Mesothelioma Doctors: Trends Show Younger Patients, 4th Key Treatment
July 12, 2012
WASHINGTON, D. C. — After many years — even decades — of frustration, there has been a definitive shift in attitude toward the advances being made in the treatment of mesothelioma cancer.
Progress finally is coming.
“There are things out there now that can make a real difference,” said Raja Flores, M.D., a surgeon from Mount Sinai Medical Center in New York City. “Things are happening.”
Flores spoke Thursday at the 9th annual Mesothelioma Foundation Symposium. He was part of an All-Star panel of thoracic surgeons, pulmonologists and investigators that included Harvey Pass (New York University), David Sugarbaker (Brigham and Women’s Hospital), Daniel Sterman (University of Pennsylvania Medical Center), Raffit Hassan (National Cancer Institute) and Lee Krug (Memorial Sloan Kettering Cancer Center).
“They (patients) want a cure, and they want it now,” Flores said. “Unfortunately, we don’t have that yet. But there are a lot of things out there that sound pretty good.”
Mesothelioma Markers to Be 4th Big Treatment
The Symposium, which started Wednesday with a lobbying effort on Capitol Hill, was orchestrated by the Mesothelioma Applied Research Foundation (MARF).
“We think we can change the nature of this disease,” Sterman said. “We’ve just scratched the surface, but you can see the future.”
The basic, approved treatment regimen for mesothelioma — the cancer caused by asbestos exposure — hasn’t changed much. It’s still surgery, radiation, and chemotherapy — a three-pronged approach known as multimodal therapy — but the techniques are being improved, and a fourth prong is close to being added.
Markers are being uncovered that are leading to earlier detection, which is leading to much better treatment results. More targeted radiation has proven effective. Better chemotherapy agents are helping to stimulate immune response. Genetic sequencing is working against specific tumor mutations. Certain drugs can target those mutations in a specific tumor.
“Targeted personalized therapy, that’s the future for treatment of mesothelioma,” Sterman said. “It’s not off-the-shelf for everyone, anymore. You can find drugs that may not kill everyone’s tumor, but in yours specifically, it may work.”
Sterman believes soon there will be an approved immunotherapy specifically for mesothelioma, adding another weapon against the deadly cancer.
“There are going to be four arms of treatment, instead of three (surgery, radiation and chemotherapy),” he said. “A revolution in cancer treatment is going to wash over mesothelioma, too.”
Frustration and Younger Mesothelioma Patients
Krug opened the day with what he called “the state of the mesothelioma union,” talking about the many clinical trials now underway around the country. He also talked about future advances like oncolytic viruses, angiogenisis inhibitors and the immunomodulating drugs on the horizon.
He challenged the audience of survivors and their families, medical professionals and health care providers on three issues: A need to expand the research funding pool; a better collaboration among investigators; and increasing the enrollment in clinical trials.
Krug also talked about the frustration that often comes with battling a rare cancer like mesothelioma. There have been setbacks. An example recently was the large study of a promising drug called Vorinostat.
It took five years, and 125 hospitals covering 23 different countries to test it. And after some promising early results, it failed its effectiveness test.
Sugarbaker, in response to a question from the audience, said although advances have been made, there was one disturbing trend he has seen in the mesothelioma patients at Brigham and Women’s Hospital.
Patients are younger than ever. And there are more women than ever being diagnosed, too.
Asbestos use in the United States has been dramatically reduced, but he has been busier than ever. An estimated 3,000 people annually in America are diagnosed with mesothelioma. That estimate might be climbing.
“Our median age use to be 71. Now it’s 60. There has been more than a 10-year drop. Women are coming with mesothelioma at age 50 and younger. I’ve got patients now in their 20s and 30s,”‘ he said. “I’ve seen kids as young as 16. It’s definitely a trend.”
Both Pass, in New York, and Hassan, from suburban Washington, D.C., agreed.
Sugarbaker declined to speculate why. “I really don’t know why that is,” he said, “but it’s out there.”
No Mesothelioma Decline Seen
Flores also said he didn’t expect to see any decline in mesothelioma patients in the coming years. In New York, he expects just the opposite, especially now because of the recent 10-year anniversary of the 9/11 terrorist attack that crushed the World Trade Center, released 400 tons of asbestos into the air.
There is typically a latency period of 10 to 50 years after exposure to asbestos before mesothelioma symptoms appear.
“We’re going to see greater numbers in the future, making early detection so important,” Flores said. “There may be a whole slew of things that will develop that we’re not even aware of now.”