Mesothelioma: No Cure Yet, But Much Promise in New Therapies

Clinical Trialsby Mary Hesdorffer, NP, Executive Director of the Meso Foundation

Mesothelioma has often been referred to as a cancer resistant to chemotherapy. That attitude changed when in 2004, the combination of Alimta and Cisplatin demonstrated a survival advantage over Cisplatin alone. This was a large randomized study that paved the way for pharmaceutical companies to become interested in this disease often thought to be recalcitrant.

Today, rather than telling our patients to go home and get their affairs in order, we can instead provide them with a wide array of treatment options, whether first diagnosed, after a recurrence, or even after several prior regimens.

Having options is an incredible step forward in this cancer that even merely a decade ago was seen as hopeless. But with options also come some challenges.

One such challenge is the healthcare providers’ lack of time necessary to fully inform patients with mesothelioma about their options. For this reason, providers will often present only a few of the many options to their patients.

Patients are fortunate that some providers unable to fully perform this task are referring their patients to the Mesothelioma Applied Research Foundation. At the Meso Foundation, a dedicated nurse practitioner spends the necessary time to go through the options, taking into account insurance coverage, stage of disease, histology and readiness to participate in a clinical trial.

The initial presentation and consultation during this stage is often complicated by the physical, emotional and legal challenges associated with the diagnosis. Patients and family members are often in a “tail spin” and desperate for information that might lengthen survival time or better yet, make mesothelioma into a chronic disease. It is crucial that time is taken to consider all of the options in a calm, supportive environment to ensure that decision making is optimized.

I outlined below some very promising new clinical trials. PLEASE NOTE: This is not a comprehensive list of available trials. Each mesothelioma case is different, so please only use this list as a loose guide. To obtain a full consultation, which will take into consideration all available treatments, please contact Mary Hesdorffer, APRN.

Among treatment options available today are specialized forms of radiation therapy given before or following a surgical procedure. Recently, a small trial using IMRT (Intensity-Modulated Radiation Therapy) prior to an extrapleural pneumonectory (EPP) demonstrated a 50% increase in survival over historical controls. A randomized trial is now in the planning stages to confirm these results in a larger patient population.

There are other trials currently under IRB review that will look at IMRT following either an EPP or Pleurectomy Decortication (PD). Randomized trials are the only way for scientists to demonstrate whether an intervention is better than the standard of care.

In fact, a randomized trial of a PD vs. PD, coupled with photodynamic therapy (PDT) has recently commenced following an initial, single center, non-randomized trial, which reported a significant increase in overall survival, including patients with advanced disease.

Another trial I’d like to mention uses a vaccine (CRS207) prior to treatment with Alimta and Cisplatin. It has reported a 69% durable response. A larger trial is now underway to confirm these results with plans for a future randomized trial.

Patients who respond or are stable following treatment with Alimta and Cisplatin are also eligible for Defactinib, an agent targeting cancer stem cells with the goal of lengthening the time to relapse or perhaps, in the best case scenario, preventing relapse altogether.

In the second-line setting (for patients who have had a recurrence following first-line treatment), immunotherapy appears to have taken the lead with a multi-nation, placebo-controlled trial of the drug tremelimumab. In melanoma, this agent has induced durable responses and, so far, has shown much promise in mesothelioma.

Definitely worth mentioning is also the NCI’s stellar new drug SS1P, an immunotoxin which utilizes mesothelin (a protein) to gain entry into the cell. Early phase I studies have demonstrated results in advanced patients who had failed multiple prior treatments, and a phase II study is currently underway.

These are just a few of the trials currently offered to mesothelioma patients. We strongly urge clinicians to refer patients to clinical trials in mesothelioma, as they are known to expedite research progress.

For instance, children’s cancers that saw the highest enrollment in clinical trials have experienced significant advances in treatments of those conditions. Our hope is to do the same for mesothelioma.

Visit curemeso.org to view the Meso Foundation’s Clinical Trials Brochure and learn more about enrolling in a clinical trial.

Live Broadcast of Mesothelioma Conference for Patients and Family Members

International Symposium on Malignant MesotheliomaThe Mesothelioma Applied Research Foundation will provide an online live broadcast of its annual International Symposium on Malignant Mesothelioma on March 6-7

Alexandria, VA (PRWEB) February 27, 2014

On March 6-7, the Mesothelioma Applied Research Foundation (Meso Foundation) will make available a free-of-charge live broadcast of its 11th International Symposium on Malignant Mesothelioma. The Symposium is a unique event that covers important treatment information and research advances presented by mesothelioma experts. The Meso Foundation understands that many mesothelioma patients are unable to travel for health reasons, so to ensure the community can still access this life-saving information, live video coverage of most session will be available through the Meso Foundation’s website.

The free live stream is a real-time broadcast of the Thursday and Friday sessions of the Symposium. Only a computer (or smart phone/device) and an internet connection are needed to access the live stream, which will be available athttp://www.curemeso.org/symposium. The same webpage also contains the full agenda of the event.

Some of the topics covered during the Symposium and its live stream include pleural and peritoneal mesothelioma, immunotherapy, post-surgical recovery, early detection, novel therapeutics, radiation oncology, chemotherapy: poison or antidote?, chemo brain, survivorship, nutrition, exercise, caregiver conversations, healing from loss of a loved one, getting involved, and an update on the work of the Meso Foundation.

The Symposium is geared to attendees from all walks of life, including patients and their families, advocates, medical professionals, and those who have lost a loved one to mesothelioma. The Symposium will be held from March 5-7 at the Hilton Alexandria Mark Center in Alexandria Virginia. Symposium events will include an advocacy day on Capitol Hill, science and community sessions, a Celebration of Life ceremony, an Awards Dinner, a Community Dinner featuring the Meso Fighters Band, and more. A full list of events, topics, and speakers can be found 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.

Meso Foundation Awards Half Million Dollars to Mesothelioma Research

DNA-SmallToday, all of us at the Meso Foundation are extremely excited to share with you the 2013 grant awardees. The peer-review process is now complete, and the top five projects will receive a total funding of $500,000. With the completion of the 2013 grant process, the Meso Foundation’s total funding awarded to mesothelioma research is now $8.7 million!

The grant application process began in April of 2013 and yielded 49 research proposals in the area of mesothelioma research. The Foundation’s Science Advisory Board, which is comprised of 18 world-renowned mesothelioma experts, evaluated and ranked all proposals through a peer-review process modeled after the National Cancer Institute. The top five proposals to come out of this intense peer-review process will receive funding of $100,000 each for a total of half a million dollars.

The grant recipients include Marc De Perrot, MD, of the University Health Network for his project “Optimizing the radiation approach to mesothelioma with immunotherapy”; Christian Ottensmeier of the University of Southampton for his project “Evaluating the effect of immunity on outcomes of patients with mesothelioma”; Tao Dao, MD, PhD, of the Memorial Sloan-Kettering Cancer Center for his project “Specific immunotherapy for mesothelioma by use of bi-specific TCR-like antibody“; Usha Pendurthi, PhD, of the University of Texas Health Science Center at Tyler for her project “Endothelial Cell Protein C Receptor Attenuates Mesothelioma Progression”; and Elisa Giovannetti, MD, PhD, of the VU University Medical Center for her project “Novel lactate dehydrogenase inhibitors for the treatment of mesothelioma.”

The focus of the five projects is varied, as they all attempt to combat mesothelioma through different mechanisms. One of the projects, in particular, seeks to demonstrate that combining immunotherapy with ‘high intensity/fewer doses of radiation’ (which alone appear to have immunotherapeutic effects), increases tumor reduction compared to each therapy alone. Another project funded seeks to target a protein receptor in the mesothelioma cells that regulates the life cycle of the cell itself, the purpose of which is to stop tumor growth.

As Mary Hesdorffer, NP, states, “All five of these projects are remarkable and hold much promise in their ability to add to our currently limited arsenal for treating mesothelioma.” She speaks for everyone at the Meso Foundation as she continues, “I am very proud of the life-saving work our mesothelioma researchers are doing.”

For complete descriptions of the funded projects, visit curemeso.org/grants2013.

Personalized Medicine and Mesothelioma – Are We There Yet?

personalized_medicine_mesothelioma

Personalized medicine is the ability to select a biologic target and direct therapy against this target.  It is associated with improved outcomes in a number of tumor types. The most startling was the development of Gleevec which targets CKit in gastrointestinal stromal tumors. The field has since grown by leaps and bounds. We are making progress in mesothelioma, too.

An example of what I’m talking about is displayed in the presentation made by one of our grant recipients, Liang-Chuan (Steve) Wang, Ph.D., at our International Symposium on Malignant Mesothelioma.

In his presentation of his Foundation-funded grant, Dr. Wang and his colleagues at UPenn identified a gene that may be responsible for chemotherapy resistance in mesothelioma patients to Pemetrexed (Alimta) and cisplatin. As per Dr. Wang, this may identify a group of patients who may need higher doses or longer duration of therapy or perhaps should be encouraged to try new drugs. This is step one and Dr. Wang has assured us that he will continue to work on the concept and in the future hopes that it will lead to a clinical trial.

Another example is the work currently underway to exploit mesothelin as a target and way into the malignant cell. Many of you have met patients at our symposium who have benefited from some of these trials and I remain excited and committed to stewarding patients through the clinical trials system to ensure that they know of all opportunities to participate in cutting edge research. Please take a moment to visit the research section on our website to see how the Meso Foundation has funded grants that have laid the groundwork upon which much of what you read about in mesothelioma news has been built upon.

To further advance our ability to get to the point of personalized medicine the Foundation will continue to foster communication among clinician, basic scientists, pathologists and members of biotech and pharmaceutical companies to disseminate information, as well as fund the work that will take us to the next level. Early on, we partnered with Dr. Mike Becich to ensure that the Mesothelioma Virtual Tissue Bank became a reality and we are proud to say that our efforts have paid off. Mesothelioma researchers now have access to mesothelioma tissue to conduct their experiments and further their scientific endeavors.