It took nearly a century of research for doctors to learn what causes this cancer, who is most at risk for contracting it, what symptoms indicate its presence and what tools are most effective at diagnosing it. These strides significantly impacted how medical professionals treat asbestos cancer, but the investigation is hardly finished. Current efforts on developing more effective treatments and an eventual cure.
Researchers from around the world are probing for ways to combat this disease that has grown into a worldwide problem, particularly now in developing nations. Work is being done in Europe, Australia, Asia and North America by clinicians and scientists looking to move closer to finding a cure for the cancer caused by exposure to asbestos.
Internationally, much research about mesothelioma takes place in England, Italy, China and Japan. The International Mesothelioma Interest Group (IMIG) unites researchers and clinicians from around the world to collaborate and share information. IMIG hosts a conference every two years where the latest findings in research and treatment are shared, helping to drive progress in therapeutically managing the disease.
The U.S. Food and Drug Administration (FDA) oversees the drugs that are tested, and the nation's top cancer centers and hospitals look at novel therapies. Because there is no cure for asbestos diseases, the hope for the future is that doctors will be able to manage them as a chronic diseases, using treatment plans that are tailored to each patient's case and genetic makeup.
There are two FDA-approved chemotherapy medications for the treatment of mesothelioma. Alimta, which works to stop cell division, is often administered along with the platinum-based chemotherapy agent Cisplatin in the most effective chemotherapy combination.
Currently, a Phase II-III trial in France is investigating whether the addition of bevacizumab (Avastin) to the proven combination of Alimta and Cisplatin could improve overall survival. Avastin is a targeted anti-angiogenesis drug, which slows or halts new blood vessel growth that enables metastasis. Researchers hope that the addition of Avastin will delay the cancer spread and increase overall survival rates.
Targeted therapies are being investigated. These drugs target specific biological steps in the life cycle of a cancerous cell. Rather than inhibiting all rapidly dividing cells like chemotherapy drugs do, targeted therapies interfere with specific molecules necessary for tumor growth.
In July 2013, defactinib, a targeted drug that inhibits cancer stem cells, received orphan drug status from the FDA. (The Orphan Drug Designation program helps advance drugs for rare diseases through the lengthy approval process.) A Phase II clinical trial testing defactinib, called COMMAND (Control Of Mesothelioma with Maintenance Defactinib), is enrolling participants in 11 countries.
The process of introducing a new asbestos cancer medication typically takes 12 to 15 years. To ensure patient safety, adequate time must be spent in each stage of the development process. The table below outlines the average process of testing and presenting a new pharmaceutical product.
|Stage of the Process||Step of Development|
|Years 1-3||Basic Research|
|Years 4-6||Pre-clinical testing using in vitro (artificially created environments) and animal trials|
|Years 7-10||Clinical testing via Phase I, II and III clinical trials|
|Year 10||Register the drug with the U.S. Food and Drug Administration|
|Year 11||Introduction of the drug to the public|
|Years 11-15||Product monitoring and Phase IV clinical trials|
Intensity Modulated Radiation Therapy is a more precise form of delivering radiation, sparing healthy tissues around a tumor. Now implemented in hospitals nationwide, the relatively new procedure is one of the most precise forms of externally-delivered radiation therapy.
A Phase III clinical trial underway in the United Kingdom is studying the effectiveness of prophylactic radiation of tracts – such as tracts from biopsies, chest tubes and surgical incisions – to prevent or delay the onset of cancerous chest nodules in pleural mesothelioma patients. Similar U.S. studies have produced mixed results, and researchers hope for more positive results. This is the first Phase III trial to study prophylactic radiation in people with asbestos cancers.
Gene therapy, which uses laboratory-modified viruses that activate the immune system and kill cancerous cells, is still in the experimental phase. Although not yet widespread, clinical trials have yielded promising results. Clinical trials are also exploring the effectiveness of photodynamic therapy, which exposes sensitive cancerous cells to light that can kill them, and immunotherapy, a technique that manipulates the patient's immune system into attacking the antigens in cancerous cells.
A current immunotherapy clinical trial is evaluating TroVax in pleural mesothelioma patients. TroVax is an anti-cancer vaccine designed to stimulate the immune system to fight cancerous cells containing the protein 5T4, widely found in mesothelioma cancer cells. This Phase II trial is administering TroVax before, during and after combined chemotherapy treatment with Alimta and Cisplatin to see if the addition of TroVax improves overall survival.
Biomarkers are also generating considerable interest in research projects. Identifying specific compounds in fluid or tissue samples can indicate the presence or absence of a certain disease. Fujirebio Diagnostics' test is the first of its kind that can detect the biomarkers associated with mesothelioma with a simple blood screen, and its developers hope it will increase the rate of early diagnosis.
Photodynamic therapy has shown promising results, according to researchers and clinicians at the University of Pennsylvania's Perelman School of Medicine, and especially in combination with a pleurectomy/decortication, lung-sparing surgery. Photodynamic therapy involves using light energy to kill cancer cells. It involves the injection of a photo-sensitizing drug that stays longer in cancer cells than healthy ones. When the wavelength-specific light is administered by laser, it triggers a reaction that kills the cancer cells.
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Clinical trials are one of the major ways that researchers can gather information about a specific drug or procedure's effect on patients. Because asbestos cancers are so rare, any opportunity to observe a patient's response to an emergent treatment can greatly assist medical researchers in understanding the impact of the therapy in question.
Because the purpose of clinical trials is to explore treatments that showed some success and safety in a lab setting, participants can benefit from a drug or therapy routine not yet available through their doctor or oncologist. These trials are professionally monitored, and the nature of the treatment as well as its risks and benefits are explained to a patient before they give their informed consent to participate.
Clinical trials involve four phases, each focusing on a crucial aspect of product development.
|Phase I||Determines basic information such as drug dosage or methods of administration.|
|Phase II||Focuses on the treatment's safety and interaction with the intended target.|
|Phase III||Compares the new method of treatment to current options. If it appears to significantly impact prognosis, FDA approval will be requested, which can take up to a year.|
|Phase IV||Begins after the drug has been approved for use and it becomes clinically accepted. This monitoring is used to measure its continued affects on a wider population.|
Advocacy groups raised asbestos-related diseases out of relative obscurity and in some cases secured federal funding for eligible studies. In 2008, the U.S. Department of Defense (DoD) included mesothelioma in the Peer Reviewed Medical Research Program and the first ever DoD grant for asbestos cancer was awarded to a researcher for $1.3 million. A number of smaller grants, private donations and proceeds from independent fundraisers have been awarded to other research organizations.
The Meso Foundation's Science Advisory Board reviews dozens of international research proposals each year and awards five $100,000 grants per year.
Since 2004, the Annual Asbestos Awareness Conference has been sharing the results of recent research with medical professionals, patients and their families. The Meso Foundation sponsors a yearly International Symposium on Malignant Mesothelioma, and the International Mesothelioma Interest Group has hosted a yearly mesothelioma conference since 2000. These events, along with smaller local presentations hosted by hospitals or physicians, are typically open to the general public and provide attendees with new information about treatment, diagnosis and screening research.
A number of cancer treatment centers are intensifying research about asbestos diseases. One of the more recent success stories is the Health Sciences Tissue Bank at the University of Pittsburgh Medical Center. It allows researchers everywhere to have access to the tissue samples that are being collected, believing that collaboration is good for all. Mesothelioma patients have elected to donate tissue for research, knowing it will be put to good use at the UPMC, Mesothelioma Specialty Care Center.
September 26 each year is designated Mesothelioma Awareness Day. Those who support mesothelioma and asbestos awareness often travel to New York and join a "Today Show" audience with signs and shirts to raise the profile of this disease.
In 2011, supporters received more than two minutes of visual recognition and one volunteer had 15 seconds of airtime with Al Roker to explain their cause. In the small world of asbestos cancers, it was a banner moment.
Miles for Meso is a 5K race that raises awareness and money for mesothelioma. People who enter the race can run or walk, and the money earned is reserved for mesothelioma research. Miles for Meso began in Alton, Illinois, in 2009 and has spread to other cities around the country. Starting a Miles for Meso event near you is an easy way to promote research for and knowledge of mesothelioma.
In South Florida, Larry Davis helped organize an annual Miles for Meso event and has since been recognized with the Mesothelioma Volunteer of the Year Award. Davis, a 6-year survivor who credited his lifespan to running, walking and swimming, spent much of his time raising funds for mesothelioma research and encourages elected officials to ban the use of asbestos. Davis passed away in 2012, but not before crafting a legacy of hope that more awareness and more research into mesothelioma will prevent this disease from taking more lives.
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