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August 5, 2015

Improving standards and stepping outside of the box in the battle against mesothelioma

by: Vincent L. Greene IV

No matter how much we may try to maintain a professional detachment, litigating on behalf of asbestos victims always becomes personal. How can it not be when dealing with people’s lives?

For example, I’ll never forget a recently resolved case for a young man, 39-years-old, who quickly lost his life to mesothelioma. Diagnosed with stage 2 mesothelioma in August 2011, the highly aggressive cancer soon spread and quickly reached stage 4. He fought bravely, but in April 2012 he passed away, leaving behind two young daughters, a wife of 12 years and a community that loved him for his bright, kind and selfless nature. Three years after his death, he finally testified in Court in early July, when his pre-recorded deposition was viewed at the beginning of a trial. 

If not for the actions of so many companies and asbestos-related industries, the issue of asbestos exposure, let alone an aggressive mesothelioma diagnosis, likely would never have been a thought for his family. But like so many before him, it’s my belief that this young man passed away because others weren’t willing to accept the dangers of asbestos exposure or take measures to protect those who worked around it.

However, there are researchers, scientists, doctors and even patients who are working every day to bring change to the outcome of a mesothelioma diagnosis. Toiling away in labs and hospitals, their work is critical. Below are some of their developments:

New Drug Studies

Many cancer patients are familiar with the chemotherapy regimen of pemetrexed and cisplatin, which when combined work by damaging cancer cells in order to halt growth and keep the cells from reproducing.

In May 2015, a Phase 3 French study found that adding the drug bevacizumab, which blocks blood vessel growth, to this chemotherapy regimen consistently resulted in longer survival rates than pemetrexed/cisplatin alone.

According to Dr. Lee Krug of the Memorial Sloan Kettering Cancer Center, this "is the first positive phase three trial in mesothelioma since the original study of pemetrexed and cisplatin in over ten years."

Additionally, the drug Iressa (gefitinib), previously used for advanced non-small cell lung cancer (NSCLC), was just recently approved by the FDA on July 13, for first line treatment in NSCLC that contain specific gene mutations. These mutations are present in about 10 percent of NSCLC, which is the most common type of lung cancer. According to the FDA, results have shown “that tumors shrank in about 50 percent of patients after treatment and this effect lasted an average of six months.”

If anything, the results with Iressa show that we are moving closer toward identifying and targeting the multitude of variations found in cancers.

Destroying cancer cells at their root 

Another potential treatment undergoing intensive testing is a process that would seek out and destroy a cancer’s “stem cells.” These stem cells are the root of cancerous tumors and can be rendered dormant after treatments but can sadly reemerge later. In hoping to destroy these stem cells, a team at the University of Kansas has been testing chemical combinations that inhibit the HuR protein, which promotes tumor growth.

In identifying six chemical compounds that block this protein, the team is hopeful that they may be able to develop a class of cancer drugs that could effectively inhibit the growth of cancerous tumors reported to contain high levels of HuR, including brain, breast, colon, lung, ovarian, pancreatic and prostate cancers.

“The success of our study provides a first proof-of-principle that HuR is druggable, which opens a new door for cancer drug discovery,” said Dr. Liang Xu, co-author of the scientific paper discussing this research published in the American Chemical Society’s Chemical Biology journal.

The team at the University of Kansas will continue to conduct research into these compounds in the hopes of developing an eventual treatment that would eliminate tumors for good.

New treatment options

Another potential treatment, tremelimumab, recently received orphan drug status from the FDA, which means that incentives and other means of support will be available to assist with its research and development.

Tremelimumab is being investigated as a treatment for patients with malignant mesothelioma and is designed to activate the body’s natural immune system to destroy cancer cells.

Big potential with nanotechnology

Another approach to developing a new potential mesothelioma treatment almost verges on science fiction—and it’s showing some very promising results.

In a study published in the American Journal of Respiratory and Critical Care Medicine in June 2015, a team of Australian researchers discussed the findings of a study involving six patients who underwent an experimental treatment for malignant pleural mesothelioma. The study, conducted over eight weeks, involved the delivery of a particular type of microRNA discovered to be missing from malignant pleural mesothelioma cells using a unique nanocell delivery system.

Of the six patients in the initial study, four patients didn’t change and one patient’s cancer even became worse. However, the interesting results came for one patient, a 51-year-old plumber who improved so greatly that four weeks after the study, PET and CT scans showed almost the complete disappearance of mesothelioma. While very promising, it should be noted that this patient’s result is only a very early observation that requires several years of additional study. Additional trials are being arranged as researchers work to further refine and observe the results of this innovative approach.

Highly focused radiation before surgery

Lastly, a study into using a very specific type of radiation therapy before surgery has shown promise in positively impacting mesothelioma survival rates.

The study, nicknamed SMART (Surgery for Mesothelioma After Radiation Therapy), was conducted on 25 patients with resectable malignant pleural mesothelioma and involved an accelerated course of hemithoracic intensity-modulated radiation therapy (IMRT) in high doses before undergoing extrapleural pneumonectomy (EPP), or surgical removal of the affected lung and surrounding affected tissue. The idea behind this radiation-before-surgery approach was, according to the feasibility study, to “decrease distant recurrences by preventing tumor cell dissemination during surgical resection.”

The results of the SMART approach showed a doubling of patients achieving 3-year survival in epithelial mesothelioma (from 32% to 72% survival). With the SMART approach showing positive results, researchers are preparing to conduct a phase three trial in multiple research centers and continue perfecting the process.

In all, there’s a lot being done daily to help those suffering from mesothelioma; work that I certainly applaud. From improving current approaches to approaching treatments from innovative, out-of-the box directions, the support, creativity and wealth of knowledge backing these studies is not only impressive but to me, they’re also very encouraging.