International Mesothelioma Conference Raises Hope for Better Treatment

Jacques Fontaine, M.D.

Earlier this year, I attended the International Mesothelioma Interest Group (iMig) conference in Cape Town, South Africa, and left feeling the future of mesothelioma treatment is bright.

It starts with better cancer staging, an ability to clearly understand how advanced the disease is, and analyzing specific genetic characteristics of the tumors, allowing us to better target the treatment for each individual.

All mesothelioma patients now are still lumped together and talked about in very broad terms. That’s not the best way of doing it. We don’t do that for breast cancer and lung cancer, which present more tailored treatments for very specific groups of patients. Custom-tailored treatments can be more effective and minimize side-effects.

Because there haven’t been enough in-depth mesothelioma studies done, we often hear “Oh, this treatment doesn’t work for this disease.” But can it work for a specific group of patients with the illness? We have never looked at these things in the past. Now we are beginning to do that.

Staging has been tough for mesothelioma because it’s a cancer around the lining of the lungs, and it’s hard to be exact.

Instead of asking about its thickness or if it’s traveled into the lymph nodes, we now inquire about its volume. That gives us a better way of knowing how far the cancer has progressed and how it will react to certain treatments. Some of the studies presented at the conference in South Africa investigated methods to quantify the volume.

Genetic Analysis

One of the hot topics at the conference was genetic mutation analysis.

Every cancer has its own distinct fingerprint. The study of genes for lung cancer and breast cancer has come a long way and led to real breakthroughs in terms of therapy.

The thinking now is that we need to do that with mesothelioma. It will help refine the treatments we use.

The only thing we say about mesothelioma now is whether it’s epithelial, sarcomatoid or biphasic mesothelioma. However, what we should be saying is that yes, it’s epithelial, but it also has this type of mutation or that type of mutation, and whether it’s this gene or that gene.

Instead of the shotgun approach of giving the same chemotherapy for every single mesothelioma patient, let’s find a chemotherapy that targets a specific gene, and only give it to the patient whose tumor expresses that particular gene. It will produce more of a lock-and-key approach to treatment.

Genetic analysis would bring an almost tailor-made therapy for that specific type of mesothelioma.

If you know the cancer will not respond to one particular type of chemotherapy, you avoid it and its side effects. Knowing the genetic makeup of the tumor, you will also predict which therapies likely will work or not.

Targeted therapy often comes in a pill that homes in on specific genetic mutations on the cancer. One example of targeted therapy is a study we are offering at Moffitt Cancer Center in Tampa. The study involves a new drug being used for mesothelioma patients who already received at least four cycles of standard chemotherapy.

Immunotherapy

Better identification of genetic characteristics will lead to improved, more novel approaches to therapy, including immunotherapy and targeted therapy.

Immunotherapy is the future for cancer therapy. It could mean a patient is injected with a vaccine that contains a protein similar to the cancer, jump-starting the patient’s own immune system into fighting the cancer cells. Immunotherapy has been effective in the treatment of melanoma and renal cell cancers. Mesothelioma has just been behind in that regard.

Surgery Debate

We heard plenty about surgery at the conference, too.

The goal of surgery always has been a complete macroscopic resection, which means removing all the disease seen with the naked eye. To achieve that in the past, many people thought the best way was an extrapleural pneumonectomy (EPP), removal of the entire diseased lung, lining around the lung and heart (pleura and pericardium), as well as the diaphragm.

Based on various studies in North America and Europe, the consensus now is sparing the lung and removing tumors growing in the chest cavity. The procedure is known as a pleurectomy/decortication (P/D). More and more surgeons are recommending the P/D instead of the EPP because it is less aggressive.

The speakers provided a lot of technical pearls for the surgeons there, and showed how this surgery is the preferred way to go with an improved technique. Even with bulky disease, where the tumor burden is considerable, you can achieve a complete macroscopic resection.

iMig Conference Is Important for Everyone

This really is the only quality conference for medical oncologists, surgeons, radiation oncologists, nurses, researchers and others in the medical community who are focused entirely on mesothelioma.

Usually when oncologists attend a conference for thoracic surgery or lung cancer, the discussion about mesothelioma is second fiddle to other illnesses because it’s such a rare cancer.

As a mesothelioma specialist, I left the conference feeling there’s progress in fighting this disease.


Dr. Fontaine is a thoracic surgeon who joined the Moffitt Cancer Center in 2011 and quickly moved into a leadership role as the director of the Mesothelioma Research and Treatment Center. He also holds an appointment as an assistant professor of surgery at the Morsani College of Medicine at the University of South Florida.

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