Listen to the “Meet the Mesothelioma Experts” Session with Dr. Joanna C. Horobin

COMMAND trialThe most recent installment of the Meso Foundation’s “Meet the Mesothelioma Experts” series is now available for listening on our website. The session was held on April 8 with Dr. Joanna C. Horobin, the Chief Medical Officer at Verastem, Inc. Dr. Horobin discussed the company’s latest investigational agent, defactinib, which is being developed for use in patients with pleural mesothelioma.

During the call, Dr. Horobin was interviewed by Mary Hesdorffer, the Meso Foundation’s executive director and experienced nurse practitioner. The session focused on learning more about investigational agent defactinib, which is used to delay the time to progression after having a response or stabilization with first-line therapy.

Dr. Joanna C. Horobin, M.B., Ch.B, has been the Chief Medical Officer at Verastem, Inc. since October 2012.

You can listen to the session with Dr. Horobin, as well as past “Meet the Mesothelioma Experts” session here.

Hypnosis Therapy may Decrease Fatigue in Mesothelioma Patients

RelaxationIt was recently reported that a clinical trial that randomized patients to receive hypnosis and cognitive therapy had a statistically significant reduction in their fatigue levels as compared to 79 percent of patients who did not have this intervention. The sudy was led by Guy Montgomery, PhD, Director of the Integrative Behavioral Medicine Program at Mount Sinai Hospital in New York.

Two hundred breast cancer patients who were undergoing radiation therapy were eligible to participate in this study. It was unusual to find that six months after the completion of radiation therapy, the intervention group reported less fatigue than 95% of the control group (patients who did not receive hypnosis and cognitive therapy). Mesothelioma patients often receive radiation therapy following the completion of an extrapleural pneumonectomy (EPP) or a Pleurectomy Decortication (PD). Though there are no studies currently underway in mesothelioma, it seems reasonable that patients who will be undergoing surgery plus radiation should be put in touch with integrative medicine to ascertain what services might be available to them.

A few years back, we invited a hypnotherapist to conduct a workshop at the Meso Foundation’s Symposium to aid the community in banishing negative thoughts usually implanted during the initial diagnosis when they were informed of the disease and prematurely provided with a prognosis from a doctor unfamiliar with mesothelioma. A positive outlook certainly does not cure the disease, but patients who are positive tend to eat better, engage with others, and less often fall victim to depression, which could impact their ability to function.

The study, recently published in the Journal of Clinical Oncology (2014; doi:10.1200/JCO.2013.49.3437

New Therapeutic Approaches for Malignant Mesothelioma Using Immunotherapy to Target WT1

Slide for MARF-3-19-2014by 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).

Meet the Experts: Dr. Valerie Rusch, Memorial Sloan-Kettering Cancer Center

Meet the Experts: Dr. Valerie Rusch

The Meso Foundation would like to invite you to join us for the next installment of our Meet the Experts series: “Focused Discussion on a New Clinical Trial: GL-ONC1” on Monday, February 17 at 8 PM Eastern Time, featuring Dr. Valerie Rusch, Memorial Sloan-Kettering Cancer Center.

The teleconference will follow our usual format with Mary Hesdorffer, Nurse Practitioner, as the moderator. We encourage all listeners to submit questions through our Facebook page and email throughout the call.

The teleconference is free, but does require that you RSVP in order to receive the call-in information. You can RSVP here.

Dr. Valerie Rusch of the Memorial Sloan-Kettering Cancer Center is a thoracic surgeon with over 25 years of experience. Her focus is treatment of patients with cancers of the lung, airways (trachea, bronchi), esophagus, mediastinum, chest wall, and pleura (malignant pleural mesothelioma). Read more about Dr. Rusch here.

You can listen to previous Meet the Experts sessions, including our most recent session, “New Frontiers in Surgery” with Dr. Joseph Friedberg, on our Meet the Experts page.

Meet the Experts Recap: Dr. Friedberg on New Frontiers in Surgery

Dr. Joseph FriedbergOver 40 individuals from the meso community joined us Thursday night for our latest Meet the Experts session “New Frontiers in Surgery” with Dr. Joseph Friedberg, a surgeon at the University of Pennsylvania. With an interest in diseases of the pleura, Dr. Friedberg’s surgical protocol involves laser treatments and photodynamic therapy, on which he has published a promising study. During Thursday’s teleconference, Dr. Friedberg explained photodynamic therapy and his surgical treatment process, how it works, and the benefits it may hold for mesothelioma patients.

At the start of the teleconference, Dr. Friedberg explained that photodynamic therapy is a light-based cancer treatment that is minimally toxic, unlike chemotherapy, and not as penetrative as radiation. To administer the therapy, the patient is given a compound similar to chlorophyll, which is used by plants to capture light energy from the sun. The compound enters the patient’s cells, making them very light sensitive and giving them the ability to capture visible light energy. The light energy only penetrates a small distance into the body, which is enough to cause reactions that can kill cancer cells. In a disease such as pleural mesothelioma where, following lung-sparing surgery, microscopic cancer cells generally remain, photodynamic therapy is used to complement or augment surgery in an effort to remove all detectable cancer.

Dr. Friedberg went on to discuss the surgical treatment process for mesothelioma patients at the University of Pennsylvania, but first noted, “All surgery for mesothelioma really remains investigational at this point.” When a new mesothelioma patient goes to UPenn for treatment, a team evaluates their case and determines which type of treatments they qualify for. When a patient is a candidate for surgery, and they decide they want to go this route, Dr. Friedberg notes that they start with surgery followed by photodynamic therapy and then chemotherapy. Most of their patients do not receive radiation treatment.

For pleural mesothelioma patients, Dr. Friedberg performs lung-sparing surgery (as opposed to lung-sacrificing surgery, which is best known as an ‘extrapleural pneumonectomy’ or EPP). In his method, Dr. Friedberg mobilizes the cancer off of the chest wall, diaphragm, and mediastinum, so that the cancer is tethered solely to the lung. The pleural lining is then completely removed from the lung along with the cancer that is connected to it. The median length of stay post-surgery is 13 days with the first 1-3 days spent in the ICU. The photodynamic therapy leaves the patient with light sensitivity that lasts about two weeks and could result in very quick sunburn.

Dr. Friedberg has performed this surgery and treatment process on a few hundred patients, which includes patients with cancers other than mesothelioma. Nonetheless, he notes, “The operation is still in evolution … I’m always trying to think of ways you can make it better and more translatable.”

It is still debatable whether lung-sparing surgery or lung-sacrificing surgery is better for patients. Dr. Friedberg believes that saving the lung allows patients a better quality of life post-surgery. With two lungs, “The patients are doing more; they’re in better shape. They are just more robust.” Additionally, if the mesothelioma reoccurs, “They are typically able to tolerate better and more aggressive treatment.”

As moderator, Mary Hesdorffer, NP, relays the question of a listener who asks, “What is the average lifespan of a surgical patient who goes through a successful surgery?” Dr. Friedberg answers honestly as he states, “This is both the best and the most important, and the least answerable question a patient can ask.” He notes the unpredictable qualities of mesothelioma, as the cancer is not only different from patient to patient, but it also changes character within one patient from one region of the chest cavity to the next.

Dr. Friedberg goes on to explain the questions that arise when a mesothelioma patient is deciding whether or not they should go through with surgery. The patient needs to weigh the benefits and the risks, and also think about lung-sparing or lung-sacrificing surgery. Dr. Friedberg suggests patients ask their surgeons, “What would make you take the lung out and what is the impact of that?” The patient should also make sure the surgeon they speak with will actually be performing their surgery. They should find out who else is on the team, what additional treatments may be necessary, whether or not radiation is needed and why, and so on.

Dr. Friedberg provided a huge amount of information regarding mesothelioma surgery and photodynamic therapy. He discussed who qualifies for his treatment and who will benefit from it, how mesothelioma surgery differs from surgeon to surgeon, what role photodynamic therapy appears to be playing in the treatment process, and much more. We are extremely grateful to Dr. Friedberg for taking part in this Meet the Experts session and providing the community with excellent insight into mesothelioma surgical treatment.

You can listen to the full teleconference on the Meet the Experts page.

UPCOMING MEET THE EXPERTS
The next Meet the Experts session will be held on February 17th at 8PM Eastern with Dr. Valerie Rusch of Memorial Sloan-Kettering Cancer Center. More details will be announced as they become available on the Meet the Experts page.