Summary of Mesothelioma Studies Presented at ASCO

Microscopeby Lee M. Krug, MD, Memorial Sloan Kettering Cancer Center

The American Society of Clinical Oncology meeting was held from May 30 – June 3, 2014 in Chicago. This is the largest oncology meeting each year with around 30,000 attendees from all over the globe who congregate to discuss the latest research in all cancer types. I will provide you with my annual summary of the most prominent studies in mesothelioma.

Randomized trial of arginine deprivation with ADI-PEG20: This abstract was presented by Dr. Szlosarek from the United Kingdom. Arginine is an amino acid that normal cells make using an enzyme called ASS (time to make the joke here!). However, many cancer cells lack the ASS enzyme so they cannot make arginine and they need to get it from outside the cell. ADI-PEG20 starves the cancer cells of arginine. In this trial, patients with mesothelioma were randomized to receive treatment with ADI-PEG20 or just supportive care. In order to qualify, the tumor samples were tested to make sure they had low levels of ASS. Side effects were very mild with this treatment. About half of the patients had stabilization of their disease. The time for cancer growth to occur was longer in the ADI-PEG20 arm, but only by a small margin (1.9 versus 3.2 months). A future study will combine ADI-PEG20 with chemotherapy, and that trial should open later this year.

Phase 2 study with tremelimumab: Probably the hottest drugs in oncology right now are the antibodies that boost the immune system. These types of treatment have shown great benefit in melanoma, lung cancer, and many others. Tremelimumab is one of these drugs, and this trial, conducted in Italy by Dr. Calabro and colleagues, showed that mesothelioma also responds to these therapies. Of the 29 patients, 14% of patients had shrinkage of their mesothelioma and 38% had stabilization. These data support the international, randomized trial with tremelimumab that is currently ongoing that will include 542 patients. If this large trial shows that tremelimumab improves survival, this drug will get FDA approval for mesothelioma.

Anti-mesothelin vaccine CRS-207 plus chemotherapy: Dr. Hassan from the National Cancer Institute reported these results. Mesothelin is a protein on the surface of mesothelioma tumors, and seems to be an excellent target for treatment. CRS-207 is a vaccine that increases the immune response against mesothelin. In this study, CRS-207 was given with pemetrexed and cisplatin. Nearly 70% of patients had shrinkage of their cancer, much more than usual with chemotherapy alone, and the responses seemed to last longer. These results should encourage a larger future randomized study.

Next-generation sequencing in mesothelioma: The report from Dr. Scagliotti at the University of Turin, Italy, described his findings from an analysis of gene mutations in a group of mesothelioma tumor samples. This type of testing has become critical for identifying potential targets in all cancers, and customizing treatment for each patient.


Lee M. Krug, MD, is an Associate Attending Physician in the Division of Thoracic Oncology, Department of Medicine at Memorial Sloan-Kettering Cancer Center in New York, New York, where he completed a fellowship and chief fellowship in medical oncology. Dr. Krug is the Director of the Mesothelioma Program at Memorial Sloan-Kettering Cancer Center. He is also the chair of the board of directors of the Meso Foundation.

GUEST BLOG: Sarah Lackner Attends the Charlie Cole Golf Classic

Lynn Cole and Sarah Lacknerby Sarah Lackner

I spent the third weekend in May in Asheville, North Carolina on behalf of the Meso Foundation at the 3rd Annual Charlie Cole Golf Classic hosted by Lynn Cole, along with her children, Matt and Katie, in memory of her husband, Charlie, who lost his battle with mesothelioma on March 31, 2010 after only 17 months.

I hadn’t met the Cole family prior to this weekend, but what occurred during that quick less-than-48-hour trip is exactly what the Foundation is about. The warmth and strength that the family displayed, their incredibly supportive and loving friends, as well as other local meso community members all contributed to making the day an absolute success.

Not only was I able to thank the Cole family for their commitment, their friends and family for their support, I was able to spend time truly connecting with each of them. Katie and I were the same age when we lost our parent and zipping around on the golf cart gave us a few hours to share our experiences, both of the loss and of life after the loss. Later that evening, Matt and I were able to also have those conversations that only occur with someone who has been through what we as a community go through. C.S. Lewis says that friendship is born that moment when one man says to another “What? You too? I thought that no one but myself…”

Charlie Cole Gold ClassicThis event was, for me, everything that the Foundation works for: supporting research, education, support, and advocacy programs through raising funds and awareness as well as bringing together those affected by mesothelioma. It takes what is often an isolating disease and provides a place where if you want to talk about it, everyone understands, and if you don’t want to talk about it, everyone understands.

Thank you, so much, Lynn, Matt and Katie for allowing me to share the weekend with you. And thank you for believing in and working towards a cure.

Calling Him Dad: What My Father Meant to Me

Jennifer Gelsick dancing with her father, Donald Edward Smitley, who was diagnosed with pleural mesothelioma in January of 2012.by Jennifer Gelsick

When I was asked to write about my Dad, I struggled with it. I wasn’t sure where I should start. My father, Donald Edward Smitley, was born on April 25, 1956. He was diagnosed with pleural mesothelioma on January 30, 2012 and fought as he lived, with faith, grace, and love, until he took his last breath on October 15, 2013 at the age of 57. Mesothelioma ultimately took his life, but it was a beautiful life, and he was so much more than just a disease.

Over these past few months, I’ve been reflecting on what it was like growing up with my Dad. I had told many people that I would have rather had 30 short years with him as my father than 100 with someone else. I mean that from the bottom of my heart. My Dad was the perfect father to me.

Growing up, there aren’t a lot of memories that don’t involve my Dad’s laughter. He had an unfailing knack to make the best of any situation and bring out the best in those around him. People were always drawn to him; he had a magnetic personality that just made people want to be close to him. I was blessed to have him all the time.

Dad was a handyman. He could literally fix anything. In my home, there was never a call to a plumber, contractor, or electrician. Mom and I just told Dad what was broken, and the next thing we knew, it was fixed.

Dad was a musician. He always said he just “played at” the guitar, but he had the most beautiful voice. I remember growing up and sitting with him while he played and sang. He would always sing “You are My Sunshine” to me, and “Rocky Top” became what he called his theme song. Later on, he worked up the courage to begin singing in Church and became a staple at community events; people loved to hear him sing. His love of God and neighbor always shone through. He also joined a bluegrass band called The Dunbar Boys (named after the town where he lived his whole life) and loved being on that stage performing for whomever happened to be around. It didn’t matter if there were 10 people or 300 people there; he always had the best time singing with his friends.

Jennifer Gelsick remembers her father, Donald Smitley, who lost his battle with pleural mesothelioma in October of 2013.Dad was a special kind of dad. He was fun, goofy, and never afraid to look silly to make me smile. We were watching some home movies over Christmas where Dad and I were walking our dogs. Then, of course, I decided to walk Dad. I put the chain around his waist and dragged him all over the place. Some neighbors who were outside asked him what he was doing and he just laughed and said, “I’m getting walked!” He was constantly doing things like this. When he saw that I was happy, he was happy too.

Even though I danced my whole life, Dad wanted me to try out all different sports. Not necessarily by being on an official team, but with him. We spent hours outside playing baseball, kickball, and throwing a football around. I never exceled at any of these activities, but looking back, he was trying to help me become more well-rounded (or maybe to just be able to play games with the other kids). Plus, he liked chuckling at me when I would kick as hard as I could and miss the ball completely.

We were always going on adventures together. Whether it was taking a ride in the mountains or trying to bake cookies at home, he made even the most seemingly ordinary activity special. My Mom worked late one night a week; I was never in bed on time those nights. It became a game to see if I could get ready and be “asleep” under the covers by the time she got home. We never made it.

You would think that these things would have changed a bit as I got older, but they didn’t. Every Saturday morning was our time. Mom would be at work, and we’d be off. We would go out to breakfast, shopping, up to the mountains, for ice cream, do a project at home, and visit family… all in the same day. Those days are such precious memories for me.

Dad was more than just fun. We always had the kind of relationship where we could talk about anything. Dad gave the greatest advice of all time. No topic was off limits for us: school, work, faith – we discussed it all. He always knew exactly what to say. If he wasn’t sure, he would tell me to let him think about it and he would let me know what he came up with later. And he always did.

The day my Dad passed away, a piece of me went with him, but a piece of him stayed here with me. Even when he felt his worst, he wanted to work to help others battling mesothelioma. He believed that if he could help even one person, then what he was going through was worth it. His faith in God always carried him through.

I am honored to continue to work with the Mesothelioma Applied Research Foundation as a part of their Rising Leaders Council to help to eradicate this awful disease that causes so many families to be torn apart. I am also a part of MesoConnect, which allows me to remain in close contact with those in the meso community and do my best to help them heal, vent, and grieve. This organization does so much for so many, and my family and I will be forever grateful to them.

I could write a book, or 50, about Dad and his kindness, generosity, and genuine love for life, God, and his family. He was perhaps the single most powerful influence on my life. He didn’t just tell me how to live a good life, he showed me. This is a true testament of the life of the most amazing person I’ve ever known, and I was blessed to be able to call him “Dad.”

GUEST BLOG: A Mother’s Day Letter from Sarah Lackner

Sarah Lackner and motherby Sarah Lackner

May 10th, 2014 will mark the three year anniversary since my mom passed away from mesothelioma. She was 57 years old. This year, her anniversary is the day before Mother’s Day, which, for those of you who knew her, is perfectly fitting.

I was 21 when my mom was diagnosed with meso and 23 when she passed away. Tragically, my mom’s diagnosis was not the first time I heard the word mesothelioma, and her passing was not the last time our family would suffer a loss from it. Sixteen months after my mom passed away, her sister, my Aunt Linda, lost her own battle with the disease.

Mesothelioma has been woven into my family’s story for over 30 years. As a child I didn’t comprehend the harshness of this cancer, I just knew it was something Uncle Jimmy, my mom’s brother, had passed away from when I was a baby. I knew asbestos was why I never met my grandparents. While meso will always be part of my family history, I am determined to make being part of a cure, my legacy. That is why I’ve joined the Mesothelioma Applied Research Foundation’s newly formed Rising Leaders Council. The council will help the Foundation obtain resources needed to continue its quest to eradicate this disease. Each council member will be asked to either individually donate or fundraise for a specific amount. Whether you’re fighting meso yourself or fighting to honor a loved one, WE, more than anyone, need to stay involved.

With that, I ask that you join with me in committing to support the Foundation by joining the Rising Leaders Council. When you become a Council member you will:

  • Receive an invitation to a quarterly call with other council members and staff to get an insider look to the Meso Foundation’s current projects and goals.
  • Become a Meso Foundation Representative at community events.
  • Receive an invitation to the VIP reception at the 2015 Symposium.
  • Be given special recognition at the 2015 Symposium.
  • Have the ability to honor your loved one or current patient.

You can learn more about the Rising Leaders Council and sign up at curemeso.org. Please take this opportunity to make a difference in the lives of others.

GUEST BLOG: Relaxation Breathing, Stretching, and Initial Exercise Precautions

Relaxationby Carol Michaels

Exercise is good for our physical and emotional health. It is one thing that you can control and do for yourself. It is empowering. Physical activity can decrease depression and anxiety, reduce stress, increase confidence, and build positive health habits. Exercise can improve endurance, increase energy level, and decrease the fatigue that may be caused by treatments.

Relaxation Breathing and Stretching
There is an emotional toll that cancer survivors face in addition to the physical one. A cancer diagnosis can cause depression, anger, anxiety, fear and stress. Proper breathing techniques and stretching can improve the psychological recovery.

Research has shown that breathing can help reduce stress and anxiety. When feeling stressed, we usually take shallow breaths. During these exercises we will use our full lung capacity and breathe slowly and deeply. You should be aware of your breathing as it has a calming effect. Inhale for 5 seconds and fill the torso up with air, then exhale from the lower abdomen for 5 seconds, pressing the navel in towards the spine. Imagine all of your tension and stress leaving your body with each exhalation.

You should begin relaxation breathing immediately after surgery, as it allows you to focus all of your energy on healing. The stretching program will restore mobility in the chest and back that allows for freer movement of the lungs and diaphragm. We will discuss stretching in a future article.

Cancer surgery and treatments affect many areas of the body. I hear numerous complaints of stiffness, pulling, tightness, and a lack of flexibility. Often this occurs when the muscles and skin are shortened because of the surgery, which can also leave scar tissue. Surgery can irritate the nerves. As a result, you may feel burning, tingling, or numbness.

When can you start an exercise program after having cancer surgery and treatments? You should start stretching exercises as soon as you get clearance from your doctor. It is important to talk to your doctor before starting to exercise. This way you can determine what program is right for you.

Initial Exercise Precautions:

  1. Your immune system may be compromised, which places you at risk for infection. Gyms carry a high risk for infection. Exercise at home while your immune system is weak.
  2. If you have poor balance, you may want to start with exercises that are safer for those who have balance problems. Poor balance may be due to the chemotherapy, weak muscles, neurological issues, or normal aging. A common side effect of chemotherapy is peripheral neuropathy, which changes the sensation in the legs or arms. It can last a short time or be long-lasting. This can affect the way you walk, your balance, and your general movement. If you have peripheral neuropathy, you should select activities that decrease your risk of falling. For example, we recommend avoiding uneven surfaces and exercising with a stationary bike instead of a treadmill without handles. Strengthening your core will help your balance. It is also a good idea to keep all the muscles strong to compensate for the ones that are affected by the neuropathy.
  3. Be smart and safe by doing the exercises that are right for you at this particular time. You are exercising to get healthy, not to get hurt. This is an important point to keep in mind, particularly for those who were physically active before cancer. You will not be able to immediately resume the same level of pre-cancer activity.
  4. Exercise in a temperature controlled environment. Cold temperature can crack your skin, while extreme heat can cause swelling or light-headedness.
  5. At the start of your exercise program, you should warm up with deep breathing techniques and shoulder rolls. We recommend that you warm up before you stretch by walking, marching in place or using a stationary bike. You can also exercise after a warm shower, which may relax the muscles.
  6. Never hold your breath during an activity. People often hold their breath during exercise, so remember to breathe deeply.
  7. Drink plenty of water, especially when sweating.
  8. If your blood count or the mineral levels (potassium and sodium) are low, check with your health professional before resuming exercise.
  9. Some medications affect the heart rate, so your pulse rate is not a good indicator of the level of your exercise exertion.
  10. Learn to move slowly and smoothly without jerky movements. Do not continue an activity if it causes pain or unusual fatigue. You should feel a gentle stretch, not pain.
  11. Know your limits. You should be able to differentiate between discomfort and unusual pain. Stop if you feel pain.  Listen to your body and use common sense. If something does not feel right, do not do it. You should consult with your doctor if you are experiencing pain, swelling, or unusual fatigue.
  12. Wear comfortable and loose clothing and appropriate footwear. For those with peripheral neuropathy affecting the feet, supportive footwear is particularly important.

Exercise Progression
Many variables determine the exercises that are effective and safe for your particular situation. Every day brings new challenges and new accomplishments for the cancer patient. It is important to be able to modify your exercises to fit your needs at a given time.

Pain and fatigue levels can change from day to day, and even from hour to hour. You may wake up feeling fine, but may have increased fatigue as the day progresses. Track your energy levels throughout the day to determine the best time to schedule your exercise sessions. For example, if you have more energy in the afternoons, you should exercise in the afternoons.

Exercise when your energy levels are high. Common sense and listening to your body are of utmost importance. You should not feel like you have to follow a set protocol or a strict schedule. Your routine must be customized due to the numerous physical and psychological side effects you may be experiencing.

Both healing times and pain tolerance can differ greatly from one person to the next. Speed of recovery depends on your pre-surgery fitness level and type of surgery and treatments. The progression and timing of a cancer exercise program can only be determined after a thorough discussion between the patient and her or his healthcare professional.


Carol Michaels FitnessCarol Michaels is a cancer exercise specialist and creator of the Recovery Fitness cancer exercise program. Recovery Fitness is taking place at Morristown Medical Center and several other facilities in New Jersey. Michaels also wrote “Exercise for Cancer Survivors,” a resource for cancer patients going through surgery and treatment.