- In a talk concerning adjuvant radiation following EPP, it was stated that radiation oncologists who are inexperienced may not give as high a dose or may shy away from difficult areas. It was felt to be important based upon lower local failure in centers with expertise in radiation oncology. Concern was expressed about patients having radiation locally and perhaps this needs to be emphasized at the time of the initial surgical consult. This is an important take home message and reason to explore accommodations where there is expertise early in the process.
- Dr. Joseph Friedberg presented on his current approach using photodynamic therapy. Dr. Friedberg has been championing this procedure over the past few years and has discussed that he does a “radical pleurectomy” coupled with photodynamic therapy. Photofrin, which is the agent used in this light-based therapy, has recently received orphan drug status. This procedure will not be offered to non epithelial patients. Dr. Friedberg agreed with one of the earlier speaker that node 2 disease patients benefit from this procedure. It has been noted that pleurectomy decortication is not a standardized procedure and there are variations among the surgeons. There has been discussion at this conference and others about the need to standardize these approaches so that we can compare series of patients with confidence that we are comparing results of the same procedure. There are plans underway to do a randomized trial (eliminates investigator bias) to determine if PDT is superior to a radical pleurectomy without PDT. Will keep you posted when this trial gets underway.
- Polymeric films are under investigation as a new method to deliver drugs directly to the chest cavity. The films facilitate increased drug penetration in comparison to Cisplatin solution for prolonged periods of time. Animal models of these polymeric films containing Cisplatin demonstrated ease of application, ability to cover the pleural space ability to reach highly concentrated drug in comparison to intravenous or intra-pleural Cisplatin. This new approach also appears to be associated with less kidney toxicity. Work is ongoing and anticipated that it have applicability in mesothelioma patients in the next few years.
- Dr. Paul Sugarbaker was the first speaker in the session about peritoneal mesothelioma. He stated that the median survival is now at 10 years, with about 1/3 of the patient requiring another surgery at some point during the course of the disease. Dr. Sugarbaker currently has a new protocol which he spoke about using bidirectional treatment where surgery is performed and then for 6 months following surgery patients will receive 6 additional cycles of chemotherapy both IV and intraperitoneal via ports placed into the abdominal cavity.It was discussed that patients who recur in the chest have surgery and rarely recur again in the chest cavity. He was congratulated by chest surgeons who are striving to replicate these results in pleural mesothelioma.
- Dr. Steven Albelda, a member of our SAB, spoke about immunotherapy in mesothelioma and mentioned the large number of immunology trials taking place in mesothelioma. Passive immunotherapy use of antibodies to treat cancer – antibodies can inhibit signaling pathways or can coat malignant cells making them targets for drugs or be immunotoxin for example SS1P at the NCI. Mesothelin is highly expressed in many cancers and has become a target in a number of mesothelioma clinical trials. Soluble mesothelin can be used as a biomarker (Mesomark).Amatuximab (anti mesothelin antibody) given in combination with Pemetrexed and Cisplatin will be moving into a randomized trial at least that is the underlying buzz at this conference.Some trials were reported using immunotherapy in small number of patients which appeared to result in prolonged stability after initial response.Many of us of heard of Provenge being approved in prostate cancer we also have vaccines now being studied in the clinics. In the Netherlands they are investigating dendritic cell vaccines, at MSKCC we are looking at the WT1 vaccine both initially funded by the Mesothelioma Foundation.UPenn has a t cell vaccine which is being offered to patients who have failed prior therapy.
The presentation ended with a discussion with the use of gene therapy which is under investigation at UPenn. The gene therapy utilizes an adenovirus to stimulate the immune system.