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.

Measles Virus Successfully Used to Treat Cancer

New study reports measles vaccine successfully eliminated cancer in one patient.It was recently reported that the Mayo Clinic has successfully used the measles vaccine to eliminate cancer in a patient enrolled in an experimental trial. The patient, 50-year-old Stacy Erholtz, was suffering from blood cancer, which had spread widely throughout her body, when she resorted to a clinical trial at the Mayo Clinic last June.

Erholtz’s cancer went into remission and became undetectable following a single, massive dose of the measles vaccine. Erholtz was injected with 100 billion infectious units of the measles virus. A typical dose contains only 10,000 infectious units of the virus. The virus works by attaching itself to tumors in the body and using them as hosts for replication, which eventually kills the cancer cells.

A similar experiment using the measles virus to treat mesothelioma is currently being conducted in a clinical trial by Dr. Tobias Peikert of the Mayo Clinic. The clinical trial uses the measles virus to attack mesothelioma cells in patients with pleural mesothelioma regardless of whether they have undergone prior therapy.

Dr. Peikert is using the same measles virus (MV-NIS) in his clinical trial that was used for Stacy Erholtz. Rather than an intravenous injection, however, patients in Dr. Peikert’s trial have the virus delivered into the pleural cavity. The dose used in the trial is also lower than that used for Erholtz.

“This is extremely exciting,” Dr. Peikert said in response to the successful use of the measles virus for Erholtz. “It is very encouraging to see a convincing clinical response to the virus, although one has to caution that thus far this represents a single case.” Dr. Peikert believes the dose of the virus will likely matter as future measles studies for mesothelioma are conducted.

The Meso Foundation held a previous Meet the Mesothelioma Experts podcast session with Dr. Tobias Peikert to discuss his measles virus clinical trial. You can listen to the session below.

Additionally, a video of Dr. Peikert’s panel from the International Symposium on Malignant Mesothelioma can be viewed here.

Listen to more Meet the Mesothelioma Experts podcasts at curemeso.org/experts and check back for information about upcoming sessions.

Listen to the “Meet the Mesothelioma Experts” Session with Dr. Evan Alley

Meet the Mesothelioma Experts: Dr. Evan Alley.The 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 May 14 with Dr. Evan Alley of the University of Pennsylvania. During the call, Dr. Alley was interviewed by Mary Hesdorffer, the Meso Foundation’s executive director and experienced nurse practitioner. He discussed his new clinical trial for pleural mesothelioma patients, which is looking into an agent that would inhibit the PD-L1 protein.

PD-L1 is a protein believed to play a role in suppressing the immune system. Generally, it is associated with pregnancy and autoimmune diseases. In cancer, a high tumor expression of PD-L1 is linked with more aggressive disease and a poorer prognosis. Research into PD-L1 inhibitors has already shown much promise in melanoma, renal cell carcinoma and lung cancer, evidencing both tumor shrinkage and durable response, and prompting a number of mesothelioma centers to open trials testing similar agents.

Dr. Alley is part of the Penn Mesothelioma and Pleural Program team and the interim chief of the Division of Hematology and Medical Oncology at Penn Presbyterian Medical Center.

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

Results of the NGR-hTNF Mesothelioma Clinical Trial Now Available

Find information about the NGR-HTNF pleural mesothelioma clinical trial.Today, MolMed, an Italian pharmaceutical company, released results from its NGR-hTNF for mesothelioma clinical trial. While the trial, which enrolled 400 pleural mesothelioma patients, demonstrated no increases in overall survival of the entire population, it did show an improvement in survival for those patients with a poorer prognosis and whose disease had progressed between first-line chemotherapy and the start of the trial.

Moreover, for this latter group of patients, researchers observed a 40% longer progression-free survival.

Dr. Julie Brahmer, who led the trial at Johns Hopkins (this was a worldwide trial), said that “it is great to see a survival advantage with the addition of a new drug in combination with chemotherapy for mesothelioma.” She added that, “unfortunately the study was not positive for the overall population. It is unclear why this subpopulation would benefit and the whole population would not. I look forward to the full presentation of the results.

“This study is the first of its kind in mesothelioma, and may provide a new treatment option for patients who had cancer growth after standard chemotherapy,” said Lee Krug, MD, the chair of the Board of Directors of the Meso Foundation, and thoracic oncologist at Memorial Sloan-Kettering Cancer Center.

More information is available through this press release by MolMed.

The Meso Foundation previously wrote about this clinical trial, and discussed the NGR-hTNF clinical trial in one of its “Meet the Mesothelioma Experts” broadcast.

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.