CDC Reinstates $2.2M Grant to Fund the Mesothelioma Tissue Bank

The mesothelioma community â€" researchers, doctors, patients, families and advocates â€" received a much-needed boost this week when the Centers for Disease Control and Prevention (CDC) reversed an earlier decision and reinstated funding for the National Mesothelioma Virtual Bank (NMVB).

Officials at the CDC in June restored a two-year, $2.2 million federal grant that will carry the NMVB through 2016.

"Without this [funding], research of mesothelioma could have stagnated," Michael Feldman, M.D., Ph.D., professor of Pathology and Laboratory Medicine at the University of Pennsylvania, told Asbestos. com. "It [NMVB] is like the cornerstone of a building: A foundation on which to build upon and so important for any advancement. We're very pleased right now."

The NMVB is a biospecimen registry designed to facilitate scientific research and advance the goal of developing novel therapies, preventative measures, diagnostic tools and eventually a cure for mesothelioma.

It provides tissue samples, paraffin-embedded blood products and a vast amount of other clinicopathological information free for researchers around the country.

Everyone Should Benefit

The NMVB, which was founded in 2006, is the only federally funded program specifically designed for mesothelioma research. It is a collaborative effort involving the University of Pittsburgh Medical Center, the New York University School of Medicine, the University of Pennsylvania School of Medicine, and the Mount Sinai School of Medicine.

The theory behind the NMVB is that researchers everywhere, at various levels and in various disciplines, are eligible to apply for tissue specimens. Officials believe that kind of open sharing will spark new ideas and become a national model and a leader among tissue banks.

Researchers in recent years have made significant strides in trying to accomplish that goal. For example, they’ve been helping doctors extend patient survival rates. Novel treatments in recent years, many in clinical trials, are revolving around immunotherapy, where designer drugs help a body's own immune system fight the cancer.

"This was not a good time to be scaling back," Feldman said. "We're at a crossroads [with mesothelioma]. We're better understanding this disease and seeing real progress. It would have been the worst time to cutting back the research."

What Led to the Loss of Funding?

Under mounting problems with raising the debt limit, the federal government in 2013 put the budget sequester into place. More than $85 billion in automatic spending cuts affected health care, nonprofit organizations and scientific research and more.

As part of the sequester, the CDC, in association with the National Institute of Occupational Safety and Health (NIOSH), told the NMVB they would no longer fund it.

The NMVB then informed researchers that after Sept. 1, 2014, tissue samples might no longer be available for free and expansion was in doubt.

Looking Ahead

The reversal in funding means that researchers can continue working on medical innovations in the treatment of mesothelioma.

There are more than 1,300 biospecimens in the tissue bank today and researchers plan to expand it significantly with the addition of new medical centers. Those plans had been sidetracked by the announcement in 2013 that left everyone in limbo.

While the NMVB is the only agency eligible to receive this grant money, it still must submit an official application before July 31, 2014 to the Procurement and Grants Office of the Department of Health and Human Services.

"We had been working to try and get this reinstated, but you never know until someone says yes. There are no guarantees with these budgets," said Feldman, a member of the Research Evaluation Panel for the NMVB. "We are fortunate, but we won't rest on our good fortune. We're already looking to see what the next opportunity [beyond 2016] is."

Author: Tim Povtak

Tim Povtak is an award-winning writer with more than 30 years of reporting national and international news. His most recent experience is in researching and writing about asbestos litigation issues and asbestos-related conditions like mesothelioma.

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Could Red Wine Enhance Effectiveness of Chemotherapy for Mesothelioma?

Researchers in South Korea have uncovered an unusual synergy between a chemical found in red wine and a drug used to treat childhood leukemia that has translated into a potential future treatment options for malignant mesothelioma.

The combination of resveratrol, which comes from the skin of red grapes, and the drug clofarabine, has shown an ability to make mesothelioma cells much more vulnerable to chemotherapy.

Researchers found the resveratrol/clofarabine combination prevented tumor cell proliferation and triggered programmed cell death. It also left healthy cells untouched.

"I think that our results showed therapeutic potential in overcoming chemo-resistance against malignant mesothelioma," researcher Sang-Han Lee, biochemistry professor in the College of Medicine at Soonchunhyang University, told Asbestos.com. "We have been struggling to find effective therapeutic agents for mesothelioma. I hope our dream [of finding one] comes true sooner rather than later."

Not So Fast Says Researcher

Lee was quick to caution against too much optimism, emphasizing the findings were in vitro, and a long way from even reaching the clinical trial stage where it can reach the actual patients who need it quickly.

"Further studies are needed," Lee said. "A lot of drugs have been demonstrated to be effective in in vitro study, and most of them fail in preclinical animal testing for a number of reasons. We still need time and efforts for the development of an effective systemic treatment regimen."

One of the biggest challenges with cancer treatments is finding a drug combination that avoids the healthy cells while killing the malignant cells. The ability of the resveratrol/clofarabine combination to provide a better target for the chemotherapy is what has researchers intrigued.

Clofarabine for Childhood Leukemia

Clofarabine is typically used to treat actue lymphoblastic leukemia that has recurred or resisted chemotherapy treatments with children. It is part of antimetabolites drug group that prevents cells from making RNA and DNA, halting the growth of cancer cells.

Resveratrol, which is found in both red wine and grape juice, has been studied in previous cancer research but with mixed results. South Korean researchers have shown it to be effective in suppressing tumor growth in laboratory mice. Other scientists have been skeptical.

There is little scientific proof that resveratrol works in human cancers, and it has not been FDA approved, but it is among several medicinal alternatives that some patients insist have helped them. That group of alternatives includes plant extracts, teas, vitamins, minerals and amino acids.

Family doctors have encouraged patients for years to drink a daily glass of red wine to help with cardiovascular health. Korean researchers previously found that drinking red wine was effective with mesothelioma cells because of its interaction with a specific protein known as Sp1.

The Synergistic Effect Works Well

The latest research revolves around another protein known as Mcl-1 and how the synergistic effect of resveratrol/clofarabine activates "caspases," which are proteins that cause tumor cell death.

Mesothelioma, which is caused primarily by asbestos exposure, is a cancer without a definitive cure. Chemotherapy, too often, is not an effective, long-term tool in fighting it. Overcoming the resistance to chemotherapy has been a goal of researchers for many years.

And while the incidence of mesothelioma cancer has begun to show a decline in the U.S., it continues to rise in several, still-developing countries like South Korea, where asbestos products still are being used.

"We are still in the early st ages [of this research]," Lee said. "Our studies have been aimed at finding the potential roles of natural compounds … for higher efficacy of chemotherapeutic regimens, and for alleviating their adverse effects. It still needs the accumulation of more valuable data for the preclinical and clinical setting."

Author: Tim Povtak

Tim Povtak is an award-winning writer with more than 30 years of reporting national and international news. His most recent experience is in researching and writing about asbestos litigation issues and asbestos-related conditions like mesothelioma.

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Immunotherapy Clinical Trial Showing Promise in Stopping Mesothelioma Recurrence

Even after the best multimodal treatment approach â€" a combination of two or more therapies (chemotherapy, surgery and radiation) â€" the probability of mesothelioma cancer recurrence remains high because of the diffuse nature of the disease.

Researchers are moving closer to fixing that dilemma.

Doctors currently are testing a Wilms’ tumor 1 (WT1) peptide vaccine for its ability to halt mesothelioma recurrence in a Phase II clinical trial conducted at the MD Anderson Cancer Center in Houston.

MD Anderson still is accepting new participants for this randomized study that began in 2013. The expected completion date is 2017.

"To this point, it looks very promising," Anne Tsao, M.D., director of the Mesothelioma Program at MD Anderson, told Asbestos.com. "We've been encouraged with what we've seen."

Immunotherapy Is the Key

The vaccine is a form of immunotherapy designed to trigger the body's own immune system into preventing any new growth of the tumor. Tsao said the vaccine has been well tolerated by patients and shown no serious side effects.

It is one of several immunotherapy agents researchers are exploring in the fight against mesothelioma, an aggressive cancer which has no definitive cure and is caused by exposure to asbestos fibers.

Mesothelioma tumors typically have high levels of WT1, a protein that causes cell growth and regulates gene expression. When it becomes abnormal, it can lead to the development of cancer. The vaccine is given in combination with drugs GM-CSF and Montanide, which together are designed to cause white blood cells to grow and encourage an immune response.

The addition of the analog peptide vaccine helps direct the response to any mesothelioma cells that remain.

"After treatment [surgical resection and radiation], the premise here is that the immune system can then prevent recurrence from any microscopic disease that was left behind," Tsao said. "So far, that's our hope."

Getting Into the Trial

To qualify for the trial, patients must have finished a multimodal therapy that included a complete surgical resection through either a pleurectomy/decortication (P/D) or an extrapleural pneumonectomy (EPP).

They must test positive for high levels of the WT1 protein and have received either chemotherapy or radiation within the previous 4-12 weeks.

As part of the trial, patients will be given six injections over a 12-week period. All will receive GM-CSF and Montanide. As a random trial, though, only half of patients actually will be receiving the WT1 peptide.

Researchers will be looking for one-year progression-free survival calculated from the date of randomization to date of progression, death or the last follow-up.

MD Anderson Recruiting Patients

Tsao said centers involved in the study are actively recruiting new patients for the trial. She also talked about how much patients can be helped at a specialty center like MD Anderson, along with the importance of enrolling in a clinical trial to advance the goal of eventually finding a cure.

"It's absolutely essential to have patients enrolled in clinical trials to move forward with this disease," she said. "It's important to identify which of these immunotherapy agents work the best."

Most mesothelioma experts agree that immunotherapy may offer the best hope for the future, moving away from the toxicity of traditional chemotherapy and radiation, which can scare off many patients.

"I think there are several promising treatments out there now," she said. "Advancements are being made, both for patients and for research."

Author: Tim Povtak

Tim Povtak is an award-winning writer with more than 30 years of reporting national and international news. His most recent experience is in researching and writing about asbestos litigation issues and asbestos-related conditions like mesothelioma.

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Study: Higher Survival Rates for Women Could Lead to New Treatment Options

A recent study, the largest ever about the effect of gender on the asbestos-related cancer, proved definitively what doctors have suspected for years: women have an advantage over men when it comes to living longer after a diagnosis.

"This is very exciting," said Andrea Wolf, M.D. of the Division of Thoracic Surgery at Mount Sinai Medical Center in New York, an assistant professor who worked on the study. "It's great news for women, yes, but the goal now is to take what we've learned and use it to benefit both men and women."

Published in the Annals of Thoracic Surgery, the study did not examine why women survived longer, but it forwarded the theory that the protective effects of estrogen in a woman could be key to developing better therapies for both sexes.

"The obvious suspicion is that this is a hormonal phenomenon," Wolf told Asbestos.com. "It tells me that next there should be some sort of trial looking into a hormonal modification in treating this disease."

The study included 14,228 pathologically confirmed American mesothelioma cases in the national Surveillance, Epidemiology and End Results (SEER) data base, ranging from 1973 to 2009.

About 22 percent of the cases involved women patients. Despite similar baseline characteristics, the five-year survival for women was 13.4 percent compared to 4.5 percent for men. For women who were diagnosed before they turned 50 years old, the survival rate was 38.6 percent. For men under 50, the rate was 17.3 percent.

Survival Advantage Decreases With Age

Although females had a survival advantage in all age groups, the difference between the two groups grew smaller as they grew older. And the difference was not as dramatic among those who did not have surgery. Some 32 percent of men survived at least one year without surgery or radiation. That compared to 35 percent of the women in the same category.

The stage of diagnosis and treatment options for men compared to women was similar in the study, but the percentage of women opting for surgery was higher.

The effect of gender on survival was consistent across all other categories, including age, race and stage of disease. It differed depending upon treatment received.

"The fact that even older women have better survival rates than men suggests that there may be more than just hormones involved," Wolf said. "Younger women seem to do great, and it gives us good reason to be more aggressive in treating them."

The SEER database is a program run by the National Cancer Institute and the most authoritative source on cancer incidence and survival in America. It includes cancer-based registries that cover approximately 28 percent of the United States populations.

This study included cases from Georgia, Connecticut, Michigan, Hawaii, Iowa, New Mexico, California, Washington, Utah, Alaska, Kentucky, Louisiana and New Jersey. Researchers worked at Mount Sinai Medical Center and the North Shore/Long Island Jewish Health System-Hofstra School of Medicine.

Study Confirms Earlier Findings

The low incidence of women with the disease is mostly related to occupational exposure to asbestos, the primary cause of mesothelioma. It is normally associated with blue-collar professions, which traditionally have a smaller percentage of women.

Although the use of asbestos dropped dramatically in America over the past three decades, it still might be many years before there is an equally-dramatic drop in mesothelioma rates. The latency period between exposure to asbestos and diagnosis of mesothelioma can range from 20 to 50 years.

"There could be many factors in why women seem to do better with this disease. It could be different types of exposure, for example. Historically, women were not working in the shipyards with all the asbestos, but they were cleaning the clothes of workers who did work there.

Wolf previously was involved in similar studies when she worked at Brigham and Women's Hospital in Boston, but those studies carried a much smaller scale.

The small scale of those studies made it difficult to draw any strong conclusions from a single-center database. The findings of the more sweeping recent study confirmed what she already suspected.

"This study really supports some of the earlier findings," Wolf said. "There is something very real here. This could lead to a whole different route in treating the disease."

Author: Tim Povtak

Tim Povtak is an award-winning writer with more than 30 years of reporting national and international news. His most recent experience is in researching and writing about asbestos litigation issues and asbestos-related conditions like mesothelioma.

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Vietnam Vet Credits Strong Will, Alternative Medicine to Mesothelioma Survival

Doctors told United States Army soldier Billy K. almost 50 years ago that he never would walk again, his left leg irreparably damaged by a spray of bullets when his patrol was ambushed in the jungle during the Vietnam War.

Doctors told him last year he had six months to live, an unfortunate victim of malignant pleural mesothelioma, an aggressive and incurable cancer around his lungs.

He didn't listen either time.

Billy was back home last week cutting grass with a push mower, making plans to go camping with his wife and best friends.

A proud military veteran and mesothelioma survivor doing surprisingly well today, Billy, 72, is doggedly stubborn in his belief that he can overcome any obstacle in his path, still living life on his terms.

"I went to Vietnam knowing I might never return home alive â€" but I did. I'm a fortunate guy. I'm a determined guy, too," he said by phone from his home in southwest Ohio. "If someone tells me I can't do something, I make sure I do it. I've always believed you can beat anything if you put your mind to it."

Billy spent more than six months in two different hospitals recovering from his war wounds. He worried more about his friends who never made it back alive. He received the Purple Heart medal for his combat service, slowly but surely working his way out of the wheelchair he used initially.

His crutches soon disappeared, too, and the harder he worked in rehabilitating his leg, the less he limped. He moved to Arizona, Colorado and other places over the next 40 years working different jobs before He retired 10 years ago and moved back to Ohio to be nearer to his close-knit family.

To him though, retirement meant at least a part-time job, which became a lawn service business that included cutting 10-15 yards around town each week. A little limp never stopped him from doing anything, but he knew something was wrong when it got tougher and tougher to catch his breath between lawns.

When it became almost unbearable, he finally went to a doctor. That eventually led to his diagnosis of pleural mesothelioma, confirmed by both the Ohio State University Comprehensive Cancer Center and then the Mayo Clinic in Rochester, Minn.

Billy knew little about this rare and deadly disease, but he approached it with the same hard-headed determination that he takes with anything that stands in his way.

"I told every doctor I saw, `I'm going to beat this cancer,' " Billy said. "They didn't say much back."

Still Camping and Fishing

Billy is the fifth of eight brothers and sisters, but the oldest of the four still living. He and wife Sharon are regulars at church each Sunday but even more regulars at camping, where they spend considerable time on the water, fishing and boating.

They have traveled numerous times to Washington, D.C., to visit the Vietnam Veterans Memorial, which honors all who served and the more than 58,000 Americans who died during that war. Billy is proud of his country. He is proud to have served it.

"He doesn't talk too much about (his time served in Vietnam) unless you ask him. It's still very emotional for him," said Billy’s nephew Dennis, who lives nearby and has helped educate his uncle about mesothelioma. "But I can tell you he's a very determined guy."

Billy was diagnosed in October of 2013 and hospitalized briefly. He underwent three rounds of chemotherapy but opted against major surgery and radiation. Instead, he became a believer in alternative medicine and two particular health and wellness products.

Moringa Tree Has Medicinal Powers

He credits his good health today to the medicinal powers of Moringa, a tree grown in tropical climate and native to parts of Africa, South America and India. The leaves of the tree are rich in vitamins, nutrients and a variety of antioxidants, delivering anti-inflammatory and anti-tumor activity.

Moringa extract has been utilized for centuries for its health benefits, although never fully accepted by the traditional medical community.

Billy uses the powdered form of Moringa with purified water called Kangen, becoming a believer after seeing the benefits of other family members and friends who had used it before him.

"I just figured I had nothing to lose, so why not try something like this," Billy said. "I feel great, so you could say I'm a believer now. People say I look better now than before I got sick. I'm sure this Moringa had something to do with it."

Billy credits the Moringa for keeping his cancer in check. Yes, he gets tired quicker than before and the nerves in his left leg often flare up, but his lungs feel strong and his last CT scan showed no sign of cancer.

"My last check-up, the doctor couldn't believe how good I looked. He didn't say was totally out of the woods, but I'm in complete remission right now," he said. "I must be doing something right."

Author: Tim Povtak

Tim Povtak is an award-winning writer with more than 30 years of reporting national and international news. His most recent experience is in researching and writing about asbestos litigation issues and asbestos-related conditions like mesothelioma.

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Study: Majority of Peritoneal Mesothelioma Patients Avoid Surgery, Despite Benefits to Survival

Peritoneal mesothelioma patients are neglecting surgery as a therapeutic option - for a variety of reasons - and needlessly losing out on years of survival time, a recently published study from the Medical College of Wisconsin shows.

Even though the benefits are clear, surgery is not being performed on 62 percent of peritoneal patients, according to the study using 1973 to 2010 data from the Surveillance, Epidemiology and End Results (SEER) database.

The Annals of Surgical Oncology published the study in its May journal.

"It's unfortunate, but you can see the missed opportunity here," said Kiran Turaga, M.D., one of the study's co-authors and assistant professor in the division of surgical oncology at the Medical College of Wisconsin. "It's a reason to raise awareness. Surgery is a really good option - most patients can benefit - but I think too often, it's not being offered or recommended."

The SEER data consisted of 1,591 peritoneal patients with a median age of 74, most of whom had metastatic disease. The overall survival rate of those who underwent cytoreductive surgery was an average of 20 months, compared to just four months for those who did not have surgery.

Surgeries Becoming More Advanced

Recent advancements in surgery and other therapeutic options have improved everyone's survival rate. Surgical patients, for example, had an overall survival rate of only 15 months from 1991 to 1995, but they survived an average of 38 months from 2006 to 2010.

While the most recent time period reflected a survival rate that more than doubled, the percentage of patients going without surgery remained almost the same. It was 55.8 percent from 1991 to 1995 and 56.8 percent from 2006 to 2010.

The latest surgical procedures involve a combination of radical resection of the tumor, along with hyperthermic intraperitoneal chemoperfusion (HIPEC), which is a heated chemotherapy bath of the abdominal area.

Peritoneal, which attacks the thin membrane around the abdomen, is a less common form of mesothelioma, which strikes an estimated 3,000 Americans annually. Less than a third of those patients are diagnosed with peritoneal. The majority of the cases are pleural, which starts in the lining around the lungs. The SEER database was not specific regarding why patients were not having surgery, leaving much of it to speculation.

"The reason for this practice pattern could be varied, including nihilism for disease or treatment, misinformation, host of disease characteristics precluding therapy or data collection bias," the authors wrote.

Reasons for Finding a Specialty Center

Turaga told Asbestos.com that perhaps some patients are too weak or just refused surgery, "but it could be the fact there wasn't the proper facility available to do it."

"My bias is that most patients are not referred to a specialty center, where they would see someone who could talk about all the options," Turaga said. "Many medical oncologists out there today don't know enough about it [peritoneal mesothelioma], and just tell a patient, the surgery is not worth it."

Turaga also said it is rare when a pleural patient comes to Medical College of Wisconsin and is not offered at least limited surgery to increase their chances of survival. Without surgery today, the prognosis with peritoneal remains poor, typically between 6-12 months.

"The majority of patients who come to us end up getting surgery," Turaga said. "The bottom line is that patients who undergo surgery can end up living a long time."

When separating the patients in the study by limited/regional disease indicators, the SEER study shows that patients with radical surgery had an overall survival rate of 40 months, but only 27 months with limited surgery and 13 months with no surgery.

The authors also detailed a separate, multi-institutional study involving 405 patients with peritoneal mesothelioma, and those results were even more encouraging for surgical patients. Patients who had both cytoreductive surgery and HIPEC had an overall survival rate of 53 months. There was a five-year survival rate of 47 percent.

There was considerable disparity, though, based on the tumor histology, which was not reported in the SEER data. Patients with epithelial peritoneal mesothelioma who had surgery and HIPEC had a median survival of 63 months. Those with either biphasic or sarcomatoid mesothelioma, with comparable surgery and HIPEC, averaged only 16 months.

"It's not surprising that survival time is greatly improved with surgery," Turaga said. "It's disappointing that more patients are not being given that option."

Author: Tim Povtak

Tim Povtak is an award-winning writer with more than 30 years of reporting national and international news. His most recent experience is in researching and writing about asbestos litigation issues and asbestos-related conditions like mesothelioma.

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New Leadership at Brigham and Women's Bolsters Mesothelioma Care

The departure of renowned mesothelioma specialist David Sugarbaker, M.D. from Brigham and Women's Hospital in Boston earlier this year didn't lessen the hospital's commitment. It made that long-standing promise to patients even stronger.

Raphael Bueno, M.D., is making sure of that.

Bueno, who has replaced Sugarbaker as the chief of the thoracic surgery division, reiterated his pledge recently that Brigham and Women's would remain the country's most prestigious destination for patients with malignant pleural mesothelioma.

"It's even better now," Bueno told Asbestos.com. "Patients understand that it’s the whole program and not just one individual that makes this the place to come." Sugarbaker left after more than 20 years to build the new Lung Institute at Baylor College of Medicine in Houston - bringing his reputation as the well-respected leader in mesothelioma care.

Bueno Wearing Many Hats

Bueno officially assumed the role on June 1, but he has been the acting chief for the last five months, mixing new administrative duties with his surgical and research work. He had been the associate chief of thoracic surgery under Sugarbaker for more than 10 years.

"It's been busy lately, but it's been a very rewarding move," he said. "It's an opportunity to really optimize the care for a lot of mesothelioma patients. We're working to make it the best for everyone."

Since Bueno became chief, Brigham and Women's designated every Friday as the day to handle mesothelioma patients exclusively, making sure the surgeons, oncologists, radiologists and pathologists all can focus together on the rare and aggressive cancer caused by asbestos exposure.

Bueno is a product of the nearby Harvard Medical School and the Massachusetts Institute of Technology. He did his residency at Brigham and Women's and joined the thoracic surgical staff in 1996. He worked closely with Sugarbaker for many years, making him the most logical successor.

Bueno also has been a leader in mesothelioma research for more than a decade, working on the prevention and management of complications following aggressive surgery. He has helped move research to the molecular level, creating newer and better diagnostic and therapeutic tools for the disease.

He is currently one of the lead researchers in a Phase II clinical trial at Brigham and Women's involving neoadjuvant defactinib (VS-6063) treatment for patients with resectable mesothelioma. One of the purposes of the study is to assess biomarker responses from tumor tissue.

Boston Still a Major Destination

"There is much more optimism today about the future of mesothelioma treatment than there was 10 years ago," he said. "We have a much better understanding of the disease at the molecular level. There are better drugs now, and better ones coming down the line."

Brigham and Women's is a partner with the highly rated Dana-Farber Cancer Institute and a part of the greater Harvard Medical School family. They have partnered to be a leading force in cancer care.

Thoracic surgeon and mesothelioma specialist Abraham Lebenthal, M.D., works alongside Bueno at Brigham and Women's. Lebenthal also works with the VA Boston Healthcare System. He has been lauded for his work with military veterans, who comprise an unusually large percentage of mesothelioma victims.

"The great patient care is still here. The volume is still here. Patients know that," Bueno said. "Dr. Sugarbaker has been a great friend and supporter of mine. And don't take this the wrong way, but mesothelioma patients don't have to go to Texas to get great care today."

Author: Tim Povtak

Tim Povtak is an award-winning writer with more than 30 years of reporting national and international news. His most recent experience is in researching and writing about asbestos litigation issues and asbestos-related conditions like mesothelioma.

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Doctors Helping Veterans with Mesothelioma Access the VA Health Care System

The West Los Angeles VA Medical Center can provide some of the finest care in the world for patients with malignant pleural mesothelioma.

The problem is that not enough veterans - or even the doctors throughout the sprawling Veterans Administration health care system - know it's available.

"One of the biggest challenges we face is trying to get the word out, to make people aware of what we have here," said Graciela Hoal, RN, NP, who works closely with doctors and patients at the West Los Angeles VA. "The care we offer can make a big difference for a patient with mesothelioma."

In an effort to spread the word, Hoal will be speaking Saturday afternoon in Santa Monica at the 4th annual International Symposium on Lung-Sparing Therapies for Malignant Pleural Mesothelioma. Her topic is "Mesothelioma Among Veterans: The Benefits and Challenges Experienced at the World's Largest Health Care System."

The catalyst behind the symposium is renowned surgeon Robert Cameron, M.D., director of the UCLA Mesothelioma Comprehensive Research Program, and chief of thoracic surgery at the West Los Angeles VA. Cameron has been a pioneer in the treatment of mesothelioma for the last 20 years.

While the U.S. Department of Veteran Affairs overall is under attack these days for rampant mismanagement and falsified recordkeeping that led to the recent resignation of VA Secretary Eric Shinseki, Cameron's work with patients is one of the shining lights within the system.

Cameron Offers Veterans Hope

"Veterans are very lucky to have Dr. Cameron in the system," Hoal told Asbestos.com. "A lot of doctors have little or no experience with mesothelioma. The life expectancy, where there is not a specialist, can be six to nine months. But we have patients we first saw in 2008 who are living fairly healthy lives today. A great specialist can make a difference."

Mesothelioma is a rare and aggressive cancer diagnosed in an estimated 3,000 Americans annually. It is caused almost exclusively by exposure to asbestos, which once was used extensively by the U.S. Armed Forces for its ability to strengthen and resist heat. That reliance on the toxic mineral is a big reason why a disproportionate number of veterans (almost one-third), compared to civilians, are diagnosed with the disease.

Cameron is one of only two thoracic surgeons within the VA system who specialize in this asbestos-related cancer. Abraham Lebenthal, M.D., in Boston is the other. Both have tried to spread the word of their availability throughout the system, but have been frustrated with the results.

Once in the VA system and in possession of a referral from the local VA office, a veteran anywhere in the country with mesothelioma can travel and receive care from a specialist like Cameron or Lebenthal.

The West Los Angeles VA approved the Admiral Zumwalt Mesothelioma Specialty Program in 2013. Yet very little has been done nationally by the VA to promote the program. There are more than 150 hospitals and almost 1,000 clinics within the VA system, but only a fraction know how to handle or where to refer a patient diagnosed with the disease.

Cameron has seen mesothelioma patients at the West Los Angeles VA from California, Oklahoma, Arizona and Iowa, but not as many as he would like - and not nearly as many who could use his help. Cameron is the foremost expert on the lung-sparing, pleurectomy/decortication surgery, developing a multimodality treatment plan that incorporates resources from the Pacific Meso Center, the UCLA Research Program and his local VA.

New Therapies Are Helping Veterans

At the West Los Angeles VA, Cameron utilizes mesothelioma specialists in radiology and chemotherapy. He's had considerable success with novel interventions like Betadine Lavage Therapy, immunotherapy and cryoablation, a minimally invasive procedure that uses controlled freezing to dissipate small cancer tumors.

Cameron has examined records and made recommendations virtually via computers for patients and physicians outside his area, but can only do so for those who are aware of his services. "This is not a situation unique to the VA System," Hoal said. "A lot of times, oncologists and pulmonologists are telling patients there is nothing they can do [for mesothelioma patients]. Patients are just being told to get their affairs in order. But there are new therapies now that can help them if they get to a true mesothelioma care center."

At the Santa Monica symposium, Hoal will be joined by a distinguished international faculty that includes Jan P. van Meerbeeck, M.D., at Antwerp University Hospital in Belgium; Percy Lee, M.D., chief Thoracic Radiation Oncologist at UCLA; Joachim Aerts, M.D., at Erasmus MC Cancer Institute in the Netherlands; Richard Lemen, Ph.D., former Assistant Surgeon General of the United States; and Olga Olevsky, M.D., of the UCLA Medical Center.

The symposium is for physicians, medical students, nurses and other health care professionals wanting to hear about the latest advances in mesothelioma research and therapies. Mesothelioma patients, families and advocates also will be attending.

Author: Tim Povtak

Tim Povtak is an award-winning writer with more than 30 years of reporting national and international news. His most recent experience is in researching and writing about asbestos litigation issues and asbestos-related conditions like mesothelioma.

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Mesothelioma News Center | Latest in Asbestos & Mesothelioma News

Rosalie C. carries an iPad with a message that she sees each time it awakens, helping inspire her through the good times and the bad: "Life isn't about waiting for the storm to pass. It's about learning to dance in the rain."

She isn't sure what her future holds â€" it's in God's hands â€" but she can tell you confidently now her immediate plans: Dance in the rain every day.

Rosalie and her husband, Larry, will leave Florida soon, returning to their farm outside Ft. Wayne, Ind., to start planting spring crops, fully expecting to return again to the Sunshine State after the late-fall harvest.

Her diagnosis of malignant pleural mesothelioma in 2011 may have altered their retirement strategy, but it hasn't stopped them from living life on their terms.

"You know that song by Tim McGraw, 'Live Like You Were Dying?'" she asked from their new winter home on Florida's west coast. "Well, we decided to just live like you are living. And I think that's a pretty good way to be."

Once childhood sweethearts, the couple celebrates their 50th wedding anniversary this fall. Rosalie and Larry, whose last name is being withheld because of privacy concerns, are still inseparable and still so much in love, determined to fight this disease together, holding hands, and encouraging each other like they always have. She was 16 when they met and 17 when they married. She turns 67 in April.

"We have been together forever," she said.

Driving Cross Country to See Sugarbaker

Just days after her original diagnosis â€" in the midst of the fall harvest â€" he left the farm suddenly and drove her 850 miles to Boston to see renowned mesothelioma specialist David Sugarbaker, M.D., whose schedule had a last-minute opening.

They returned to Boston three weeks later for the aggressive extrapleural pneumonectomy surgery that left her with one lung, a rebuilt thoracic cavity, and a long road to recovery â€" needing Larry more than ever before.

Larry became her primary caregiver, learning to do things he never thought he could do. He was nurse, housekeeper and cook all rolled into one. He hasn't missed many chemotherapy sessions, either.

He grows emotional when speaking about her illness. She takes the phone and finishes. She worries more about him, than she worries about herself. They both know the odds are long. But after 50 years together, anything is possible.

"I really believe if we had stayed in Indiana, where they really didn't know how to treat this disease, and not gone to Boston, I wouldn't be here today," Rosalie said. "I've been so lucky through this. We've had unbelievable support, from friends, family and church. I've never really been scared, because I know it is in God's hands. And I know where I'm going if something happens."

They See a Future in Florida

They bought their winter villa in Florida last summer after renting for several years, deciding the time was right because she was feeling so much better. The past few months have been wonderful, adding memories to the life they have shared.

While their Indiana home has been buried in snow, they have basked in the Florida sunshine together â€" 1,100 miles away.

They walk on the beach. They walk the dog together. She weaves her baskets that will become Christmas gifts this winter. She shops. They talk regularly by phone to the children and grandchildren back home.

"We're having a great time right now. Everything seems perfect. You never know when the bubble is going to burst, but you just can't live being a pessimist," she said. "I've been so fortunate in so many ways."

She is thankful for registered nurse Karen Selby at The Mesothelioma Center. Selby originally recommended they call Sugarbaker, who assisted them early in the process.

Rosalie raves about the way she was treated at the Brigham and Women's Hospital in Boston, from Sugarbaker in surgery and the doctor who brought her Halloween candy, to the nurse who got soaked helping her in the shower and the way others treated her whole family.

Life Is Good Again

While the first year and a half after diagnosis was a struggle â€" follow-up surgery was needed, traces of cancer returned, chemotherapy was tough â€" the last year has been considerably better.

"Things are going so well now that I almost feel guilty, but I also know it can change at any time," she said. "I remember telling Dr. Sugarbaker I was going to be one of his long-term survivors. And I still feel that way. I know now you can live with one lung. When I'm sitting in a chair, I don't feel any different than I ever did. I'm limited a little, but I'm doing just fine."

She is looking forward to springtime in Indiana, seeing the corn and the soybeans growing again on the family-run farm. She'll see it from a distance, watching the grandkids swimming in the pond out back, enjoying the day.

"A year ago, I didn't think I'd ever make it back to see the Gulf ever again, but I turned the corner," she said. "I've never had that 'why me feeling.' I've always said, 'why not me?' This kind of thing happens to a lot of people. I'm not worried."

She looked down at her iPad and saw a Biblical passage from Matthew 6:34 that she keeps close to her heart: "So do not worry about tomorrow, for tomorrow will care for itself. Each day has enough trouble of its own."

"I don't worry about what could happen in the future," she said. "We're enjoying ourselves today."

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Dr. Stevens Wants Beaumont to Be Midwest Leader in Mesothelioma Treatment

Craig Stevens, M.D., has heard too many stories about patients with mesothelioma leaving Michigan to seek treatment elsewhere, searching for the best, specialized care they could find.

He wants to stop that exodus by making the Beaumont Cancer Institute in suburban Detroit the best regional center for mesothelioma treatment.

Stevens is the recently-appointed chairman of the Radiation Oncology Department at Beaumont. He is a pioneer in the use of Intensity Modulated Radiation Therapy (IMRT) and a specialist in the treatment of pleural mesothelioma, a rare and aggressive cancer.

He wants to build and integrate a new specialty program for this asbestos-related cancer with an already acclaimed multidisciplinary lung cancer program at Beaumont. It's one of the major reasons he left the Moffitt Cancer Center in Tampa.

"There is no real [mesothelioma] program in the state like what we're putting together," Stevens told Asbestos.com. "Everyone is enthused about this. When you think about the best mesothelioma treatment in the country now, you think about New York, Boston and Houston, but really nowhere in the Midwest. We can change that here."

Michigan Ranks High for Mesothelioma Incidence

Michigan ranks 9th among the 50 states with the most asbestos-related cancer deaths, according to data from the Centers for Disease Control and Prevention. The auto industry, once huge in the state; the shipping industry on the Great Lakes; and a past reliance on manufacturing all play a role in Michigan's prevalence of the disease.

The cancer is caused by exposure to asbestos, which was used extensively in those industries.

"There is a need in this state for a real mesothelioma program, when you think about the jobs and industry here, the number of brake pads that were produced and handled here," Stevens said. "Beaumont already is a preferred place to be treated for any number of diseases. We need this to be a place where a patient with mesothelioma can get the finest care possible."

Emphasis on Multimodality Approach

Stevens' goal at Beaumont is a center with a multimodality approach, where aggressive surgeries can be combined with state-of-the-art radiation therapy, and the latest in chemotherapy treatments. He wants to have an experienced mesothelioma specialist in each of those disciplines, meeting regularly to discuss cases. Clinical trials involving immunotherapy also will be available.

Although mesothelioma has no cure, and often still comes with a grim prognosis, some patients at the big specialty centers are living longer than ever before, reaching 2, 3, 4 and 5 years after diagnosis.

"You need to have enough experience with this disease to know how to handle it best. Patients can do well with it if managed properly," Stevens said. "If it's not treated correctly, which happens too often in many places, the results are not good."

Beaumont already has several multidisciplinary programs designed for cancer patients. They combine a comprehensive clinical, academic and research approach, delivering oncological services that are second to none.

The National Institutes of Health regularly rank Beaumont among the top cancer centers in America. The Cunnington Family Comprehensive Lung Cancer Center at Beaumont boasts renowned experts in thoracic surgery, pulmonology, nuclear medicine, and diagnostic and interventional radiology.

The radiation oncology department is known for its innovative treatment and advanced technology, a big reason they wanted Stevens to lead the staff. Beaumont helped develop high-dose brachytherapy, image-guided radiation therapy and hyperthermia therapy.

Stevens brought years of experience as a leader in the field, too, first at the University of Pennsylvania and then at M.D. Anderson Cancer Center in Texas.

Stevens a Radiology Leader

He spent almost a decade at Moffitt, where he was department chair of radiation oncology, focusing on thoracic cavity diseases. He worked on thoracic oncology, radiation oncology and experimental therapeutics programs, always looking for better ways to fight different cancers. At Moffitt, he wrote a lengthy article titled "Personalized Treatment Approaches in Radiation Oncology: The Future is Now," urging colleagues to look toward newer and better therapies.

The goal of IMRT is delivering the maximum radiation doses to the cancer cells without hurting the healthy ones nearby, a process that works well with mesothelioma patients. He also is following closely a novel radiation delivery system being used in Toronto with surgical patients that is experiencing notable success.

"Until there is a cure for this disease, we should encourage people to try new things, be as creative as we can," he said. "We're always looking for novel ways to get better at treating this disease. That's what we want to do here."

Author: Tim Povtak

Tim Povtak is an award-winning writer with more than 30 years of reporting national and international news. His most recent experience is in researching and writing about asbestos litigation issues and asbestos-related conditions like mesothelioma.

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Cerfolio Leads the Charge for Robotics in Thoracic Surgery

Just a few years ago, renowned thoracic surgeon Robert Cerfolio, M.D., was one of the biggest robotic surgery skeptics, discounting the notion that a computer-controlled system could perform a precise operation in the chest better than he could as absurd.

He is now its biggest proponent â€" taking a 180-degree turn.

Cerfolio, the chief of thoracic surgery for the University of Alabama at Birmingham Health Care System, has performed more robotic thoracic operations using the da Vinci Surgical System in the past four years than anyone in the world.

Robotic surgery involves tiny instruments attached to a robot remotely controlled by the surgeon at a computer board. While urologists and gynecologists have been using it for more than a decade, only in recent years have thoracic surgeons utilized it.

Robotics for Mesothelioma Patients

Cerfolio uses it to simplify the diagnostic and staging process, making it less invasive and more accurate for his patients.

"It's about getting the diagnosis correct and treating people with small incisions and scopes," he told Asbestos.com. "Too many surgeons will do a thoracotomy and spread the ribs of [mesothelioma] patients when they don't need to do that."

In March, Cerfolio lectured on robotics at the Fox Chase Cancer Center Advances in Thoracic Oncology Conference, which is aimed at medical professionals involved in the management of thoracic malignancies. Karen Selby, our staff nurse at The Mesothelioma Center, also attended the seminar.

Although many established surgeons remain dedicated to Video Assisted Thoracoscopic Surgery (VATS) and open chest lung surgeries, Cerfolio is determined to convert them. The da Vinci robot can be used for wedge resections, lobectomies and lung biopsies, all of which are done on mesothelioma patients.

"I'm convinced absolutely that robotics is the way to go. My initial opinions were all wrong," Cerfolio said. "I've been honest, and changed my practice. You have to be a man, and admit you were wrong. Most surgeons won't do that. They won't admit when they're wrong."

Too Many Positives to Ignore

Cerfolio, now 52, didn't do his first robotic surgery until 2010, well after others had started. He performed more than 1,000 robotic surgeries in 2013. He is known for his robotic pulmonary resection and using robotics for esophageal surgery. Making the change wasn't easy, particularly because he already was good at what he did. Yet, it was a chance to get better.

It was impossible to ignore the advantages of robotics:

• Improved visualization
• Less painful, quicker patient recovery
• Improved instrumentation
• More complete lymph node dissection
• Easier teaching tool

"Change is hard to do when it's not forced upon you. I can't tell you as a surgeon how hard or difficult that is. It's just going out of your comfort zone," he said. "It's like you're a golfer shooting 70 and winning tournaments, but now you have to go back to the driving range and learn a new grip, then shoot 80-82 for six months. The idea, though, is that eventually, you're shooting a 66."

Many thoracic surgeons have been slow to adopt the robotic platform. The equipment is complex and expensive, eliminating it as an option for many small medical centers. It requires not just a surgeon to embrace the technology, but an entire staff that must train alongside that doctor.

It Takes an Entire Team

"You're a pitcher, but you're only as good as your shortstop and second baseman," Cerfolio said. "If your nurse is having a bad day, you're a bad surgeon. If the anesthesiologist is struggling, you're a bad surgeon. It requires everyone going through the same pathway."

He believes that more study data will be released soon, providing more evidence that lung cancer patients will be better served by robotics than with VATS or open chest operations. Lymph node resections will be more complete. Survival rates will be higher. Patients will recover quicker from less painful procedures. The robotic technology is rapidly improving, too.

"It doesn't take a rocket scientist to figure this out," he said. "We need to do a better job of helping our patients and learning from our mistakes. Robotics can do that. It can make better surgeons. Sometimes change gets forced upon you. And you have to evolve. That helps the patient."

Author: Tim Povtak

Tim Povtak is an award-winning writer with more than 30 years of reporting national and international news. His most recent experience is in researching and writing about asbestos litigation issues and asbestos-related conditions like mesothelioma.

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Fox Chase Committing Its Best to Mesothelioma Treatment

The Fox Chase Cancer Center in Philadelphia doesn't handle as many pleural mesothelioma cases as some of the other specialty centers, but the care it provides them and outcomes it produces are second to none.

Mesothelioma cancer is a high priority.

"I don't think you can get better care anywhere else," said Walter Scott, M.D., chief of thoracic surgical oncology at Fox Chase. "We've got the experts with experience. And we've got that great support team around them."

Scott spoke at the conclusion of the sixth annual Advances in Thoracic Oncology Conference last week. The program, which included presenters from Fox Chase and other specialty centers, was aimed at medical professionals and focused on the latest advances in mesothelioma treatment. The audience included surgeons, radiation oncologists, pulmonologists, physician assistants and nurses, including Karen Selby, our nurse at The Mesothelioma Center.

Growing Hope for Mesothelioma

Prashant Shah, M.D., thoracic surgeon at Fox Chase, told Asbestos.com, "There is real reason for hope now with mesothelioma."

"We're not moving mountains, but we are making steady progress," Shah said. "There still is a long way to go, but we've come a long way, too. Attitudes [toward mesothelioma] are changing."

Shah spoke on "Strategies for Treatment of the Pleura During Surgery for MPM” (malignant pleural mesothelioma). He touched on the staging system and adjuvant therapies used at Fox; the ongoing debate on whether surgical candidates are better served by the extrapleural pneumonectomy (EPP) or pleurectomy/decortication (P/D); and the future of mesothelioma treatment.

Shah and Stacey Su, M.D., handle the majority of the mesothelioma surgeries at Fox. Both trained in Boston at Brigham and Women's Hospital under renowned mesothelioma specialist David Sugarbaker.

Fox Chase, which is part of the Temple University Health System, is lauded for its multimodality treatment approach for multiple cancers, including mesothelioma. It is known as a pioneer in lung cancer treatment advances, and it's now focusing more on asbestos-related cancers.

"I think it's fair to say we've got it all here at Fox Chase," Scott said. "The care that you'll receive is better than ever. With mesothelioma, you need an experienced team that understands this disease, and we have that."

Joseph Testa, Ph.D., professor of human genetics at Fox Chase, is praised for his work in advancing the scientific understanding between mesothelioma and molecular signaling pathways, leading to immunotherapy advances currently used in several specialty centers around the country.

Conference Addresses Numerous Issues

The conference at Fox Chase also included a segment on "State of the Art: Robotic Surgery for Complex Thoracic Cases," by Robert Cerfolio, M.D., from the University of Alabama at Birmingham. He has used robotics extensively for more than a decade, though not necessarily for mesothelioma surgeries.

"Robotics is the future of surgery," Cerfolio said. "Change isn't always easy, but it's about doing what is right for our patients."

Radiation oncologist Kenneth Rosenzweig, M.D., who handles many of the mesothelioma cases at Mount Sinai Hospital in New York, spoke on "Novel Radiotherapy Approaches for MPM."

He, too, talked about the importance of experience when treating mesothelioma, a rare cancer that is diagnosed in an estimated 3,000 people annually in the U.S. It is particularly important now with the latest Intensity Modulated Radiation Therapy (IMRT), which is used in combination with both aggressive surgical options and for patients who are not surgical candidates.

IMRT â€" if delivered correctly â€" kills remaining tumor cells and reduces the risk to surrounding healthy tissue and nearby organs.

Rosenzweig also talked about the latest pre-surgery radiation done in Toronto with patients undergoing the aggressive EPP, which removes an entire lung. Neither Mount Sinai nor Fox Chase is using that radiation approach yet, but they are following it closely.

He was optimistic, yet cautious, when discussing the future of mesothelioma treatment. He is now seeing patients he first treated four, five and six years before. People are living longer than ever.

"My personal approach [to treatment], has evolved. It's tough with this disease to say we've had any big victories or that we've figured it out, but things are getting better," Rosenzweig said. "We're seeing successes."

Conferences like the one at Fox Chase, where novel therapies and recent advancements are discussed, are helping the cause. There also were presentations on immunotherapy, molecular testing and palliative care, all designed to help medical professionals help their patients.

"There still is a long fight ahead," Shah said. "But we're moving in the right direction."

Author: Tim Povtak

Tim Povtak is an award-winning writer with more than 30 years of reporting national and international news. His most recent experience is in researching and writing about asbestos litigation issues and asbestos-related conditions like mesothelioma.

Related News Posts

Japan Study Finds Standard Chemotherapy Still Best Hope for Mesothelioma

The long-standing chemotherapy combination of cisplatin and pemetrexed will remain the front-line treatment regimen for mesothelioma patients in the foreseeable future, despite recent efforts to develop newer and more effective drugs.

Nothing better has emerged.

Researchers at the Shizuoka Cancer Center and Juntendo University in Japan recently concluded that the cisplatin/pemetrexed (Alimta) combination remains the best choice.

"It should continue to be the standard, front-line chemotherapeutic regimen for inoperable MPM (malignant pleural mesothelioma)," wrote the authors of the March study, published in Respiratory Investigation.

The medications are most effective with asbestos-related cancer when used in conjunction with surgery and radiation, but more often they are used alone with patients who are not surgical candidates because the cancer already has metastasized.

Although Alimta was not approved by the U.S. Food and Drug Administration (FDA) until 2004, it has been used since the mid-1990s after it was granted an early compassionate-use exception. It was the first medication specifically approved for the treatment of mesothelioma. It has been used for almost two decades in combination with cisplatin, and both drugs increase the effectiveness of the other.

Study Compares Chemotherapy Combinations

Gemcitabine, carboplatin, doxorubicin and vinorelbine are other chemotherapy drugs used, but often found to be less successful. More are being tested in clinical trials.

The recent study in Japan compared the combination of gemcitabine (Gemzar) and cisplatin with the combination of pemetrexed (Alimta) and cisplatin. Both Gemzar and Alimta, the two most widely used drugs, are marketed by Eli Lilly and Company and used with a variety of cancers.

The study included 30 MPM patients between 2002 and 2011, including 17 with the cisplatin/Alimta combination, and 13 with the Gemzar/cisplatin combination. Doctors analyzed the patients' medical charts for antitumor efficacy and drug toxicity.

The response rate for cisplatin/Alimta was 35 percent, but only 15 percent for Gemzar/cisplatin. The progression-free survival rate was 215 days for Alimta and 142 days for Gemzar. The median overall survival rate was 597 days for Alimta patients and 306 days for Gemzar patients.

Researchers found hematological toxicities, particularly neutropenia and thrombocytopenia, were more severe and more frequent with those in the Gemzar/cisplatin group.

Powerful Drugs

The study was in response to previous trials that showed an improvement in both response and survival rates when cisplatin (approved by the FDA in 1978) was supplemented by either Alimta or Gemzar. The study was the first to compare the two separate combinations.

Cisplatin has been used for a wide variety of cancers, both as a single-agent treatment and in conjunction with other chemotherapy drugs. As a single agent for mesothelioma, the response rate has been less than 15 percent.

Chemotherapy has been the most widely used category of drugs for mesothelioma patients, but others are growing in use as doctors and patients seek more effective treatment options.

Immunotherapy, targeted therapy, photosensitizing and anti-angiogenesis drugs also are used on various levels. Chemotherapy agents are powerful, but they attack both cancer and healthy cells, causing a variety of side effects.

Targeted therapy drugs, such as NGR-hTNF, are designed to target specific molecular alternations in cancer cells. Immunotherapy drugs are designed to help the body's immune system better recognize and attack the cancer cells. Photosensitizing drugs are constructed to make the cancer cells easier targets for particular beams of light to destroy. Anti-angiogenesis drugs help starve cancer cells and prevent them from multiplying. The newer categories of drugs are less toxic.

While the newer types of drugs have shown considerable promise, they remain in clinical trial phases, out of reach to many doctors and patients.

Researchers in Japan concede the limitations of their retrospective study â€" particularly the limited number of patients â€" but do assert the cisplatin/Alimta combination remains the best option available today.

Author: Tim Povtak

Tim Povtak is an award-winning writer with more than 30 years of reporting national and international news. His most recent experience is in researching and writing about asbestos litigation issues and asbestos-related conditions like mesothelioma.

Related News Posts

Japan Study Find Standard Chemotherapy Still Best Hope for Mesothelioma

The long-standing chemotherapy combination of cisplatin and pemetrexed will remain the front-line treatment regimen for mesothelioma patients in the foreseeable future, despite recent efforts to develop newer and more effective drugs.

Nothing better has emerged.

Researchers at the Shizuoka Cancer Center and Juntendo University in Japan recently concluded that the cisplatin/pemetrexed (Alimta) combination remains the best choice.

"It should continue to be the standard, front-line chemotherapeutic regimen for inoperable MPM (malignant pleural mesothelioma)," wrote the authors of the March study, published in Respiratory Investigation.

The medications are most effective with asbestos-related cancer when used in conjunction with surgery and radiation, but more often they are used alone with patients who are not surgical candidates because the cancer already has metastasized.

Although Alimta was not approved by the U.S. Food and Drug Administration (FDA) until 2004, it has been used since the mid-1990s after it was granted an early compassionate-use exception. It was the first medication specifically approved for the treatment of mesothelioma. It has been used for almost two decades in combination with cisplatin, and both drugs increase the effectiveness of the other.

Study Compares Chemotherapy Combinations

Gemcitabine, carboplatin, doxorubicin and vinorelbine are other chemotherapy drugs used, but often found to be less successful. More are being tested in clinical trials.

The recent study in Japan compared the combination of gemcitabine (Gemzar) and cisplatin with the combination of pemetrexed (Alimta) and cisplatin. Both Gemzar and Alimta, the two most widely used drugs, are marketed by Eli Lilly and Company and used with a variety of cancers.

The study included 30 MPM patients between 2002 and 2011, including 17 with the cisplatin/Alimta combination, and 13 with the Gemzar/cisplatin combination. Doctors analyzed the patients' medical charts for antitumor efficacy and drug toxicity.

The response rate for cisplatin/Alimta was 35 percent, but only 15 percent for Gemzar/cisplatin. The progression-free survival rate was 215 days for Alimta and 142 days for Gemzar. The median overall survival rate was 597 days for Alimta patients and 306 days for Gemzar patients.

Researchers found hematological toxicities, particularly neutropenia and thrombocytopenia, were more severe and more frequent with those in the Gemzar/cisplatin group.

Powerful Drugs

The study was in response to previous trials that showed an improvement in both response and survival rates when cisplatin (approved by the FDA in 1978) was supplemented by either Alimta or Gemzar. The study was the first to compare the two separate combinations.

Cisplatin has been used for a wide variety of cancers, both as a single-agent treatment and in conjunction with other chemotherapy drugs. As a single agent for mesothelioma, the response rate has been less than 15 percent.

Chemotherapy has been the most widely used category of drugs for mesothelioma patients, but others are growing in use as doctors and patients seek more effective treatment options.

Immunotherapy, targeted therapy, photosensitizing and anti-angiogenesis drugs also are used on various levels. Chemotherapy agents are powerful, but they attack both cancer and healthy cells, causing a variety of side effects.

Targeted therapy drugs, such as NGR-hTNF, are designed to target specific molecular alternations in cancer cells. Immunotherapy drugs are designed to help the body's immune system better recognize and attack the cancer cells. Photosensitizing drugs are constructed to make the cancer cells easier targets for particular beams of light to destroy. Anti-angiogenesis drugs help starve cancer cells and prevent them from multiplying. The newer categories of drugs are less toxic.

While the newer types of drugs have shown considerable promise, they remain in clinical trial phases, out of reach to many doctors and patients.

Researchers in Japan concede the limitations of their retrospective study â€" particularly the limited number of patients â€" but do assert the cisplatin/Alimta combination remains the best option available today.

Author: Tim Povtak

Tim Povtak is an award-winning writer with more than 30 years of reporting national and international news. His most recent experience is in researching and writing about asbestos litigation issues and asbestos-related conditions like mesothelioma.

Related News Posts

Study: Palliative Chemotherapy Not Meeting Patient Expectations

Mesothelioma patients and their caregivers should take a closer look and decide on their priorities before starting palliative care chemotherapy, which has disappointed many in the past, according to a recent study.

Although it is designed to prolong survival and ease symptoms for terminal cancer patients, palliative care chemotherapy often ends with a diminished quality of life, more invasive, late-stage medical procedures, and dying in a less than desirable setting.

Researchers also have found a startling gap between the type of end-of-life cancer care patients wanted, and what they actually received, according to a collaborative study of palliative care chemotherapy published recently in the British Medical Journal (BMJ). Weill Cornell Medical College, Dana-Farber Cancer Institute and Harvard Medical School officials conducted the study.

"It's hard to see in this data much of a silver lining to palliative chemotherapy for patients in the terminal stage of their cancer," said Dr. Holly Prigerson, professor of medicine at Cornell. "This study is the first step in proving evidence that specifically demonstrates what negative outcomes may result."

Palliative Chemotherapy Shortens Hospice Care

During a six-year period, investigators analyzed data from 386 terminally ill patients who were part of Coping with Cancer, a federally funded study. The American Society of Clinical Oncology recently identified palliative care chemotherapy as one of the practices that, if stopped, could improve patient care and reduce costs.

This study found the use of palliative chemotherapy was associated with late hospice referrals and higher rates of cardiopulmonary resuscitation and mechanical ventilation in the last week of life, but not increased survival. Patients also were less likely to die at home and more likely to die in intensive care, compared with those who did not receive palliative chemotherapy.

"Palliative care was intended to prolong life and ease symptom burden, but it might not do either," Prigerson said. "It might, in fact, make things worse. Patients may want [chemotherapy] if it brings hope, but it should not be false hope. They should have data from studies like this, and know what the potential costs are when they are that advanced in the illness."

Fewer Die at Home After Chemotherapy

According to the study, 47 percent of the patients who received chemotherapy died at home, compared with 66 percent of the patients who did not receive palliative chemotherapy. Only 2 percent of the patients not receiving therapy died in intensive care, compared with 11 percent of those receiving palliative chemotherapy.

The study also found that 54 percent of those receiving chemotherapy were referred late (in the last week of life) to hospice care, which is designed to provide both comfort and emotional support for patients. Only 37 percent of those not receiving chemotherapy were referred late to hospice care.

"We often wait until patients stop chemotherapy before asking them about where and how they want to die," said Dr. Alexi Wright, medical oncologist at Dana-Faber. "But this study shows we need to ask patients about their preferences while they are receiving chemotherapy to ensure they receive the kind of care they want near death."

Both researchers agreed there often is a misunderstanding of the consequences and purpose of palliative chemotherapy. The study followed each patient until they died. Afterward, researchers interviewed the caregivers about each patient's care, where the patient had wanted to die, and then compared those answers to medical charts detailing the last week of life.

"Until now, there hasn't been evidence of harmful effects of palliative chemotherapy in the last few months of life," Prigerson said. "Additional studies are needed to confirm these troubling findings."

Author: Tim Povtak

Tim Povtak is an award-winning writer with more than 30 years of reporting national and international news. His most recent experience is in researching and writing about asbestos litigation issues and asbestos-related conditions like mesothelioma.

Related News Posts