The National Cancer Institute (NCI) Cancer Bulletin on July 14 featured a new clinical trial for a combination immunotoxin and chemotherapy regimen to treat pleural mesothelioma. This is a Phase I Study of SS1 (dsFv)-PE38 Immunotoxin in combination with Pemetrexed Disodium and Cisplatin in patients with unresectable malignant epithelial pleural mesothelioma (NCI-08-C-0026).

The principal investigator for the studay is Dr. Raffit Hassan of the NCI Center for Cancer Research.

According to the NCI bulletin, researchers hope an experimental immunotoxin called SS1 (dsFv)-PE38 (or SS1P) can improve the outcome of patients with unresectable (or inoperable) mesothelioma. Clincial trial information says that SS1P is a “genetically engineered biological agent in which part of a bacterial toxin is linked to an antibody that recognizes the protein mesothelin.”

Mesothelin is the protein found on the surface of epithelial mesothelioma cells and other types of cancer cells. It is hoped that combining SS1P with chemotherapy will lead to increased antitumor activity, as compared with either treatment alone.

“Given the marked synergy between SS1P and chemotherapy in preclinical studies, combining them could potentially result in increased antitumor activity in patients,” Dr. Hassan is quoted in the Bulletin.

For more information, see the Entry Criteria.

Find trial contact information online or call the NCI Clinical Trials Referral Office at 1-888-NCI-1937. The call is toll-free and confidential.

There is much debate over the issue of nanotechnology, with recent reports swinging to the positive side of the spectrum. Scientists at the University of Arkansas at Little Rock Nanotechnology Center say nanotechnology may provide an avenue for physicians to track cancer cells in the body, and enable targeted treatment.

A recent report in the Arkansas Democrat-Gazette says the scientists, led by Alexandru Biris, assistant professor and the chief scientist at the university’s Nanotechnology Center, have developed a technique for attacking cancer cells by injecting them with nanoparticles a few thousand times smaller than the diameter of a human hair, then heating the particles with low-frequency radiation. The heat kills the cancer cell completely. The nanotechnology scientists are working in cooperation with physicians from the University of Arkansas Medical Sciences department.

The Gazette article quotes Dr. Piotr Grodzinski, director of the National Cancer Institute’s Alliance for Nanotechnology in Cancer as saying the concept of using nanoparticles to treat cancer isn’t new, but that the type of nanoparticle developed by the Little Rock team is groundbreaking. The Little Rock team usues a highly magnetic cobalt particle surrounded by layers of graphitic carbon.

Scientists at the UALR Nanotechnology Center have had promising results from initial research, killing about 98 percent of cervical cancer cells used in the study. Before they can move into clinical trials with human beings – at least two years away – they must investigate a number of issues, including how the technique will affect surrounding tissues and how to reduce the toxicity of the metals used in the nanoparticles, among others.

It is the mission of the Nanotechnology Center at UALR to “advance the science of Nanotechnology through research and outreach and accelerate technological innovations into practical applications for society.” The Center received $5.9 million in funding from the Arkansas State Goverment in 2006, which helped the program garner an additional $1.9 million in federal grant funding.

Read the full article online at the UALR Nanotechnology Center web site.

Nanotechnology has raised safety concerns in the past as a concern for mesothelioma. Last May, this site featured information from an article published in the scientific journal Nature Nanotechnology, which likened the effect of carbon nanotubes to asbestos fibers when introduced into the body.

The UALR Nanotechnology Center acknowledges that as with exposure to asbestos, nanotubes can be potentially dangerous if the tiny fibers are inhaled, noting that manufacturers, lab researchers, suppliers and other professionals who handle nanotubes are at risk and should use protective clothing. The Center also recommends appropriate ventilation in areas where carbon nanotube fibers may become airborne. Scientists are still examining the possible connection between carbon nanotubes and mesothelioma.

The results of a recent study provide hope in the fight against mesothelioma. The research says attacking mesothelin, a protein produced by all pancreatic cancers and mesotheliomas, as well as some ovarian and non-small-cell lung cancers, may be effective in shrinking tumors.

Findings of the study, which was directed by Dr. Carl H. June at PENN Medicine in partnership with the National Cancer Institute, were published in the Feb. 9 issue of the Proceedings of the National Academy of Sciences.

According to a news release from PENN Medicine, the new study uses genetically engineered human T cells (immune system cells) to target human mesothelin. Previous laboratory research has shown that certain T-cells can kill tumor cells that express mesothelin, and that antibodies directed against mesothelin protein can shrink tumors.

The release quotes Dr. June, Professor of Pathology and Laboratory Medicine and director of Translational Research at Penn’s Abramson Cancer Center, as saying, “Based on the size of the tumors and the number of cells administered, we estimate that one mesothelin-targeted T cell was able to kill about 40 tumor cells.”

Clinical trials are being developed to investigate this approach to fighting tumors in patients with mesothelioma and ovarian cancer.

PENN Medicine is a $3.6 billion enterprise dedicated to the related missions of medical education, biomedical research, and excellence in patient care. PENN Medicine consists of the University of Pennsylvania School of Medicine and the University of Pennsylvania Health System.

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.

Earlier this month, about 33,000 medical professionals gathered for the annual meeting of the American Society of Clinical Oncology. The event is the world’s largest gathering of cancer specialists, and includes among its programs updates about various cancer treatments, as well as an opportunity for physicians to visit vendors from drug companies to learn about new products.

A special focus of this year’s conference was lung cancer, which is the leading cause of cancer deaths in the United States. Mesothelioma affects the lining of the lungs, and may also affect the abdomen or the pericardium (the sac around the heart).

There was a great deal of hope for a new drug, Erbitux, which doctors hoped would prove to have significant results in prolonging survival for lung cancer patients (it didn’t), as well as review of a currently popular lung cancer drug, Avastin, which in its Phase III trial was shown to help keep the disease from progressing.

But among the reports of facts and figures and products and treatments, was a report by Robert Bazell at MSNBC.com. Why, he wondered, are we not further along in the War on Cancer, which was declared as a national health priority in 1971, when President Richard Nixon signed the National Cancer Act.

The Act, Bazell points out, created the National Cancer Institute as a separate entity from the National Institutes of Health, with a dedicated budget for curing cancer. The NCI started with $230 million per year, and now has a budget of $5 billion.

Certainly, progress has been made, and there have been steady declines in breast, colon and prostate cancers, most due to better methods for early detection, Bazell points out. But, overall, he says, the death toll from cancer has declined only 5 percent between 1950 and 2005. FIVE percent!

What are the challenges? Why are we not winning this war?

Certainly, the nature of cancer itself has something to do with it – there are more than 200 diseases that fit into the definition of “cancer,” uncontrolled cell growth, he points out. And, even though funding has increased, if you adjust that $5 billion budget for inflation, spending on cancer research has actually been falling in recent years, he says.

But I was intrigued by his most compelling argument, which seems so simple. He notes that “it would be very useful to have a discussion on how much we spend on BASIC RESEARCH and PREVENTION, compared to how much we spend on marginally useful treatments.”

Is it possible that we can no longer see the forest for the trees?

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.

In the ongoing quest for a cure for mesothelioma and other life-threatening illnesses, the debate over the validity and effectiveness of complementary and alternative medicine (CAM) continues to stir up strong emotions.

Complementary medicine is used along with standard medicine, while alternative medicine is used in place of standard treatments.

Complementary and alternative medicine may include dietary supplements, megadose vitamins, herbal preparations, special teas, acupuncture, massage therapy, magnet therapy, spiritual healing, and meditation.

Not long ago, I shared Charlene Kaforey’s good news, when she discovered her mesothelioma mass had diminished by half after completing a first round of cancer vaccines, considered an alternative treatment.

Recent news has included reports of research ranging from the effects of nonsteroidal anti-inflammatory medicines in combination with chemotherapy, to the use of Chinese mushrooms in homeopathic treatment, to a study indicating traditional chemotherapy might enhance the effectiveness of cancer vaccines, which are currently in clinical trials.

The problem, according to complementary medicine (CM) professor Edzard Ernst, in an editorial published recently in BMJ Clinical Evidence, is that “one side of the debate argues that there is no scientific evidence that can support CM, while the other side believes scientific evidence cannot be applied to CM.”

The danger, he says, is that waiting for absolute evidence might prevent someone from trying a therapy that could be beneficial, but siding with the idea that CAM simply cannot be proven may lead a patient into treatment that could cause more harm than good.

The National Cancer Institute’s Office of Complementary and Alternative Medicine (OCCAM), which coordinates the Institute’s research program in CAM, has established a goal of evaluating data from CAM practitioners with the same rigorous scientific methods employed in evaluating treatment responses with conventional medicine.

Major categories of CAM therapies, as determined by OCCAM, include alternative medical systems (built upon complete systems of theory and practice, like traditional Chinese medicine or homeopathy), energy and electromagnetic based therapies, exercise therapies (like yoga), manipulative and body-based methods, mind-body interventions (like hypnotherapy), nutritional therapeutics, pharmacological and biologic treatments (like vaccines), and spiritual therapies (healing, prayer).

OCCAM is developing the NCI Best Case Series (BCS) program based on its evaluations of CAM therapies, in which it provides an independent review of medical records and medical imaging from patients treated with unconventional cancer therapies.

But whether or not alternative and complementary medicine can be proven effective, people will still seek it out, says Professor Ernst. The “almost insatiable hunger of patients” for CM has driven its importance, he says, despite criticisms, praise or skepticism from the medical community, scientists or politicians, and in spite of the fact that more often than not health insurance does not cover the treatments.

Obviously, this topic – and its accompanying debate – needs much more examination. I will be exploring it more in the future. Do you have an experience with complementary or alternative medicine? Share it with us!

The Lung Cancer Alliance (LCA) announced Feb. 25 that statistics recently released by the American Cancer Society (ACS) indicate that lung cancer continues to kill more people each year than all the other major cancers combined.

Beginning in 2003, ACS started using the 2000 census for its age adjusted statistical analysis. Since that time, the incidence rate for lung cancer in men rose from 86 new cases per every 100,000 of population to 89, and incidence rates for women went from 51.4 to 55.2.

The LCA points out that in research dollars per death, lung cancer is receiving a fraction of the amounts given to breast, prostate and colon cancers.

The five-year survival rate for breast cancer now stands at 88 percent, prostate cancer 99 percent and colon cancer 65 percent, while lung cancer remains at 15 percent.

The ACS credits screening as a major component in achieving high survival rates. So, part of the problem, according to an article published in the Baltimore Sun Feb. 27, is that there is not yet any effective way to screen for lung cancer.

Reporter Stephanie Desmon found that neither physicians nor major medical societies advocate lung cancer screening at this time, because no one has proved that it saves lives.

Studies have shown that screenings find more cancer, but also more lesions and nodules that may or may not be cancer, Desmon’s report said. This leads to confusion about how to treat these spots, or whether to treat them at all. There also are concerns that lung screenings may lead to further tests, biopsies and surgeries, some of which may be unnecessary or harmful to a patient. Scans that produce “watch and see” results also lead to fear and anxiety, and emotional cost to the patient.

In 2002, the National Cancer Institute launched the National Lung Screening Trial (NLST), which will compare two ways of detecting lung cancer – spiral computed tomography (CT) and the standard chest X-ray. By Feb. 2004, nearly 50,000 people (smokers or former smokers) had joined NLST at more than 30 study sites across the country.

The trial (now closed to further enrollment) is slated to collect and analyze data for eight years to examine the risks and benefits of each type of screening. The NLST is a randomized, controlled study and is large enough to determine if there is a 20 percent or greater drop in lung cancer mortality from using spiral CT compared to chest X-ray. The trial is scheduled to last until 2009.