This week BBC News / Health reported on a recent study published by The Lancet, which features independent and authoritative commentary on global medicine, including research and analysis from all regions of the world. The study suggests that chemotherapy is not effective in dealing with mesothelioma, which is an asbestos-induced cancer that effects the lungs and, more rarely, the abdomen.

The results are based on a study of 409 patients, mostly from the United Kingdom, which set out to assess the potential benefits of combining active symptom control, which usually involves steroid drugs and radiotherapy, with chemotherapy. Results showed no real benefit from adding the chemotherapy drugs compared with just treating the symptoms of the disease.

The BBC quotes one of the authors of the study, Dr Richard Stephens from the Medical Research Council Clinical Trials Unit, as saying, “While thousands are and will be affected by this deadly disease, our trial, which is one of the few large trials ever conducted in this disease, emphasizes how difficult mesothelioma is to treat. This is mainly because mesothelioma forms in the lining of the lung. This makes it hard to target.”

One chemotherapy drug, vinorelbine, was shown by the study to have some promise, but researchers do not think blanket chemotherapy treatment is a promising direction for treatment of mesothelioma, according to the Lancet report.

Researchers do not necessarily consider these findings to be bad news, as a study that defines what does not help can be beneficial to patient health because it helps reduce the chance that patients will undergo stressful treatments that are ineffective.

Results of a completely different chemotherapy study conducted by researchers at Duke Comprehensive Cancer Center were released May 18, revealing that chemotherapy given in conjunction with cancer vaccines may actually boost the immune system’s response to the vaccines, according to a report by ScienceDaily.

The Duke study focused on a drug used to treat lymphoma, but could have implications for clinical trials with vaccines being used to treat many cancers including lung cancer, brain tumors and colorectal cancer.

According to the FDA, it is the goal of cancer vaccine clinical trials not to prevent cancer, but to treat existing tumors. The idea is to train the person’s immune system to recognize the living cancer cells and attack them.

In July 2007, the American Association for Cancer Research examined the issue of cancer vaccines and, according to a report by Medical News Today, they found that “ongoing therapeutic cancer vaccine trials have yet to show evidence of vaccines spurring a patient’s immune system to shrink tumors - yet patients who receive these vaccines in trials tend to live longer and respond better to subsequent treatment.”

The full study, titled Cancer Vaccines: Moving Beyond Current Paradigms is available to read online at Clinical Cancer Research.

Full results of the Duke study will be presented May 31 at the American Society of Clinical Oncology meeting in Chicago, Ill.

Clinical Cancer Research, a publication of the American Association for Cancer Research, recently released the results of a study from Japan, in which researchers examined the potential of establishing a tumor marker to aid in screening for early diagnosis of mesothelioma.

The study was based on the fact that because mesothelioma initially progresses on the surface of the pleura and peritoneum without forming masses, it has been difficult to diagnose at an early stage, so it would be useful to identify a tumor marker that would help in identifying it.

Researchers had previously identified N-ERC/mesothelin as a potential biomarker for mesothelioma. The recent study used a newly developed ELISA (enzyme-linked immunosorbent assay) system to gather data in clinical trials.

The report states that 102 healthy volunteers were recruited for the study, as well 39 patients diagnosed with mesothelioma, 53 patients diagnosed with diseases that should be distinguished from mesothelioma, and 201 subjects diagnosed with asbestos-related nonmalignant diseases.

The findings show that N-ERC/mesothelin is a “very promising tumor marker for mesothelioma, especially epithelioid mesothelioma.” Serum N-ERC/mesothelin levels showed that the median values from patients with mesothelioma were extremely high compared with levels from other patients.

Researchers participating in the study represented Juntendo University School of Medicine, National Organization Tokyo Hospital, Fukujuji Hospital, Hirano Kameido Himawari Clinic, Immuno-Biological Laboratories Co., Ltd., Hyogo Prefectural Tsukaguchi Hospital, Yokosuka Kyosai Hospital, St. Marianna University School of Medicine, and Tohoku University Hospital.

• Treating Mesothelioma
• New Research
• Research at UAB

Treating Mesothelioma

Because this is such a rare cancer, it has been hard for doctors to compare the value of different treatments. Since many doctors have little or no experience treating this disease, you may be referred to a specialist at a large medical center.Treatment options include surgery, chemotherapy and radiation therapy.One problem with treating mesothelioma is that it does not grow as a single mass. Instead it tends to spread along surfaces, nerves, and blood vessels. This makes it hard for one or more types of treatment to get rid of all of the disease.While surgery is not likely to cure the cancer, it might extend the patient’s life.Depending on the type and stage of the cancer, chemotherapy may be given as the main treatment or along with surgery. Chemotherapy for this disease is given to relieve symptoms, not to cure the cancer.As a rule, radiation treatment doesn’t help much for mesothelioma, and the need to treat a large part of the lung leads to problems with lung damage. But radiation can be used along with surgery to kill small areas of cancer that cannot be seen and removed during surgery. It can also be used as a way to ease symptoms such as shortness of breath, pain, bleeding, or trouble with swallowing. If fluid builds up in the chest, radioactive drugs can be put into the space after the fluid is drawn out. This might help keep the fluid from coming back.

New in Mesothelioma Research

There is always research going on in the area of mesothelioma. Much of this research has focused on learning exactly how asbestos changes normal cells and their DNA to cause cancer. Understanding how these fibers produce cancer might help us find ways to prevent those changes.Now that we know about the dangers of asbestos, we can limit or stop its use in homes, public buildings, and the workplace. But rules to protect people from asbestos are much less strict (or they do not exist at all) in some other countries.Research is also going on to learn about the role (if any) of a virus (SV40) that has been linked to mesothelioma in some studies.Because chemotherapy drugs have not worked very well against advanced mesothelioma, several new ideas are now being studied. These include drugs which kill cancers by stopping their blood supply and drugs which interfere with the ability of some cancer cells to grow quickly.Doctors are always learning more about the best way to treat people with mesothelioma. Treatments that combine surgery, radiation therapy, and chemotherapy are now being studied and may provide the most promising option for some patients.New drugs, along with other types of treatments, are now being tested in clinical trials.Another new approach is a type of gene therapy. This treatment uses special viruses that have been changed in the lab. The virus is injected into the space around the lungs where it infects the cancer cells. When this happens, the virus in turn injects a gene into the cancer that may help immune system cells to attack the cancer.

Research at UAB

The University of Alabama Birmingham (UAB) Comprehensive Cancer Center is a research and teaching hospital, and is currently conducting a number of studies on the treatment of mesothelioma.In 2005, UABs Spring/Summer magazine published information about ongoing studies being conducted by Katri Selander, M.D., Ph.D., a Cancer Center Associate Scientist, and Pierre Triozzi, M.D., about the effects of bisphosphonates on cancer cells.Bisphosphonates are drugs that are commonly used to treat and prevent osteoporosis. They also are used to treat metastatic breast and prostate cancers.The UAB article reported that Drs. Selander and Triozzi “have examined the effects of bisphosphonates on cancer cell cultures and in animal models, and have found that the drugs kill mesothelioma cells in both.” Further results of these studies were reported in the May 1, 2006 issue of Clinical Cancer Research, Vol. 12, 2862-2868; and in the European Journal of Pharmacology, Volume 559, Issue 1, dated March 15, 2007. Key points of the article in Clinical Cancer Research said that “the diagnositc use of radioactive bisphosphonates has revealed the accumlation of bisphosphonates in mesothelioma” and said that results of the studies “support further study of bisphosphonates in the management of mesothelioma.” The European Journal of Pharmacology report states that “Pre-clinical studies indicate that bisphosphonates also ihibit the growth of various cancer cells in vitro” and “in … mouse AB-12 mesothelioma cells.” For more information, visit UAB’s Comprehensive Cancer Center.

If you are reading this blog, chances are good that you are already familiar with Mesothelioma, and may actually have been diagnosed with this cancer yourself. But part of the mission of this blog is to raise awareness, so let me start by offering some general information and some resources.

There are links on this page to a number of web sites that provide medical information and information about asbestos, exposure to which is the leading cause of Mesothelioma. Check back regularly, as I will be adding to that list of links in addition to posting new information here.

Here is a good general definition, from the University of Alabama Birmingham (UAB) Medical Center, which has a Mesothelioma Clinic at its Comprehensive Cancer Center :

Q: What is mesothelioma and who is at risk?

A: Mesothelioma is an aggressive form of cancer in which cells of the mesothelium (the membrane that covers and protects most of the internal organs) become abnormal, form tumors, and grow without control or order. The disease usually affects the surface of the lung or less commonly the lining of the abdomen. It is relatively uncommon, with 2,500-3,000 new cases diagnosed in the United States each year. The major risk factor is working with asbestos, but the disease has been reported in some individuals without any known exposure to it. An experimental drug, Pemetrexed®, has shown promise in treating advanced mesothelioma. The UAB Mesothelioma Clinic and Comprehensive Cancer Center offer clinical trials for treating the disease. Early referral for the best treatment is important after diagnosis.

UAB is a research and teaching hospital, and is currently conducting a number of studies on the treatment of mesothelioma.

In 2005, UAB’s Spring/Summer magazine published information about ongoing studies being conducted by Katri Selander, M.D., Ph.D., a Cancer Center Associate Scientist, and Pierre Triozzi, M.D., about the effects of bisphosphonates on cancer cells.

Bisphosphonates are drugs that are commonly used to treat and prevent osteoporosis. They also are used to treat metastatic breast and prostate cancers.

The UAB article reported that Drs. Selander and Triozzi “have examined the effects of bisphosphonates on cancer cell cultures and in animal models, and have found that the drugs kill mesothelioma cells in both.”

Further results of these studies were reported in the May 1, 2006 issue of Clinical Cancer Research, Vol. 12, 2862-2868; and in the European Journal of Pharmacology, Volume 559, Issue 1, dated March 15, 2007.

Key points of the article in Clinical Cancer Research said that “the diagnositc use of radioactive bisphosphonates has revealed the accumlation of bisphosphonates in mesothelioma” and said that results of the studies “support further study of bisphosphonates in the management of mesothelioma.”

The European Journal of Pharmacology report states that “Pre-clinical studies indicate that bisphosphonates also ihibit the growth of various cancer cells in vitro” and “in … mouse AB-12 mesothelioma cells.”

For more information, visit UAB’s Comprehensive Cancer Center online at www3.ccc.uab.edu or click on the link in my list.