for the patient.
The Medical Team
At a mesothelioma treatment center, several types of physicians can be involved in the treatment of mesothelioma. Often physicians’ specialties will overlap and several doctors may be available to offer treatment and support in the same discipline. Types of specialists that may be included on a team are:
- Oncologists. Medical professional specializing in cancer.
- Thoracic surgeons. Thoracic surgery is the field of medicine involved in the surgical treatment of diseases affecting the thorax or the chest including the lungs, chest wall, and diaphragm.
- Pulmonologists. Physicians specializing in the treatment of diseases of the lungs and the respiratory tract.
- Chemotherapy (oncology) Nurse. The RN or team of nurses responsible for patient assessment, chemotherapy administration and supportive care during the chemotherapy treatment.
- Radiation Therapist. The radiation therapist develops a treatment plan in conjunction with a radiation oncologist, explains the treatment plan to the patient, and administers the radiation.
In addition to the above specialists, many other medical professionals will be supporting the patient’s needs such as nutritionists, pharmacists, and the primary care physician.
“At a higher volume facility, not only will the radiation oncologist will have more experience at designing and delivering the appropriate treatment fields, but the multidisciplinary team of pathologists, radiologists, urologists, and medical oncologists will have greater expertise in making accurate diagnoses and tailoring the systemic therapy regimen to ensure the best-possible outcome for the patient,” said Dr. Nguyen.
The researchers report other cancer datasets are being planned for review “to corroborate the strong effect seen here.”
Brigham and Women’s is home to the International Mesothelioma Program. Managing over 300 mesothelioma consultations per year, the International Mesothelioma Program is the largest program of its kind in the world. The Program has a mission “to offer state-of-the-art treatment to patients with malignant pleural mesothelioma.”
Find the full study in the March 15, 2016 issue of the International Journal of Radiation Oncology, Biology, Physics.
http://www.redjournal.org/article/S0360-3016%2815%2926845-9/abstract
Sources:
- International Mesothelioma Program
http://www.brighamandwomens.org/Departments_and_Services/surgery/thoracic-surgery/mesothelioma/default.aspx - (Brigham and Women’s Hospital ) March 14 press release
http://www.brighamandwomens.org/about_bwh/publicaffairs/news/pressreleases/PressRelease.aspx?sub=0&PageID=2299
Trojan Horse Drug Delivery Method Shown Effective in Drug Resistant Cancer May Also Kill Mesothelioma Cells
MesotheliomaHelp has previously reported on a drug delivery method where the drug sneaks up on the cancer cells via a Trojan horse concept. Now, researchers have developed another Trojan horse delivery method where a drug is hidden inside a DNA capsule.
According to researchers from The Ohio State University, using “DNA origami,” where an anti-cancer drug is enclosed in a capsule of folded up DNA, the targeted cancer cells absorbed the medicine inside the capsule and died. The laboratory test was performed against leukemia cells that had built up a resistance against the drug, however, by hiding the drug in the DNA it was once again effective.
“DNA origami nanostructures have a lot of potential for drug delivery, not just for making effective drug delivery vehicles, but enabling new ways to study drug delivery,” said Carlos Castro, director of the Laboratory for Nanoengineering and Biodesign, in a Feb. 23 press release from the University.
In the study, the researchers discovered that when leukemia cancer cells are treated with daunorubicin, a chemotherapy used to treat leukemia, after the cancer has developed a resistance to the anti-cancer drug, the medicine is fought off by being pumped out through the cell walls.
However, the researchers found that when daunorubicin was cloaked within the DNA capsule, the cancer cells actually drew the capsules in mistaking it for food. Once the capsule was inside the cell it broke down flooding the cancer with the drug, effectively killing the leukemia cells.
The technique should potentially work on most any form of drug-resistant cancer if further work shows it can be effectively translated to animal models, according to study co-author John Byrd of The Ohio State University Wexner Medical Center. This is very good news to the mesothelioma community.
Mesothelioma, an asbestos-caused cancer that attacks the lining of the organs, is like many cancers with few effective treatments and no cure. According to many researchers, the likelihood that mesothelioma will build up a resistance to the very drugs designed to combat the cancer is extremely high. The Ohio State researchers believe that their findings can lead to a new drug delivery method that can restore the effectiveness of the anti-cancer drugs.
“Potentially, we can also tailor these structures to make them deliver drugs selectively to cancer cells and not to other parts of the body where they can cause side effects,” said Byrd.
The study was confined to laboratory cells. Results of the research must next be proven in mouse models before testing on human cancers, which could be years down the road.
To find out more about the DNA Trojan horse see the Nov. 19, 2015 issue of Small.
Researchers Identify Mutations in Mesothelioma That Can Lead to Personalized Care
Biomarkers have become the de facto reference for researchers and oncologists when determining mesothelioma diagnosis, treatment, success of those treatments and prognosis. But identifying reliable biomarkers has been challenging, primarily due to the rarity of the disease. Now, researchers at one of the leading mesothelioma centers report they have identified a “spectrum of mutations” found in mesothelioma tumors.
Mesothelioma is a serious and incurable cancer that is diagnosed in just 3,000 Americans each year. The aggressive cancer, known as “asbestos cancer” since it is almost always a direct consequence of past exposure to asbestos fibers, often eludes standard cancer treatments. Through personalized, targeted therapy, with the help of biomarkers, however, patients see improved survival and a higher quality of life.
Researchers from Brigham and Women’s Hospital of Boston hope to bring personalized care to many more mesothelioma patients through their recent discovery of “previously unknown genetic alterations” in mesothelioma tumors. Some of these mutations that are prominent in other cancers, according to the researchers, have available treatments that could benefit mesothelioma patients with those same mutations.
“By studying so many samples, we’ve been able to describe a spectrum of mutations for this rare disease,” says lead author Dr. Raphael Bueno, chief of BWH’s Division of Thoracic Surgery and co-director of the hospital’s Lung Center, in a Feb. 29 press release. “A small number of these mutations have been found previously in other cancers, and drugs have been developed to target these mutations.”
The researchers performed a “comprehensive genomic analysis” on 216 malignant pleural mesothelioma samples, where they compared the DNA and RNA of the mesothelioma samples and normal, healthy samples. According to the press release, the team uncovered more than 2,500 alterations, and identified 10 significantly mutated genes.
Biomarkers play a critical role in improving the drug development process, according to National Institutes of Health researchers, in addition to identifying focused care. The PD-L1 biomarker has been top-of-the-news recently with the successful treatment in mesothelioma patients and melanoma patients who express the biomarker. The immunotherapy drug blocks PD-L1.
Read more about the immunotherapy drugs and mesothelioma.
“When you have a cancer that has a 80 to 90 percent mortality rate within five years of diagnosis, and you discover evidence that a small percentage of people may have actionable mutations, that means that you could reduce mortality,” said Bueno.
Brigham and Women’s is home to the International Mesothelioma Program. Managing over 300 mesothelioma consultations per year, the International Mesothelioma Program is the largest program of its kind in the world. The Program has a mission “to offer state-of-the-art treatment to patients with malignant pleural mesothelioma.”
“We plan to continue this important research through investigator-sponsored trials evaluating the potential use of cancer immunotherapies for the treatment of mesothelioma,” says Bueno.
The results of the study can be found in the Feb. 29 issue of Nature Genetics.
Know more about Mesothelioma and how you can deal with it.
Early Detection Tool for Mesothelioma On the Horizon
Each year, thousands of people in the U.S. and across the world are faced with a diagnosis of mesothelioma. The deadly, aggressive cancer, caused by past asbestos exposure, hibernates for decades before life-threatening symptoms become apparent. The key to increased life expectancy when battling this cancer is early detection. A reliable diagnostic tool, however, has been elusive to researchers until now. In a recent study, researchers report “exciting results” in detecting a protein indicating the presence of malignant mesothelioma.
MorNuCo Laboratories of Indiana, announced last month that with its ONCOblot® Test a team of researchers conducted a retrospective clinical trial where a mesothelioma-specific form of the ENOX2 protein “was found within the serum of asbestos-exposed individuals an average of 6.2 years in advance of clinical symptoms.”
“The completion of this trial is an exciting new chapter for our work,” says Nick Miner, Vice President of Business Development, in the company’s Feb. 4 press release. “Although asbestos-induced mesothelioma is a very specific example of early detection, we are currently pursuing larger-scale clinical trials to investigate the utility of the ENOX2 protein marker to predict the onset of cancers of other tissues of origin as well.”
Although the American Cancer Society identifies chest x-rays, CT scans, PET scans and the bronchoscopy as tests used to diagnose mesothelioma, these are only effective after a patient has presented with worsening respiratory symptoms. MorNuCo’s goal with ONCOblot, is to offer a tool that can detect the cancer early, “before the disease progresses and to begin treatment well in advance of life-threatening symptoms.”
Mesothelioma often has symptoms such as a persistent cough, shortness of breath, fatigue and wheezing, that are similar to many other respiratory illnesses. When a patient presents with these symptoms, doctors often first treat the patient for a respiratory infection before turning to testing for cancer. 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 cancer is detected early.
“The results of this study showed that two mesothelioma-specific ENOX2 protein transcript variants were detected in the serum of asbestos-exposed individuals 4–10 years prior to clinical diagnosis of malignant mesothelioma, an exciting sign of progress in the cancer detection field,” according to the press release.
The study can be found in the Jan. 22 issue of Clinical Proteomics Journal.
Note: Physicians can order the ONCOblot® Test, however, it has not yet been approved by the U.S. Food and Drug Administration. The test is CLIA Certified (Clinical Laboratory Improvement Amendments) and CAP Accredited (College of American Pathologists). The cost of the test is not covered under insurance.
For more information see the FAQs on Oncoblot’s website.
Ease Up On Aggressive Mesothelioma Treatments To Prolong Lives
Just last month, MesotheliomaHelp wrote about how the toxicity of cancer treatments, that kill many healthy cells, may open up new pathways for tumors allowing them to grow and spread. Now, another team of researchers support taking a less aggressive “kill all” approach to prevent the inevitable outcome of treatment resistance.
Researchers at Moffitt Cancer Center in Tampa, Florida, led by Robert Gatenby, M.D., study author and leader of the Cancer Biology & Evolution Program at Moffitt, want to attack cancer with adaptive therapy, which focuses on keeping resistant cells in check by maintaining an army of chemo-sensitive cells alive.
According to a Feb. 24 press release from the cancer center, bombarding cancer with the highest tolerated dose of chemotherapy, the typical approach, may effectively kill cancer cells in the short-term, but chemo-resistant cells escape the treatment and continue to grow and spread.
The old school approach to treatment, especially for mesothelioma, an incurable asbestos-caused cancer, is to take an aggressive approach in fighting the equally aggressive cancer. According to the researchers, however, by giving a lower dose of the chosen chemotherapy and keeping some chemo-sensitive cells intact, they can compete with the resistant cells and stop them from taking over.
“The goal is to enhance the value of therapy by using evolution in our favour rather than letting it beat us,” says Dr. Granby.
The approach, says Dr. Gatenby, adjusts treatment based on the size of the tumors and involves blasting the tumor with a high dose during its growth phase, then reducing the dosage as the tumor shrinks. Through this process, the patient maintains a higher quality of life with the lower toxicity levels, and the cancer is held at bay.
“Our goal is to keep playing this game with the tumour to keep it sensitive, and as long as we do that the patient is alive and fine,” says Granby in a Feb. 24 article in New Scientist. “Then they can have prolonged periods of time when they’re not getting any therapy at all.”
If the cancer recurs, another round of treatment again kills off the bulk of the cancer cells, but allows the patient to maintain a good quality of life. When tested on mice, this approach kept tumors small for much longer, “and after the initial 20 days only low doses were needed to prevent the tumours growing larger.” In addition, “therapy was stopped completely for 60 per cent of the animals, without the cancer progressing.”
The standard treatment protocol for mesothelioma patients is chemotherapy. However, the high doses often leave patients in fragile health from side effects including diarrhea, vomiting and anemia. Any treatment that improves quality of life and extends survival is a welcome approach.
Mesothelioma is responsible for the death of nearly 3,000 Americans each year.
The study can be found in the Feb. 24 issue of Science Translational Medicine.
http://stm.sciencemag.org/content/7/284/284ra57
Sources:
- Cancer Center
https://www.moffitt.org/newsroom/press-release-archive/2016/moffitt-researchers-develop-a-novel-cancer-treatment-approach-based-on-evolutionary-principals-to-inhibit-chemo-resistance-prolong-progression-free-survival - (Feb. 24 article in) New Scientist
https://www.newscientist.com/article/2078806-gentler-attack-on-cancer-may-mean-we-can-live-with-it-for-longer
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