Study Shows Bevacizumab Improves Survival in Mesothelioma

VaccineA Phase 3 French study, which will be presented at the American Society of Clinical Oncology (ASCO)’s annual meeting at the end of May, demonstrated improved survival rates for those patients who received bevacizumab in addition to the current standard chemotherapy regimen of pemetrexed/cisplatin. Bevacizumab (Avastin® Genentech, Inc.) is an antibody that blocks angiogenesis (blood vessel growth), and it is already routinely used to treat many other cancers, including lung cancer and colon cancer.

“The mesothelioma community has been waiting for this kind of news for a long time—it is the first positive phase III trial in mesothelioma since the original study of pemetrexed/cisplatin over 10 years ago,” said Dr. Lee M. Krug of Memorial Sloan Kettering Cancer Center and chair of the board of directors of the Mesothelioma Applied Research Foundation.

“The addition of bevacizumab has the potential to become a new standard of care for first-line therapy in this disease,” he added.

The study, conducted between 2008 and 2014, included 448 patients treated in 73 centers. The patients were randomized into two arms– one received standard chemotherapy (pemetrexed and cisplatin) and the other received standard chemotherapy plus bevacizumab. Overall survival was significantly longer in the experimental arm (median: 18.8 months vs. 16.1 months). The study concluded that adding bevacizumab in addition to pemetrexed/cisplatin provides a significantly longer survival in patients with malignant pleural mesothelioma, with acceptable toxicity, making this triplet a new treatment paradigm.

A Message from the CEO

Melinda Kotzianby Melinda Kotzian, Chief Executive Officer, Mesothelioma Applied Research Foundation

Over the last 24 hours, news broke that some cancer charities raised funds and did not use the money responsibly. The Meso Foundation has always prided itself on transparency when it comes to financials. We voluntarily subject our organization to an audit every year and then submit our financials to be reviewed by Charity Navigator (they rate us as a 4-star (out of 4) charity and give us a transparency score of 100 (out of 100)) and the Better Business Bureau. At curemeso.org/about, you can view our latest 990, financial statements, and annual report.

To make sure that other charities are financially responsible, you can do the following:

  • Look for financial statements and annual reports on the organization’s website
  • Check www.charitynavigator.org or www.bbb.org to see how the organization is rated
  • Call the organization and ask how much of their money is going toward programs

A reputable nonprofit organization will have a level of financial transparency. At the Meso Foundation, individuals contribute 65% of the money coming in to the organization, while law firms and pharmaceutical companies contribute the remaining 35%. Of these contributions, 86% goes directly into our programs, including patient and family support, research, education, advocacy, and prevention. Additionally, 9% goes towards fundraising and 5% goes towards management.

With $0.86 per dollar going into programs, the Meso Foundation is able to help over 600 patients, caregivers, and bereaved per month and has funded $9 million in mesothelioma research. Additionally, with the help of our advocacy programs, $9.3 million in government funding has been contributed to mesothelioma research.

To learn more about the Meso Foundation, what we do, and how we rely on donations, visit curemeso.org/about.

GUEST BLOG: Meso Patients Eligible for Access Pass to National Parks and Federal Recreation Areas

Streamby Sandy Robb

Many of you have in previous years posted pictures about your travels around the country, and many seem to enjoy the national parks and other federal facilities. With summer coming, there may be a way for you to save some money while enjoying those beautiful areas.

As you are aware, the Social Security Administration classifies malignant mesothelioma as the basis for a disability determination. One of the benefits that attach to that status is the availability of a free, lifetime Access Pass that allows free entry and numerous discounts at national parks, federal recreation areas, and facilities managed by the Forest Service, the National Park Service, Fish and Wildlife Service, Bureau of Land Management, and Bureau of Reclamation. Generally, the Access Pass means that the person and his or her vehicle (up to 4 adults) will be admitted free to the national parks, wildlife refuges, national forests, and other facilities run by these agencies.

The savings allowed by the pass can be quite substantial. To put it into perspective, both Yellowstone National Park and Yosemite National Park charge $30 entrance fees per day, but both are free to Access Pass holders. In addition to park admission benefits, the Access Pass entitles the passholder to discounts on amenities, campgrounds, boat launches, guided tours, and so on. Each facility will have its own guidelines for discounts. It should be noted that the pass is not honored everywhere; for example, the Access Pass is not accepted at Gettysburg. An overview of the Access Pass is available at http://store.usgs.gov/pass/access.html.

Anyone who has been rated as disabled by the SSA (or the VA) can obtain the Access Pass, either at one of the facilities authorized to issue them on-site, or through the mail. The mail-in application costs $10.00, while the in-person version is free.  The list of facilities is long, and can be found at http://store.usgs.gov/pass/PassIssuanceList.pdf. The mail-in application is found at http://store.usgs.gov/pass/access_pass_application.pdf.

To obtain a pass you must have identification to verify that you are a U.S. citizen or permanent resident, such as a US passport, a US state or territory driver’s license, or birth certificate or a permanent resident card (Green Card). Also, you will need documentation of your permanent disability.  Acceptable forms of proof include:

  • A statement signed by a licensed physician attesting that you have a permanent physical, mental, or sensory impairment that substantially limits one or more major life activities, and stating the nature of the impairment;
  • A document issued by a federal agency, such as the Veteran’s Administration, which attests that you have been medically determined to be eligible to receive benefits as a result of blindness or permanent disability;
  • Proof of receipt of Social Security Disability Income (SSDI) or Supplemental Security Income (SSI); or
  • A document issued by a state agency (e.g., the vocational rehabilitation agency) that attests that you have been medically determined to be eligible to receive vocational rehabilitation agency benefits or services as a result of medically determined blindness or permanent disability.

If you’re in doubt about what to supply, contact the issuing agency.

Enjoy your travels, and be sure to share your photos with us when you go.

Meet the Mesothelioma Experts: Drs. Alley and Simone of Penn Medicine

Penn MedicineOn Thursday, May 14 at 8PM ET, the Meso Foundation will interview Drs. Evan Alley and Charles Simone of Penn Medicine during a new installment of the Meet the Mesothelioma Experts live teleconference series. The interview will be led by the Meso Foundation’s executive director and expert mesothelioma nurse practitioner Mary Hesdorffer.

This session, titled Focus on Mesothelioma Centers of Excellence: Penn Medicine, is the second installment in a series of interviews highlighting mesothelioma centers of excellence.

The session will be available live on Thursday, May 14 at 8PM ET by dialing into the conference call. The session is available at no charge, but those interested in participating must RSVP ahead of time in order to receive the call-in number. Please RSVP at curemeso.org/experts.

RSVP

Drs. Alley and Simone are the co-directors of the Penn Mesothelioma and Pleural Program. Dr. Alley is a medical oncologist and is the leading investigator in the PD-1 inhibitor trial that has recently made big news in mesothelioma. Read more about the trial here.

Dr. Simone treats patients with malignant pleural mesothelioma with photon and proton radiation therapy and photodynamic therapy (PDT). He is a National Institutes of Health and Department of Defense funded investigator who performs clinical and translational research investigating the novel use of proton therapy and PDT as definitive therapy and as part of multi-modality therapy for mesothelioma.

To RSVP to this session and learn more about the Meet the Mesothelioma Experts series, visit curemeso.org/experts.

GUEST BLOG: Post-Treatment Stretching Techniques

Stretchingby Carol Michaels

Stretching is one of the basic components of fitness. Stretching improves your range of motion, which is the degree of movement that can be achieved without pain. Elongating the muscle and fascia by stretching improves circulation, increases elasticity of the muscle, increases oxygen to the muscles, and helps the body to repair. It increases the circulation of blood to the muscles and prevents tight muscles, which have less blood flow. The blood carries oxygen that the muscle needs for energy. Blood flow also removes lactic acid and carbon dioxide, which cause inflammation.

Stretching should be performed every day, after receiving medical clearance. The older you are, the more important daily stretching is to maintain flexibility. Commit to stretching regularly so that you gradually improve your posture, range of motion, and flexibility. It will help you manage the stress and anxiety of the disease.

First, warm up for 5-10 minutes by marching in place or use a stationary bicycle while swinging your arms. Stretching is more effective when warm. The muscles and tendons are easier to lengthen when warm. Then perform the stretching exercises daily in the beginning of your recovery if possible. Use only smooth, controlled non-bouncy movements.

All movements should be done slowly and with great concentration. Try to reach the maximum pain-free range of motion possible for you. Do the stretches slowly and allow the tissue to lengthen. Hold the stretch until you feel a little tension, but not to the point of pain. The goals are to restore joint mobility and break down residual scar tissue.

At first, you might suffer from fatigue and low endurance and might only be able to exercise for a short period of time. Every day you can lengthen the session. Patience and practice will pay off. As you get stronger, you can increase the length of your sessions.

Once you have achieved an acceptable range of motion, it is usually necessary to continue your stretching program so you can maintain that range of motion. If you have had radiation, stretching is very important to help keep your body flexible. Radiation typically causes additional tightening and can impact the affected area for a year or longer after the treatment is finished.

The Recovery Fitness® program uses a combination of active stretching and static stretching. In active or dynamic stretching, the stretch is held for 1-2 seconds and repeated 10 times. In static stretching, the stretch is maintained for approximately 10-30 seconds and can be repeated several (2-3) times. You should move in and out of each stretch slowly and smoothly.

The following is an example of shoulder flexion active stretching: Bring the arm upward and hold for 1-2 seconds and then lower it back to your starting position. Repeat 10 times. With each repetition, raise the arm higher until you feel tension, but not pain. Exhale as you bring your arm up and inhale as you bring your arm down.

Active stretching is used in the beginning of your session. You can then begin to hold the stretch longer and alternate between static and active stretching. Our muscles work in pairs: one muscle works or contracts, while the other relaxes or lengthens. As your stretching session progresses you will determine how long to hold the stretch. The amount of time one should hold a stretch depends on the individual. By listening to your body and using common sense, you will be able to determine what feels good and what works best. Stretching, especially active or dynamic stretching helps you to get ready for any physical activity. Examples of dynamic stretches are walking lunges, squats, and arm circles. Dynamic stretching acts as a warm-up to reduce injuries, get the muscles warm, and improve performance.

Some tips:

  • The brain and nervous system work together in every stretch, and every repetition causes neuromuscular education. By thinking about the movement and concentrating on the affected muscle, we rewire the injured or tight muscle. Be mindful of the movement and its purpose.
  • Slowly lengthen the muscle to a comfortable length while using relaxation breathing
  • The stretches should feel good. Hold the stretch until you feel tension. As you hold the stretch the muscle will relax and you will be able to increase the stretch. Each day it will get easier and you will see your flexibility improve.
  • Modify the stretches to take into account your day-to-day pain and fatigue levels. Do not worry if you are less flexible on a particular day. Just do your best and modify the stretch as needed. You might only be able to perform a few of the stretches on a particular day, or you may need to decrease the length of your session. You may also modify your flexibility routine by reducing the amount of time the stretch is held or changing the number of repetitions performed.
  • Stretching can be performed while standing, sitting, or lying on the floor. Most can even be done in bed.
  • Add a variety of angles to each stretch. For example, if you perform a shoulder stretch with your arm parallel to the floor, try doing the same stretch with the arm at an angle pointing toward the ceiling.
  • Stretching improves posture.
  • Each movement helps to move lymph through the body.
  • Stretching improves movement patterns and decreases the chance of developing over-use injuries.
  • Stretching with relaxation breathing reduces stress.
  • Stretching increases feelings of well-being. You are able to perform your daily activities more easily and with less pain.

Radiation treatment can cause additional tightening. Ongoing flexibility exercises are always recommended to those who have had radiation so that they are able to maintain their range of motion and all of the benefits that good flexibility brings.

Learn more about fitness for cancer patients in our previous articles by Carol Michaels: First Steps to Starting an Exercise Program and Relaxation Breathing, Stretching, and Initial Exercise Precautions.


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.