There is not yet an absolute cure for mesothelioma, but significant progress toward that goal is allowing patients to live longer and enjoy healthier lives, providing reasons for hope where once there were none.
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Although funding for mesothelioma research is not in the ballpark of that of some other cancers, more researchers and disease specialists believe that finding a cure is not an unrealistic dream anymore. Alternative treatment options like immunotherapy and gene therapy, along with promising clinical trials, better drugs and a multimodal approach, dramatically changed the perception of a mesothelioma diagnosis within the past generation.
“Cure Meso” it’s more than a slogan on a T-shirt; Cure Meso is a reachable goal. Closer to a cure is a reality.
“This is not the death sentence it was 20 years ago. Long-term survival is possible. We now have the road map, and others have traveled the path,” said thoracic surgeon David Sugarbaker, M.D., who founded the International Mesothelioma Program (IMP) in Boston. “I remain optimistic that we can, in the next decade, put together the right combination of patient and treatment to affect a cure, which is our holy grail.”
While the number of patients diagnosed with mesothelioma remains constant to what it has been for years — an estimated 3,000 in the US annually — the number of survivors grows each year.
All four types of the disease are aggressive, and the prognoses many times are still measured in months. But now some patients live 10 or more years. It’s not unusual to find a five-year survivor. Surgeries are more precise, the therapies more exact, and the chemotherapy and radiation more effective.
Major surgeries, including extrapleural pneumonectomy or a pleurectomy/decortication, now can remove all visible mesothelioma cancer cells. The advancements in chemotherapy precision — done while the patient is in surgery — potentially can slow or even stop the growth of any microscopic cancer cells left behind. Many doctors believe that mesothelioma soon can be like diabetes: A disease that can be managed effectively.
Specialists have used immunotherapy to control mesothelioma successfully in clinical trials. It involves manipulating a patient’s own immune system, literally tricking it, to fight off the mesothelioma cancer cells while allowing healthy cells to flourish.
Scientists are moving forward with gene therapy, too. It involves infecting a patient with a virus that has been genetically altered and redesigned to replace the defective copy of the same gene, allowing it to kill cancer cells and halt tumor growth.
"Our goal is to turn this [mesothelioma] from a death sentence into a chronic disease that people can live with for years," said Daniel Sterman, M.D., clinical director of the gene therapy program at Penn Medicine. "We’re excited at what we’re seeing."
A multimodal approach that combines surgery with both chemotherapy and radiation has proven effective in many patients. Even patients who are not candidates for surgery have found chemotherapy combinations that can work for them.
"We can be good at controlling mesothelioma," said thoracic surgeon Robert Cameron, M.D., head of the Pacific Meso Center in Los Angeles. "You can live forever with a small tumor — if you find a way to control it. And you’re much more likely to be able to control it, than to kill off every single cancer cell in your body."
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Mesothelioma patients across the country continue to participate in clinical trials, which are designed to take advantage of cutting-edge treatment options and help advance the search to find that cure.
There are almost 100 Phase I, II or III clinical trials involving mesothelioma today being done under the National Cancer Institute (NCI) umbrella. It’s where the next great advancement likely will come. Clinical trials are used as a proving ground for treatments not yet approved by the FDA but showing considerable promise.
Clinical trials are the lifeblood of advancement for many cancer treatments, and especially for mesothelioma, a rare cancer that often is overlooked and underfunded by the big pharmaceutical companies.
The number of cancer centers in the country putting efforts into a mesothelioma program is larger than ever before. Mesothelioma programs are no longer concentrated in Boston, New York and Philadelphia. Specialized centers in Tampa, Houston, and Seattle are making progress, too.
Research efforts for mesothelioma, which still pale in comparison to the more prevalent cancers, are intensifying as they inch closer to a cure. Greater attention is being paid to places like the Mesothelioma Tissue Bank at the University of Pittsburgh’s Medical Center, where researchers from across the country are gathering to work together.
"It [the cure] is out there somewhere now," said thoracic surgeon Raja Flores, M.D., of Mount Sinai Medical Center in New York, who has specialized in mesothelioma. "We just have to start thinking outside the box more. We’ve got to come up with something that no one has put together yet. But it’s there."
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Arguably the biggest problem with mesothelioma — and it is an obstacle to finding a cure — is that too often doctors don't get a chance to treat a patient in an early stage of the disease. The insidious nature of the disease is that symptoms many times are not painful or even noticeable during an early stage. Early symptoms too often mirror those of less serious health issues, slowing the diagnosis while the disease is spreading.
Once a diagnosis arrives during stage III or stage IV of the cancer development — meaning it already has metastasized — treatment options are limited. These sad facts about this disease mean the number of people eligible for potentially ground-breaking clinical trials are also limited.
Prognosis is generally poor because most patients do not exhibit symptoms of mesothelioma until 20 to 50 years after initial exposure to asbestos occurred.
"The real gains will be made from finding it (mesothelioma) earlier," said surgeon Harvey Pass, M.D., a long-time leader in mesothelioma advancements. "Treatments will work better. It could be very important in turning this into a chronic illness."
In the past, imaging tests and invasive tissue biopsies were needed to make a definitive diagnosis. Patients also relied on limited types of treatments that were not as effective on their own.
Recent advancements with blood-based biomarkers are promising, and clinical trials now involve simple breath and urine samples, and other less invasive diagnostic tests could help speed up diagnosis.
"The goal of our program today is quality of life extension leading to a cure," Sugarbaker said. "There is hope now, and anything is possible. We are seeing things we never saw before with this disease, going places we’ve never been."Director of the Lung Institute at the Baylor College of Medicine, Thoracic surgeon
Finding the absolute mesothelioma cure still may be years away, but finding a way to control mesothelioma has taken hold. The six-months-to-live prognosis is no longer the norm at the specialty centers with experience in treating this disease. Patients are living considerably longer today with updated treatment plans.
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