The results of a study published recently in The Journal of Thoracic and Cardiovascular Surgery supports the use of extrapleural pneumonectomy-based multimodal therapy in carefully selected patients with malignant pleural mesothelioma. The Journal is published by The American Association for Thoracic Surgery.

According to the research summary, the objective of the study was to evaluate the perioperative and long-term outcomes associated with extrapleural pneumonectomy for patients with malignant pleural mesothelioma. Pleural mesothelioma affects the lining of the chest cavity and lungs. Other forms of mesothelioma include pericardial, which affects the lining of the heart and is extremely rare; and peritoneal, which affects the lining of the abdomen. Mesothelioma is atributed almost exclusively to asbestos exposure.

According to the Multimedia Manual of Cardiothoracic Surgery, extrapleural pneumonectomy was introduced in the 1940s for the treatment of extensive infections of the lung and pleural space. Over the past 20 years, the extrapleural pneumonectomy technique has been modified and applied to the treatment of locally advanced malignant pleural mesothelioma, achieving substantial reductions in mortality. The surgery involves the removal of the lung with visceral and parietal pleurae, pericardium and diaphragm.

Researchers selected 70 patients between October 1994 and April 2008 to undergo the procedure. Prognostic factors included age, gender, side of disease, asbestos exposure, histology, positron emission tomography, date of surgery, neoadjuvant chemotherapy, completeness of cytoreduction, lymph node involvement, peioperative morbidity, adjuvant radiotherapy and pemetrexed-based chemotherapy.

The mean age of patients was 55 years. The median survival was 20 months, with a 3-year survival of 30 percent. Analyses showed improved survival for patients with asbestos exposure, negative lymph node involvement, and receipt of adjuvant radiation or postoperative pemetrexed-based chemotherapy.

The study was conducted by physicians from the University of Sydney, Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital; The Baird Institute for Applied Heart and Lung Surgical; Department of Medical Oncology, Sydney Cancer Center, Royal Prince Alfred Hospital; and Department of Radiation Oncology, Sydney Cancer Center, Royal Prince Alfred Hospital; all in Sydney, Australia.

It was announced this week that Warnex Medical Laboratories, a division of Warnex Inc., will be the Canadian distributor for three recently launched genetic biomarker diagnositc tests produced by Rosetta Genomics, Ltd. The tests, branded as miRview™, include a test for the detection and diagnosis of mesothelioma.

Warnex is a life sciences company providing laboratory services to the pharmaceutical and health care industries. The company will market the miRview™ products and will send samples gathered from the tests from Canada to the Rosetta Genomics laboratory in Philadelphia for analysis. Warnex has three facilities, located in Laval and Blainville, Quebec, and Thunder Bay, Ontario.

We’ve written about the miRview™ products on this site in the past. They include miRview™ mets, which can identify the primary tumor site in patients presenting with metastatic cancer; miRview™ squamous, which differentiates squamous from non-squamous, non-small cell lung cancer (NSCLC); and miRview™ meso, which leverages microRNA’s high specificity as biomarkers to differentiate mesothelioma from other carcinomas in the lungs.

All three of the miRview tests utilize MicroRNA technology. According to Rosetta Genomics, microRNAs (or miRNAs) are recently discovered, naturally occurring, small RNAs that act as master regulators and have the potential to form the basis for a new class of diagnostics and therapeutics. This is because microRNAs have been shown to have different expression in various pathological conditions, the observation of which can provide a novel diagnostic tool for many diseases.

According to Rosetta Genomics, the miRview™ meso product is a highly accurate test that can help physicians to more easily identify mesothelioma, which can be hard to differentiate from other cancers. The test also can help rule out a meso diagnosis in patients who have been diagnosed with adenocarcinoma of the lung and who also have been exposed to asbestos, which is known to cause mesothelioma.

An article published in the most recent edition of the Surgical Endoscopy Journal shares the results of a recent study of an electrocautery pleural biopsy technique using a specialized insulated-tip diathermic knife (IT knife). The study hoped to prove this new procedure would allow physicians to obtain a larger sample than traditional biopsy methods, thereby making pathological examination easier, and allow more accurrate diagnosis of malignant pleural mesothelioma.

The study was headed by Shinji Sasada of the Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan. Scientists compared specimens obtained using the IT knife, as compared to standard flexible forceps (SFF) during semirigid pleuroscopy, and resulting diagnoses, in 20 patients. Subjects all had unexplained pleural effusion.

Results revealed that the IT knife biopsy was superior to SFF in 8 of 20 patients, produced diagnositc yields from specimens in 85 percent of cases (17 of 20 cases) versus 60 percent of cases using SFF (12 of 20 cases).

Researchers conluded that “electrocautery biopsy using the IT knife during semirigid pleuroscopy has great potential for diagnosing smooth abnormal pleura which are difficult to biopsy with SFF.”

Last year, we reported on the establishment of a mesothelioma research project in Minnesota, which is examining the possible link between taconite mining and mesothelioma. The five-year research program received $4.9 million in funding from the Minnesota state legislature in April 2008, and is being directed by the University of Minnesota in partnership with the Minnesota Department of Health.

This week, university researchers announced they are ready to begin recruiting current and former taconite workers on Minnesota’s Iron Range, and their spouses, to participate in a screening program.

Preliminary research actually began in Summer 2007, but got a boost from the legislature’s funding, allowing the study to expand significantly. The funding established the Minnesota Taconite Workers Lung Health Partnership task force.

There are four health studies associated with the project:

• a motality study under the direction of the Minnesota Department of Health related to miner deaths
• a cancer rate incidence study
• a respiratory health assessment for miners or former miners
• an occupational exposure study

According to an update in the Star Tribune, which serves the Twin Cities, Minneapolis and St. Paul, “since last year, researchers have been collecting data they need to determine why Iron Range miners die from mesothelioma at higher rates than others.”

Researchers hope to recruit around 1,200 current and retired workers for the new screenings, plus about 800 of their spouses.

Mesothelioma has been linked exclusively to asbestos exposure, so this study seeks to determine what similarities may exist in the taconite mining industry and the taconite mineral that produce high incidences of mesothelioma among its workers.

Asbestos is still not completely banned in the United States. It can still be found in a great number of products. WHY?

Asbestos industry documents from as early as 1924 indicate that manufacturers knew there was a danger to workers who inhaled asbestos fibers.

Then in 1953, Dr. Irving Selikoff, a pulmonary specialist, began studying the link between asbestos exposure and lung disease. He noted a much higher percentage of lung disease among workers who inhaled asbestos fibers. Selikoff’s groundbreaking findings about of the occupational danger of asbestos expsoure was published in 1964.

And yet, it wasn’t unitl the mid-1970s that asbestos use was widely banned, and even today, its use is not completely banned.

Selikoff hoped his findings would make the future brighter for workers, protecting them from such devastating illnesses as those suffered by the generations who had come before.  Sadly, Selikoff passed away in 1992, before ever seeing asbestos eliminated in America, or seeing the threat of mesothelioma become a thing of the past.

With such clear evidence of the link between asbestos and mesothelioma, why is this still even a question??

Among the most interesting discussions at the recent International Symposium on Malignant Mesothelioma, held in Washington, D.C., June 25-27, was a panel discussion about the challenges of finding treatment once a patient is diagnosed with mesothelioma. The panel featured physicians from three of the leading programs in treating peritoneal mesothelioma, Dr. Paul Sugarbaker, Dr. H. Richard Alexander, and Dr. John Chabot.

Peritoneal mesothelioma affects the lining of the abdomen, and makes up about 10-15 percent of all mesothelioma diagnoses. The more common form of mesothelioma is pleural, which affects the lining of the chest and lungs. All mesothelioma is linked to asbestos exposure.

The current “best practice” for the treatment of mesothelioma is a multi-modality approach, which is a combination of surgery and chemotherapy, along with immunotherapy.

“It’s a sequence of treatments that make sense,” Dr. Chabot explained.

However, Dr. Sugarbaker pointed out, only a small fraction of mesothelioma patients receive multimodality treatment.

“So many more things could be done to manage the treatment of this rare disorder,” Dr. Sugarbaker said. “We should have accumulated many thousands of data points on people with peritoneal mesothelioma. Unfortunately, a majority of patients in the U.S. do not get to a treatment center.”

There are still only a handful of treatment centers that specialize in mesothelioma, and even then there are distinctions in the treatment of peritoneal or pleural mesothelioma that narrows the field even further. Also, there are not a large number of physicians currently treating mesothelioma, and no established surgical training programs specifically for this field to develop more doctors experienced in mesothelioma treatment.

Awareness also is still an issue. Many patients are diagnosed too late for effective treatment.

Even if awareness is high and a patient is diagnosed early enough to be a viable candidate for successful mesothelioma treatment, the logistics of receiving treatment can be difficult. Most of the centers for mesothelioma treatment are located on the East Coast. There is one on the West Coast, but almost no options in the Midwest or other areas of the country. Treatment is usually extended over many months, making it necessary for patients to relocate to be near a treatment center if they are not lucky enough to live nearby.

“People often move and rent temporary housing. People live in trailers,” Dr. Chabot said. “More advocacy is needed to provide patient and family support for treatment. The travel issues for people who need treatment are huge.”

The Mesothelioma Applied Research Foundation, which sponsors the annual Meso Symposium, is laying the groundwork to facilitate discussions and establish a collaborative strategy, simply by bringing together the experts in this field. There is an emphasis now on forming a consortium to establish a new standard of care, and to try to combine the knowledge of the existing research and treatment centers, and to expand access to that research and treatment.

But, the experts acknowledge, there is still much to do.

More than 230 people gathered in Washington, D.C., last week to attend the 6th Annual International Symposium on Malignant Mesothelioma, presented by the Mesothelioma Applied Research Foundation. This was the largest attendance to date for the event, and 170 of that number also participated in Advocacy Day events, visiting their Congressional delegates on Capitol Hill.

This annual symposium is “for everybody” affected by mesothelioma. This includes patients, caregivers and family members, and those who have lost a loved one to mesothelioma, as well as advocates and scientific and medical experts. The event is designed to provide education about new research and treatment, to assist meso patients and their families and loved ones with coping skills and a network of support, and provide advocates with the tools to help make an impact in the effort to raise awareness about mesothelioma and the dangers of asbestos exposure, and to raise funds for research.

“I don’t think any community knows more about holding onto hope in the midst of difficult circumstances than mesothelioma patients and their families, ” said MARF executive director Chris Hahn. “But there is still a perception of mesothelioma as an orphan disease. It is overlooked, by the government, by the average person, despite the huge presence of asbestos in our society,” he said.

Mesothelioma is a deadly cancer that affects the lining of the chest wall or, more rarely, the abdomen, and, in very rare instances, the heart. It is caused by exposure to asbestos, and may have a latency period of up to 40 years or more from the time of exposure until symptoms manifest. It is difficult to diagnose, and often is misdiagnosed until too late for effective treatment. Even if diagnosed early, treatment is often difficult, and there is currently no known cure.

The Mesothelioma Applied Reserach Foundation is the largest independent program for mesothelioma reserach and support in the world. It operates a competitive grant program that awards up to 10 grants, or $10 million, each year to research projects most likely to lead to better treatment.

The Foundation is a non-profit organization whose main mission is dedicated to “eradicating the life-ending and vicious effects of mesothelioma.”

MARF needs funding. This is the only organization dedicated to the research and treatment of mesothelioma, but it is facing the same struggles that many other charitable foundations are facing in this tough economy – donations are down, funding is stretched thin. The foundation received 59 grant applications in 2008 – programs that WANT to explore and investigate mesothelioma in search of earlier diagnosis, better treatment methods and, ultimately a cure. But the Foundation was only able to fund five new programs in 2008.

It is estimated that 3,300 new cases of mesothelioma will be diagnosed each year.

Mesothelioma, once considered an industrial disease affecting primarily older men, is being diagnosed in younger and younger people. In 2008, a 3-year-old girl was diagnosed with mesothelioma. Mesothelioma is everybody’s problem. We cannot afford NOT to support mesothelioma research.

For more information about the Mesothelioma Applied Research Foundation and how to make a donation, visit them online.

The Foundation also needs volunteers. There are a number of ways you can help, from advocacy efforts to planning a fund-raising event, to simply helping put out the word about mesothelioma and the effects of asbestos exposure. You can find that information on their web site, too.

This was my first experience at the Symposium, and it was emotionally and intellectually exhausting, and inspiring, and motivating. I met some amazing people who, despite being personally devestated by mesothelioma, are determined to keep fighting. I’m amazed by this great group of folks.

I plan to add many more stories from information presented at the conference, and from the people I met there, in the next several days, so please check back! It’s too much to tell in one post!

As those of you who follow this blog probably already know, I’ll be traveling to Washington, D.C., next week to attend the 2009 International Symposium on Malignant Mesothelioma, which is being presented by the Mesothelioma Applied Research Foundation (MARF). On Friday morning, a regular part of the conference is a Tribute Ceremony to honor those who have lost their struggle against mesothelioma. This is a poignant time to recognize those who were so needlessly lost, and to provide a way to communicate the urgent need for funding for research and treatment.

During the Tribute Ceremony, MARF will create a collage of photos of these loved ones who have passed away. I would be more than honored to carry your photo to Washington to add to this Tribute. You may send your photo electronically, by email, and I will make color prints to add to the collage. Please let me know if you would be interested in this. You can email mymeso@gmail.com or email me directly at wendi.lewis@beasleyallen.com.

On Thursday, I also will have the opportunity to visit Capitol Hill to ask our congressional representatives to provide federal funding for mesothelioma research and treatment, and for the ban of asbestos. Please take a moment to sign the petition for these endeavors – there is a link on our home page.

I look forward to attending the Symposium next week, and will be blogging from the conference, which will provide a wealth of information about the latest progress in mesothelioma research and treatment. The conference begins on Thursday, June 25, with the visits to Capitol Hill, and continues through Saturday featuring distinguished physicians, researchers and advocates. I’m sure there will be a lot of valuable information to share.

God bless you all!

I reported last week that Debbie Brewer, our friend in the UK, had another amazing report from Germany, where she has been undergoing chemoembolization to treat her mesothelioma. Her tumor has now shrunk a total of 83 percent! Debbie is sharing her experience with media in Britain, hoping to gain more widespread acceptance of chemoembolization as a treatment for meso, and to raise awareness that the therapy, currently in clinical trials, exists.

Debbie was diagnosed with mesothelioma in November 2006, at which time her doctor gave her only a few months to live. That was when Debbie began looking for new treatments. She began chemoembolization in May 2008.

Chemoembolization, which is being pioneered by Dr. Thomas J. Vogl at J.W. Goethe University Hospital at Frankfurt University, introduces chemotherapy directly into a tumor, where it is basically sealed off so that it is concentrated in the area of need. The clinical trial started three years ago, and will continue for about two more years. The treatment is only available at the clinic in Germany.

Recently, BBC News featured Debbie and her efforts to bring chemoembolization to the UK, and beyond.

Watch the video.

This is a reminder to our readers that the Mesothelioma Bowlathon fund raiser is set for tomorrow, March 21, at Ormond Lanes in Ormond Beach, Fla. This event is being organized by Tara Music, in honor of her father, Ray Beltrami, who passed away as a result of mesothelioma on July 1, 2008.

If you live in the Ormond Beach area, it’s not too late to participate! The event is set for 1-3 p.m., with registration beginning at the bowling alley at noon. The $15 registration fee includes three games, lunch and a t-shirt. Proceeds will benefit the Mesothelioma Applied Research Foundation, which is the national organization dedicated to eradicating mesothelioma as a life-ending disease.

If you are not able to participate in the event, you can still make a donation. Mail your contribution to Tara’s attention at 11 Woodgate Court, Ormond Beach, FL, 32174. For more informatin, you can email Tara at tmusic1@cfl.rr.com or call 386-405-8264.