Looking for Inspiration

Running on treadmillby Mary Hesdorffer, NP, Executive Director of the Meso Foundation

I found myself on the treadmill looking for inspiration to go the extra mile. Two miles into it and I am running out of steam. I am not an ESPN fan, which means that I have to take inspiration from another source. Into my mind pops up the image of Joe Friedberg, MD.

Of course, I wonder, who else would channel Joe Friedberg while on a treadmill? Am I losing it?

As you know, Joe is a champion in the field of mesothelioma, toughing it out in the operating room with a grueling procedure, which has recently reported some promising results. I recalled a conversation with Joe when he suggested that to complete a pleurectomy decortication, one has to be totally committed to going the extra mile (as these operations last up to 8 hours) and one has to be willing to persevere through fatigue, and physical and mental challenges.

There has been much debate about surgery – extrapleural pneumonectomy (EPP) vs. pleurectomy decortication (PD) vs. those who believe that surgery should not be offered to patients with mesothelioma, and advocate for palliative care only.

I think about Joe in these debates, and his honesty and lack of bravado when he simply states that “we don’t know what is the best surgical option to offer patients and that all surgery in this disease is experimental.” Though the uncertainty is unsettling, the honesty is refreshing.

Recently, Dr. Friedberg and his team at UPENN have launched a new clinical trial that will randomize patients to either a pleurectomy decortication or a pleurectomy decortication coupled with photodynamic therapy. Joe has spent many years championing photodynamic therapy as an adjuvant therapy to his pleurectomy decortication surgery, making this clinical trial a one-of-a-kind move to get closer to the truth.

Doing 3 miles on a treadmill no longer seems daunting.

Here is why Joe’s courage is so important and why I hope others follow in his footsteps. It is well-known among researchers that most surgical studies have an inherent bias to them. In other words, a surgeon’s excellent numbers may be produced not only by their skill, but also by choosing to operate on patients who have the best chance to tolerate the surgery and do well after. The fact is, surgery often results in a surgical remission, but unfortunately, in mesothelioma, the cancer generally returns after a certain period of time. To extend the remission, surgeons use specific adjuvant therapies to lengthen the time to progression and, of course, create the best case scenario to prevent the return of disease. This is the crux of the discussion about what will kill the cells that are waiting like seeds in a garden ready to sprout into recurrent disease.

I am appalled to hear so many surgeons in this disease state quite frankly that their approach works and there is no need to do a randomized trial which will eliminate bias from their results. Worse yet are those surgeons who boast that their patients do better in their hands, with their procedure yet when I scour the literature there are no published reports in scientific journals. In academic medicine there is a phrase “If it isn’t published, it never happened.” In other words it is expected that you submit your results to a peer reviewed journal to demonstrate that your outcomes are accepted by your peers and your data has been analyzed by, and scrutinized by unbiased reviewers who are experts in the field of surgery. There is no room for arrogance when we are losing patients in these procedures. We need to know what is the true statistical difference. The gold standard is to compare a new hypothesis and test it against the standard to see if this really is a significant improvement.

Dr. Friedberg has reported some impressive results with his combination of pleurectomy decortication combined with photodynamic therapy, and now he’s willing to take a step further to understand if there is a difference between patients undergoing pleurectomy decortication alone from those getting both the surgery and the adjuvant therapy.

This is what the mesothelioma community needs – “proof of the pudding.” We truly do not know what is better so we need to strip back the notion of “my treatment works, and I don’t need to prove it.” Randomized clinical trials can help us find a gold standard of treatment for mesothelioma.

I guess, what that means is that I, too, should be going the extra mile on this treadmill. Mile 4, here I come.

Meso Foundation Updates its Peer-Review for Research Grant Funding

ResearchAs the only non-government funder of peer-reviewed mesothelioma research, the Meso Foundation has announced an update to its peer-review process for evaluating research grant proposals, so as to once again match the process by the National Institutes of Health (NIH).

The Foundation has always modeled its peer-review process after the NIH, so when the NIH made changes in 2013, the Foundation followed suit.

The change involves streamlining the reviews by eliminating the two-step process and replacing it with one step only. Instead of sending a project through two separate rounds of review, which would usually result in a total of 3-4 number of reviewers looking at each project, now all 3-4 reviewers evaluate the project in the one and only round. This ensures a quicker review turnaround and a more efficient process.

To learn more about the Meso Foundation’s research grant program, visit curemeso.org.

Asbestos Awareness Week: Counteracting Decades of Damage with Research?

AsbestosAwarenessWeek2014During the first week of April, the Mesothelioma Applied Research Foundation (Meso Foundation) will observe Asbestos Awareness Week while raising awareness of the deep damage inflicted by asbestos’ use and the overdue need for life-saving treatments and a cure for those who have already developed, or who will develop, mesothelioma. Mesothelioma is a cancer known to be caused by exposure to asbestos. The latency period between asbestos exposure and development of mesothelioma ranges between 20 – 50 years, meaning that patients of today were exposed decades ago, but also that patients of tomorrow have likely already been exposed.

Medical experts consider mesothelioma as one of the most aggressive and deadly of all cancers. With a 5-year survival rate in the single digits, mesothelioma currently has no cure. Approximately 3,500 Americans are diagnosed with mesothelioma every year and an estimated one-third were exposed while serving in the Navy or working in shipyards.

Asbestos, a catch-all term to describe a group of naturally-occurring mineral fibers, was used in construction for decades. Workers in a number of industries and occupations were regularly exposed to high amounts of asbestos fibers. Although, the United States has placed heavy regulations on its use, asbestos has still not been completely banned and continues to be used.

Today, the Environmental Protection Agency (EPA) estimates that asbestos is still present in tens of millions of homes, government buildings, schools, etc. Asbestos has also been found naturally-occurring in the soil in several locations in the United States, sometimes in very close proximity to inhabited areas. When disturbed, asbestos particles become airborne and are easily inhaled. Scientists have identified that no amount of exposure is safe.

“Unfortunately, asbestos’ prevalence has put all of us at risk,” said Mary Hesdorffer, nurse practitioner and executive director of the Meso Foundation.

“Given the extremely long latency period for developing mesothelioma, for thousands of Americans, the damage has already been done — the asbestos has been inhaled. Now it is our responsibility to invest in prevention research and to make sure that if they develop mesothelioma, life-saving treatments and a cure are waiting for them,” added Ms. Hesdorffer.

The Meso Foundation is the only non-government funder of peer-reviewed scientific research focused on prevention, early detection, development of effective treatments, and, ultimately, a cure for this extremely aggressive cancer. To date, the Foundation has awarded over $8.7 million to research. More information is available at http://www.curemeso.org.

New Therapeutic Approaches for Malignant Mesothelioma Using Immunotherapy to Target WT1

Immunotherapy targeting WT1 may help patients with malignant mesothelioma.by Tao Dao, Lee M. Krug and David A. Scheinberg, Memorial Sloan Kettering Cancer Center, New York, NY

Wilms’ tumor  1 (WT1) is a protein that is present at high levels in many types of cancers (especially mesothelioma), but it is generally not found in normal cells. Therefore, we think that it is a potential target for novel therapies, and particularly immunotherapies. WT1 is typically found inside the cell, in the nucleus. Only after it is processed and moved to the surface of the cancer is it possible for the immune system to see it. We think that if we could teach the immune system to attack WT1, we could find an effective way to specifically kill mesothelioma cancer cells.

At Memorial Sloan Kettering Cancer Center, we are studying two ways to boost the immune response against WT1. The first is with a vaccine. Normally, the WT1 protein does not cause an immune response to occur. However, we found that small pieces of WT1 proteins that are just slightly different from normal WT1 protein can stimulate the immune system better. If we can teach the patient’s immune system to target WT1 using a vaccine made up of these protein pieces, then perhaps it will also learn to attack the cancer cells. In fact, when we gave the WT1 vaccine to patients along with some immune booster medicines, they developed an excellent immune response specifically to WT1. We are now studying this vaccine in a larger clinical trial to see if it is effective against the cancer. Patients who have undergone surgery for mesothelioma either get the immune boosters alone or together with the WT1 vaccine to see if it can prolong the time before the mesothelioma grows back.

We are now also studying another way to attack WT1 using antibodies. Antibodies are proteins in the body that stick to foreign substances (such as bacteria or viruses) and tag them for destruction by the immune system. In this case, however, we have engineered antibodies in a laboratory so they will recognize WT1. Thus, instead of the vaccine strategy which relies on teaching the patient’s immune system to attack WT1, these antibodies can be injected and bind directly to it. We have demonstrated that this antibody is a potent therapeutic agent against human mesothelioma in animal models. Our study was published in the Science Translational Medicine in March, 2013. (http://stm.sciencemag.org/content/5/176/176ra33.long). We are working to bring this promising new drug to clinical application in the very near future.

Acknowledgement

We greatly appreciate the grant support from the Mesothelioma Applied Research Foundation for our exciting research targeting WT1 by both vaccines and antibody therapies (TD and LMK are recipients of Meso Foundation grants).

Dr. Ira Pastan of National Cancer Institute to Speak at Mesothelioma Symposium

Dr. Ira PastanThe Mesothelioma Applied Research Foundation announced that Dr. Ira Pastan, the Head of the National Cancer Institute’s Molecular Biology Section, will be the keynote speaker during its 11th annual International Symposium on Malignant Mesothelioma, taking place on March 5-7 in the Washington, DC metro area.

Alexandria, VA (PRWEB) February 28, 2014

The Mesothelioma Applied Research Foundation announced that Dr. Ira Pastan, the Head of the National Cancer Institute’s Molecular Biology Section, will be the keynote speaker during its 11th annual International Symposium on Malignant Mesothelioma, taking place on March 5-7 in the Washington, DC metro area.

Dr. Pastan is a world-renowned scientist known for his work in cancer research. Along with colleague Mark Willingham, he discovered mesothelin, a protein that is over-expressed in mesothelioma, as well as certain other cancers. This discovery has made it possible to develop an immunotoxin, SS1P, which targets the mesothelin antigen. SS1P has shown much promise in clinical trials by producing major tumor regressions lasting up to two years.

“It is an honor to have Dr. Pastan, one of those most imminent cancer researchers in this nation, joining us at our International Symposium on Malignant Mesothelioma,” said Mary Hesdorffer, NP, the executive director of the Mesothelioma Applied Research Foundation.

“Hearing about his promising work directly from Dr. Pastan will be a very inspiring experience for the mesothelioma patients in attendance, as well as others interested in curing mesothelioma,” she added.

Dr. Pastan will speak to the Symposium audience on Thursday, March 6 at 9:15 AM. The program will also be broadcast live on the web at http://www.curemeso.org/symposium.

Mesothelioma is a malignant tumor of the lining of the lung, abdomen, or heart known to be caused by exposure to asbestos. Medical experts consider it one of the most aggressive and deadly of all cancers. Approximately 3,500 Americans are diagnosed with mesothelioma every year and an estimated one-third were exposed while serving in the Navy or working in shipyards.

ABOUT THE MESOTHELIOMA APPLIED RESEARCH FOUNDATION
The Meso Foundation is the only 501(c)3 non-profit organization dedicated to eradicating mesothelioma and easing the suffering caused by this cancer. The Meso Foundation actively seeks philanthropic support to fund peer-reviewed mesothelioma research; provide patient support services and education; and advocate Congress for increased federal funding for mesothelioma research. The Meso Foundation is the only non-government funder of peer reviewed scientific research to establish effective treatments for mesothelioma and, ultimately, a cure for this extremely aggressive cancer. To date, the Foundation has awarded over $8.7 million to research. More information is available at http://www.curemeso.org.