Category: Treatments

More Personalized Treatment for Mesothelioma Patients in the Future

• Nancy Meredith
• Cancer, Mesothelioma, Research, Treatments

Physicians who specialize in treating mesothelioma predict that in the next five to 10 years, researchers will identify more accurate ways to detect the disease and tailor treatment to individual patients. Mesothelioma is an incurable cancer of the lining of the lung or abdomen closely associated with exposure to asbestos. Asbestos was widely used in building materials, fireproofing and insulation through much of the 20th century.

In an article in the November issue of Clinical Lung Cancer, Drs. Linda Garland of the Arizona Cancer Center, Raja Flores of the Mount Sinai School of Medicine in New York and Anne Tsao of the M.D. Anderson Cancer Center predict that the global burden of mesothelioma will increase in the decade ahead, particularly outside the United States. In the U.S., about 2,500 to 3,000 die each year of mesothelioma. With cases of mesothelioma expected to spread, doctors need more effective treatments for the aggressive cancer and more personalized treatments for patients, they say.

Under current medical practice, doctors select mesothelioma patients to undergo radical surgery to remove cancerous tumors based on factors including the stage of the cancer, specific structure of the cancer cells, lung function and the patient’s overall health. But these factors are not very good predictors of long-term survival. Less than a third of the mesothelioma patients selected undergo radical surgery live four to five years, according to the article.

The researchers say there is an opportunity for development of tests for earlier detection of mesothelioma through telltale molecules in the bloodstream, known as biomarkers. Biomarkers are a relatively new but promising area of genetic research. One researcher has compared biomarkers to fingerprints of the disease. For example, the prevalence of a biomarker protein identified as microRNA-29c in mesothelioma tissue has been linked to longer patient survival and improved prognosis after surgery, according to an important recent study. These patients may be better candidates for tumor removal surgery, if the biomarker are validated by further research.

The article authors say that progress has been made in the last decade in the development of chemotherapy drugs for mesothelioma. Longer survival for mesothelioma patients may be possible with chemotherapy regimens tailored to the individual patients in the future. According to the studies, this may be possible if biomarkers can be pinpointed to help doctors identify which patients are receptive to individual chemotherapy drugs such as pemetrexed-based therapy.

Doctors are still awaiting the development of a break-through drug or therapy that may allow the targeting of mesothelioma tumors, according to the article. In the next five to 10 years, they say there will be promising developments toward a brighter future for mesothelioma patients.

Guidelines for Mesothelioma Treatment

• Nancy Meredith
• International News, Mesothelioma, Patients, Treatments

The incidence of malignant mesothelioma, a respiratory cancer associated with inhaling asbestos, is expected to double in many countries in the next 20 years, according to the European Society of Medical Oncology. In the United States, approximately 2,500 to 3,000 people die of mesothelioma each year.

In an article in the July issue of the Annals of Oncology, the European Society of Medical Oncology outlines treatment guidelines for patients with mesothelioma. The clinical practice guidelines are developed by the non-profit professional organization, which promotes advances in cancer treatment and prevention, to assist doctors and patients in making decisions about appropriate health care. According to the practice guidelines:

Patients with mesothelioma often first have symptoms of shortness of breath due to excess fluid in the chest. Patients with more advanced cases may have chest pain. A chest x-ray or scan may suggest a case of mesothelioma based on thickening of the membrane lining the the lung called the pleura. Laboratory examination of chest fluid can confirm a diagnosis of mesothelioma. But the lab reports are often equivocal.

Doctors should interview the patient about their work history to try to determine if they were exposed to asbestos in their workplace, the most common cause of mesothelioma. Most cases of mesothelioma are due to occupational exposure

The gold standard for diagnosis of mesothelioma is a microscopic examination of specific antigens in a tissue biopsy obtained through a surgical procedure called a pleuroscopy. A surgical instrument is inserted into the patient’s chest through an incision to collect tissue. Research studies suggest that certain proteins and oseteopontin, a human gene product, are useful indicators to support a diagnosis of mesothelioma.

After doctors confirm a diagnosis, a CT scan of the patient’s chest is used to assess the advancement of the cancer. An accurate assessment of the mesothelioma’s stage is essential to determine the most appropriate treatment and the patient’s prognosis. Malignant pleural mesothelioma rarely spreads to distant parts of the body, but patients often have advanced localized cancer in their respiratory system when they are diagnosed.

Various surgical procedures have been used with varying degrees of success, according to the European Society of Medical Oncology. Surgery should be performed only on patients with less advanced cases of mesothelioma as part of a multi-pronged approach to treatment combined with chemotherapy and/or radiation. The use of radiation in treating mesothelioma has been limited because of the difficulty of irradiating such a large area of the body as a lung without irreparably harming the adjacent healthy lung. Still, it is used.

As far as chemotherapy, the use of combinations of cancer drugs, permetrexed and cisplatin, and to a lesser extent, raltitrexed and cisplatin, have led to improved survival results in patients as well as lung function and symptom control, compared to use of cisplatin in clinical trials. The combination of permetrexed and carboplatin is an effective alternative chemotherapy.