A recent report published in blood, the Journal of the American Society of Hematology, is examining a possible increased risk for malignant mesothelioma among patients exposed to radiation treatment for Hodgkin lymphoma. According to the study, whose lead author is Marie L. DeBruin, increased risks for second primary mesothelioma after radiation for lymphoma have been reported. Mesothelioma is primarily related to asbestos exposure.

According to the journal summary, the findings are based on a small number of patients, so researchers are approaching these results with caution and anticipate more study to confirm the results. The team examined mesothelioma in 2,567 five-year survivors of Hodgkin lymphoma, who had been treated with radiation alone, chemotherapy alone, or a combination of the two.

The study indicated that mesothelioma risk was almost 30 times greater in Hodgkin lymphona patients treated with radiation than in the general population.

The journal article was summarized by HemOncToday, which reports clinical news in oncology and hematology. The publication says the median follow-up period for patients included in the radiation-mesothelioma study was 18.1 years, at which time researchers found 13 patients had malignant mesothelioma at least five years after being treated for Hodgkins lymphoma.

HemOncToday reports there were no cases of mesothelioma among patients treated with chemotherapy alone, but that patients treated with both radiation and chemotherapy were almost 44 times more likely to develop malignant mesothelioma.

Harry S. Jacob, MD, HemOncToday chief medical editor, provided this perspective:

“Seminal studies by Scripps Research Institute investigators demonstrated that asbestos with high-iron content (as opposed to low-Fe level asbestos) was more likely to cause mesotheliomas in miners. In vitro iron-asbestos promoted oxygen radical generation that altered DNA, providing rationale for the epidemiologic studies. The combination of radiation-mediated oxygen radicals plus lung iron asbestos (or tobacco-mediated iron deposition) may underlie these findings.”

As part of her cancer treatments, or more accurately in response to her cancer treatments, our friend in the UK, Debbie Brewer, began a mistletoe treatment in May. Debbie was diagnosed with mesothelioma in November 2006, and is currently receiving chemoembolization treatment, for which she travels to Germany.

Mistletoe is in fairly widespread use in Europe as a complementary therapy in cancer care. It is given in conjunction with traditional cancer treatments such as chemotherapy, to strengthen the body’s immune system and build its natural defenses. It is believed mistletoe therapy can help cancer patients cope with the side-effects of chemotherapy and radiation.

Mistletoe is considered an anthroposophical medicine, which takes into account a total view of the human body and the human being, including physical constitution, the life force, the consciousness and the ego or free will. Mistletoe is harvested from different trees, with different types of mistletoe having different uses. According to the American Cancer Society, the type of mistletoe used in this therapy grows on species of trees native to England, Europe and western Asia. It is NOT the type of mistletoe commonly seen in the U.S. Mistletoe therapy is only available in clinical trials in the United States.

The extract, which comes from the plant’s leaves and twigs but not its berries, is generally given as an injection and after an initial professional application patients can do the treatment themselves at home. Debbie began her mistletoe treatment at The Park Attwood Clinic, which still oversees the process, although she administers her own injections now.

Debbie says she learned about the treatments from a couple who visited her web site, Mesothelioma & Me. She began the mistletoe therapy at the same time as her chemoembolization treatment, which uses targeted chemotherapy applied directly to her tumor and contained with the tumor. For about two years, she also has been struggling with alopecia, which had caused her to lose large patches of her hair.

“Since I started the mistletoe and the chemoembolization, I have noticed within the last two months my hair has grown back and is its natural color,” she wrote to me in an email. “The mistletoe boosts the immune system and also is very good at quelling the side effects of the chemo, although the side effects with chemoembolization are not as bad as the normal chemo.” She said mistletoe is offered on the German health care system, but it is not recognized by the UK system.

Debbie gives herself the mistletoe injections twice a week.

“I would have to say that a lot of the benefits I have had over the last five treatments is down to the mistletoe,” she says. “It works very well alongside the chemo treatment.”

She left today to travel to Germany for the sixth round of her chemoembolization treatments, and will learn the results of the fifth round, which she received November 6. So far, she has experienced tumor shrinkage after each round of chemoembolization.

I was thrilled this morning to get an email from our good friend Debbie Brewer in the UK reporting her tumor (nicknamed Theo) is now 43 PERCENT smaller!

As most of you know, Debbie has been battling mesothelioma since November 2006. In May 2008, she began a process called chemoembolization, which specifically targets and attacks her tumor, and basically seals the chemotherapy in with the tumor.

Debbie travels to Germany every month or so for the treatment. She saw her doctor, Dr. Thomas J. Vogl, for her fifth treatment on Thursday, Nov. 6, where she found that the tumor had shrunk another 10 percent since the fourth treatment in September. This is a total reduction of 43 percent since she started the therapy!

You can follow Debbie’s story on her blog, Mesothelioma and Me.

Bless you Debbie! We are so excited for your great progress!!

Results at the completion of a Phase II trial researching the treatment of peritoneal mesothelioma indicate a combination of the drugs Alimta (pemetraxed) and Gemzar (gemcitabine) is effective in increasing survival time and controlling disease progression. The findings were published in the July 2008 issue of the Journal of Clinical Oncology and reported by Cancer Consultants, Inc.

According to the report, the study involved 20 patients treated between 2002 and 2004 who received Alimta and Gemzar every 21 days, along with folic acid, vitamin B12 and dexamethasone. Cancer Consultants reports overall response rate was 15 percent, disease control rate was 50 percent, median time to disease progression was 10.4 months and the median survival time was 26.8 months. Additionally, the report notes that toxicities were tolerable.

Cancer Consultants notes that peritoneal mesothelioma makes up less than 20 percent of all cases of mesothelioma, with pleural mesothelioma being more common. Peritoneal mesothelioma is a specific form of mesothelioma that affects the peritoneum, which is the serous membrane that forms the lining of the abdominal cavity.

Pleural mesothelioma is the most common form of the disease, making up about 75 percent of all cases. Pleural mesothelioma affects the outer lining of the lungs and chest cavity.

Because of its relative rarity, there have been few studies of chemotherapy as a treatment for peritoneal mesothelioma, and there are no controlled trials of various treatment options available for peritoneal mesothelioma.

Traditional therapy for peritoneal mesothelioma has involved surgical debulking followed by systemic and/or intraperitoneal chemotherapy.

Cancer Consultants, which delivers educational programs and resources to more than 18 million targeted seekers of cancer information, has been producing and distributing cancer information for patients and professionals since 1998.

The publication notes that this study is one of the first devoted to systemic chemotherapy treatment for peritoneal mesothelioma and as such provides an important baseline for research.

In June, we reported the wonderful news that our friend in the UK Debbie Brewer’s mesothelioma tumor had shrunk by 10 percent following an initial round of a special treatment called chemoembolization, which she is undergoing in Germany.

She had her first round of chemoembolization therapy in May, and a second in June. Since the June treatment, her tumor is now 18 percent smaller! Debbie returns to Germany for another round of treatment this month, and is hopeful that the tumor has continued to shrink.

In July, the BBC featured Debbie in an interview, talking about chemoembolization. She hopes to spread the word about this treatment so that more people might explore it’s possibilities for mesothelioma. Click here to view the BBC video.

Debbie shares her mesothelioma story on her blog, www.mesothelioma-and-me.com. She was diagnosed with meso in November 2006. It is suspected that she contracted meso as a result of being exposed to asbestos dust on her father’s work clothes as a child. He was a lagger and would often scrape asbestos from pipes during his day’s job.

According to the web site www.radiologyinfo.org, chemoembolization is a combination of chemotherapy and a procedure called embolization, to treat cancer. Debbie is being treated by Dr. Thomas J. Vogl, Chairman, Department of Radiology, Department of Diagnostic and Interventional Radiology - University Hospital, Johann Wolfgang Goethe, University of Frankfurt am Main.

In this procedure, Dr. Vogl catheterizes the tumor and administers localized chemotherapy directly into the arteries feeding the tumor. Once the chemo has been administered, other agents can be administered to block off the blood supply to the tumor.

We look forward to another stellar report following Debbie’s visit to Germany this month!

A Minnesota woman is “claiming cured” after battling mesothelioma. Diagnosed in November 2005, Heather Von St. James, now 39, underwent surgery under the care of Dr. David Sugarbaker, who heads the acclaimed International Mesothelioma Program at Brigham & Women’s Hospital in Boston. Now nearly two years later, all traces of her cancer are gone, according to a story today in the Minneapolis Star-Tribune.

Heather’s treatment included radical surgery to remove her left lung, the lining around her heart, half her diaphragm, her sixth rib, and a few lymph nodes, followed by a chemotherapy regimen every three weeks for 12 weeks.  She now calls herself the “poster child for hope after meso.”

According to the Star-Tribune article, Dr. Sugarbaker is more guarded, although optimistic. The paper quotes him as saying, “right now in this present moment she is disease-free.”

Dr. Sugarbaker is arguably the leading mesothelioma physician in the U.S., and is largely credited with developing the surgical technique for mesothelioma resection and for recognizing the importance of a multimodality approach to treatment that combines surgery with chemotherapy and radiation therapy.

The National Cancer Institute estimates about 2,000 cases of mesothelioma are diagnosed in the U.S. each year. The disease has a long latency period of between 20 and 50 years, and it is unusual to find it in someone so young. Mesothelioma is linked only to asbestos exposure, so its victims are traditionally people who work in asbestos mining or come into contact with asbestos through other occupational exposure.

In Heather’s case, her mesothelioma is most likely due to secondhand exposure, from asbestos on her father’s work clothes. The Star-Tribune reports that Heather’s dad, Rollie Rosedahl, was a construction laborer who often worked with asbestos-containing products. Heather says she often wore her father’s jacket and boots when he’d come in from work.

The National Cancer Institute says that asbestos related disease like mesothelioma and asbestosis can occur in people with only brief exposures, and that there is evidence that family members of workers exposed to asbestos face an increased risk of developing mesothelioma.

Researchers in Denmark have discovered a chemotherapy combination that is proving to be highly effective for people with non-resectable malignant mesothelioma, according to a recent report on CancerConsultants.com. The study was published in a June issue of the British Journal of Cancer.

According to the report, the study evaluated a regimen of Navelbine (vinorelbine) and Platinol (cisplatin) for the treatment of 54 patients with newly diagnosed non-resectable mesothelioma. The median number of cycles of chemotherapy administered was four. There were two complete responses and 14 partial responses.

The median survival was 16.8 months, and the median time to tumor progression was 7.2 months. The one-year survival was 61 percent, the two-year survival was 31 percent, and the three-year survival was 4 percent.

The authors of the study say these results are as good as or better than currently used combinations for treatment of mesothelioma.

A New York medical center specializing in the treatment of mesothelioma has announced a new clinical trial accepting patients. The Mesothelioma Center within the Herbert Irving Comprehensive Cancer Center at NewYork-Presbyterian Hospital and Columbia University Medical Center is launching a program of targeted radiation and chemotherapy protocol for pleural mesothelioma, a cancer of the lung’s lining that is almost always caused by previous exposure to asbestos.

It is hoped the new treatment will replace or delay the need for the standard treatment in these cases, a pleural pneumonectomy, which involves removal of the lung and which can be extremely debilitating to patients.

According to a press release from the medical center, Dr. Robert Taub, the study’s principal investigator, director of the Mesothelioma Center at NewYork-Presbyterian/Columbia and professor of clinical medicine at Columbia University College of Physicians and Surgeons, says, “Current surgical and chemotherapy treatments of patients with malignant pleural mesothelioma are unsatisfactory, and have not been shown to significantly prolong survival. In this study, we will investigate whether a combination of chemotherapy and radiation targeted directly at the lung’s lining can improve outcomes while avoiding surgery. In addition, this approach has shown to have minimal toxic side effects compared to systemic chemotherapy.”

The Mesothelioma Center is the only one nationwide that is offering this experimental therapy to treat pleural mesothelioma.

The study is being conducted at the Mesothelioma Center within the Herbert Irving Comprehensive Cancer Center at NewYork-Presbyterian Hospital and Columbia University Medical Center. According to the release, participating patients will receive several rounds of targeted chemotherapy using the drugs cisplatin and doxorubicin via surgically implanted catheters. Some patients will be randomly selected to receive additional systemic (intravenous) chemotherapy using the drugs cisplatin and pemetrexed. All patients will receive targeted radiotherapy using the P-32 radioisotope.

Patients may elect to receive additional surgical treatment, including removal of the affected lung lining or lung. Subsequently, patients will be offered outpatient systemic chemotherapy with cisplatin and pemetrexed.

For more information, visit www.hiccc.columbia.edu.

In April I shared a web site, Mesothelioma and Me, by UK resident Debbie Brewer, who was recently diagnosed with mesothelioma. The site is Debbie’s personal journal about her experiences as she battles mesothelioma, as well as shares stories about her family and daily life.

Some of you who are following Debbie on her journal have already heard the good news - on June 20, she learned that her tumor (which she wittily nicknamed Theo) has shrunk by 10 percent after the first of three scheduled chemoembolization treatments. She had her first treatment May 20, and the second June 20, when she learned Theo had gotten smaller.

According to www.radiologyinfo.org, chemoembolization is a combination of chemotherapy and a procedure called embolization to treat cancer, most often of the liver. According to the web site, catheter embolization is the deliberate introduction of foreign (”embolic”) material such as gelatin sponge or metal coils to stop bleeding or cut off blood flowing to a tumor or arteriovenous malformation.

Debbie traveled to Frankfurt, Germany, to have the procedure, which is still a trial, done by Dr. Thomas J. Vogl, Chairman, Department of Radiology, Department of Diagnostic and Interventional Radiology - University Hospital, Johann Wolfgang Goethe, University of Frankfurt am Main.

In this procedure, Dr. Vogl catheterizes the tumor and administers localized chemotherapy directly into the arteries feeding the tumor. Once the chemotherapy has been administered, other agents can be administered to block off the blood supply to the tumor.

Debbie’s description of the procedure is a little more colorful:

“A small incision will be made to expose the artery that feeds the tumour which is in the femour. A catheter is inserted and pushed up into the area affected. Embolization is a glue like substance which is put in to seal off the tumour and the chemo is then added and the whole area sealed off. The chemo is left to do its job. It is something like having a room with 2 doors, sealing off the back door and throwing in an explosive and sealing up the front door.”

One of the strangest things? The clinic where Debbie visits Dr. Vogl for these treatments is located on a street of the same name as her tumor’s nickname! Theodore Stern Kia 7. Visit Debbie’s blog to read all about her experiences with Dr. Vogl and this treatment. She even has photos of herself at the clinic.

Debbie points out that chemoembolization is not a cure for mesothelioma, but is thought to slow the growth of the tumor or reduce it, allowing the patient a longer life.

In conjunction with or following this treatment, Debbie will undergo a dendritic cell vaccine. According to the web site drugresearcher.com, dendritic cells - a part of the body’s immune system that detects foreign proteins in the body - can be used as vaccines by mixing them with genetic material from the patient’s tumour and infusing the treated cells back into the patient. The dendritic cells present the tumour antigens to the body’s white blood cells (T lymphocytes) for destruction.

There has been a lot in the news lately about the development of new drugs to treat mesothelioma. But with this boon comes a perhaps unforeseen complication - the increasing cost of treatment. A recent study conducted by the U.S. National Cancer Institute (NCI) and published in the Journal of the National Cancer Institute indicates that costs for treating Medicare patients with cancer has increased substantially from 1991-2002.

The article, which studied the cost of care for elderly cancer patients in the United States, used Surveillance, Epidemiology, and End Results-Medicare files to identify 718,907 cancer patients and 1,623,651 noncancer control subjects. Researchers estimated net costs of care for elderly cancer patients for the 18 most prevalent cancers and for all other tumor sites combined.

The study reports that costs of care were estimated for each phase by use of Medicare claims data from January 1, 1999 through December 31, 2003. They found that costs to Medicare were highest for lung, colorectal and prostate cancers.

An article in HealthDay News examining this latest report says study co-author Robin Yabroff attributes rising costs to a growing population of seniors in the U.S., as well as the inclusion of more prescription drugs in Medicare coverage. Yabroff is an epidemiologist at the U.S. NCI.

The report states that the number of patients receiving chemotherapy for lung, colorectal and breast cancer rose from 1991 to 2002, and that those increasing costs do not even reflect many of the newest, most expensive drugs now in use.

The HealthDay report quotes Dr. Len Lichtenfeld, deupty chief medical officer at the American Cancer Society, as saying that “the impact to Medicare is going to be substantial.” He goes on to say that the increasing costs for new drugs may actually prevent some patients from getting the treatment they need. Even if the drug is covered by Medicare, he says, the cost of the patient’s co-pay may be too high for them to afford it.