In The News
3-12-08: W.R. Grace Agrees to Pay Federal Government $250 Million for Montana Asbestos Work.
3-12-08: Iowans learn about prolonged asbestos exposure through media. See the clip or read the article for yourself. Then voice your opinion at the new online forum.
3-10-08: MARS: Mesothelioma and Radical Surgery, UK Clinical Trial
3-10-2008: Radical Decortication/Pleurectomy Best Surgical Approach for N2 Malignant Mesothelioma.
3-10-08: A Conditional Mouse Model for Mesothelioma.
3-05-08 - The Asbestos Disease Awareness Organization hosts the 4th Annual Asbestos Awareness Day Conference, March 28-30, 2008 in Detroit, Michigan. Get all the details from the agenda to the registration forms.
1-04-08 - Duty To Treat: Should Lawyers Advise their Clients on Treatment Options? Lawyers and doctors report data on client cases and patient results.
12-05-07 - Camarillo, California residents and the family of Ottavio Belvedere raise over $20,000 to support mesothelioma research.
11-28-07 - Mission: Mesothelioma. Experts Work to Advance Research, Erase Asbestos Exposure.
11-15-07 - PHLBI mourns the loss of Gregory Deblock.
11-02-07 - PHLBI mourns the passing of Ottavio Belvedere. Memorial service to be held on Tuesday, November 6; funeral service on Wednesday, November 7.
10-16-07 - Dining for a cause. Join PHLBI and the family of Ottavio Belvedere for a meal on November 5, 2007 when 50% of the proceeds will benefit asbestos cancer research.
10-09-07 - PHLBI mourns the passing of mesothelioma victim, John McNamara. Memorial service to be held on Wednesday, October 10, 2007.
9-12-07 - PHLBI Director Roger Worthington memorializes his father, Punch Worthington, with a $250,000 donation to knock-out asbestos cancer!
9-10-07 - Mesothelioma patient activists, John and TC McNamara, donate apartment to PHLBI to provide access to UCLA for out of state mesothelioma patients. See the apartment!
9-08-07 - PHLBI mourns the passing of mesothelioma victim, Thomas "Tommy" Reed.
9-02-07 - PHLBI welcomes new scientific investigator for the Punch Worthington Research Lab, Nikos Hontzeas, Ph.D.
8-30-07 - Drop the Rock! What do you know about the state rock of California? Take our survey and sign a petition to repeal government code section 425.2 to remove serpentine as the state rock of California.
7-19-07 - Asbestos Found in Dust from NYC Eruption
6-05-07 - MESOMARK Blood Test: World's first in vitro test to measure and monitor biomarkers in mesothelioma available now. Speak with your physician and find a participating lab near you.
5-22-07 - PHLBI mourns the passing of mesothelioma victim, Charles "Chuck" Gaia.
3-28-07 - The Asbestos Disease Awareness Organization (ADA) supports Ban Asbestos in America ACt, 2007
3rd Annual Asbestos Awareness Day Conference, March 31, 2007
ADAO's mission is to prevent, detect, and treat asbestos-related diseases and trauma. This conference is made possible with the support and collaborative efforts from Drexel University School of Public Health and the International Ban Asbestos Secretariat (IBAS).
3-08-07 - Text of the Ban Asbestos in America Act, 2007
3-05-07 - The Meso Foundation Urges Senate to Ban Asbestos
2-20-07 - Celebrex available in clinica trial for former heavy smokers and those with asbestos exposure.
2-15-07 - Benefit Concert Raises $250,000 for Mesothelioma Research
2-10-07 - International Association of Heat and Frost Insulators and Asbestos Workers Donate $15,000 to PHLBI
2-07-07 - L.A. Lab Works To Improve Odds Against Asbestos Cancer
1-15-07 - Mesothelioma help is available now!
10-29-07 - EPP vs P/D: The Great Debate. Dr. Cameron favors the Pleurectomy/Decortication
10-03-06 - PHLBI Director Roger Worthington donates $500,000 to Punch Worthington Research Lab to comabat asbestos cancer!
10-03-06 - A Cunning Predator. Therapies Improve for Asbestos-Caused Cancer
6-30-06 - The Scandal of Restricted Treatment for Asbestosis
6-08-06 - Medical and civil justice communities mourn the loss of mesothelioma advocate, Terry McCann
3-20-06 - Asbestos Workers Union Joins New Medical Foundation's Quest for Cure of Asbestos and Benzene-Related Cancers
A Cunning Predator
Therapies Improve for Asbestos-Caused Cancer Top
Cure Magazine: Fall Issue 2006
by Kay Human
CURE: Cancer Updates, Research & Education is a quarterly magazine that combines the science and humanity of cancer for those who have to deal with it on a daily basis. CURE provides scientific information in easy-to-understand language with equally understandable illustrations.
When Klaus Brauch began experiencing chest pain six years ago, he assumed it was his heart. He was working a high-stress job and his blood pressure had been off the charts. Doctors eventually diagnosed him with congestive heart failure and the software company manager prepared for life with a diseased heart—not cancer. Certainly not a rare cancer called mesothelioma. “Misdiagnosis is how it starts for so many people,” says Brauch, now 56, of Huntington Beach, California. “It becomes a wild goose chase.” Six months after Brauch experienced his first symptoms, doctors confirmed a diagnosis of mesothelioma.
About 3,000 Americans will be diagnosed with mesothelioma in 2006, and the rising incidence of mesothelioma outside the United States isn’t expected to peak for another 10 to 20 years. While lung cancer affects the airways of the lung itself, pleural mesothelioma affects the tissues lining the lung and the chest and accounts for the majority of mesothelioma patients. Mesothelioma can also grow across the thin mesothelial tissue that lines the abdomen (peritoneum) or, rarely, the heart or testicles.
Mesothelioma is unusual in that it’s tightly linked with an environmental cause—asbestos exposure, which accounts for more than 80 percent of cases. A variety of migration mechanisms have been proposed to explain how inhaled asbestos fibers reach the pleural surface, but none have been proven. While inhaled asbestos fibers can lead to pleural mesothelioma, it’s believed that peritoneal mesothelioma develops from asbestos fibers that are swallowed and become lodged in the digestive tract. If a person has been exposed to asbestos, smoking greatly increases his or her risk of asbestos-related lung cancer, though smoking does not appear to affect pleural mesothelioma risk. Research also points to a possible connection between asbestos and laryngeal cancer.
Most mesothelioma patients worked or lived in a place where they were exposed to asbestos. Brauch handled asbestos-containing materials as a teenager during a summer contractor job, and later while refinishing a house.
Researchers believe asbestos triggers cancer in several ways, says Harvey Pass, MD, a leading mesothelioma expert and chief of thoracic surgery and thoracic oncology at New York University Medical Center. The mineral’s microscopic fibers may physically injure cells during replication, causing genetic changes that lead to cancer. Asbestos fibers may also contain elements that chemically interact with cells, damaging genetic material and thus leading to cancer. Finally, the fibers may trigger immune system changes that lead to cancer.
Making the Diagnosis
Typical mesothelioma patients worked in shipyards or as miners, but Brauch’s story isn’t unusual, says Jill Dyken, PhD, an environmental health scientist with the federal Agency for Toxic Substances and Disease Registry. Family members of miners and defense workers have also developed the disease—many with relatively little exposure. “We don’t know what level of exposure is enough to cause mesothelioma,” says Dr. Dyken.
Such epidemiological questions are vexing in part because mesothelioma tends to appear 30 to 50 years after asbestos exposure. That can also foil diagnosis, says Dr. Pass. Doctors often confuse the earliest symptoms, including shortness of breath, with heart disease or a sign of aging, so months often pass before a patient is correctly diagnosed. Delayed diagnosis is just one of several factors that makes mesothelioma a devastatingly effective killer, says Dr. Pass. It’s hard to remove surgically and is resistant to radiation and chemotherapy. Overall, fewer than 10 percent of patients survive five years after diagnosis.
Until recently, many doctors advised patients to forego grueling treatments and just live the rest of their lives as comfortably as possible. But Dr. Pass says they’re making progress. New combinations of chemotherapy agents have been found to shrink tumors up to 40 percent of the time, and surgeons are perfecting techniques for removing diseased tissue. Selective use of radiation can even delay recurrence for some patients. “Treatments are better now,” says Dr. Pass. “There is no excuse for a doctor to say, ‘There’s nothing to do.’ ” Researchers are finding ways to diagnose and track the disease, and they’re uncovering the cancer’s cellular quirks to better design new therapies.
Treatment Evolution
Beginning in 1998, one of Danielle Rosinski’s lungs kept filling up with fluid. “Every year I had it drained and nothing showed up,” says Rosinski, a 66-year-old mesothelioma patient from Westland, Michigan. In 2003, her pulmonologist suggested pleurodesis—sprinkling talc into the space between her chest and lungs to keep fluid from accumulating. That’s when he saw the cancer. “When he told me I could live a year, well, that was a big blow,” says Rosinski, noting she’s reached nearly three years now.
Brauch, who has also survived beyond the norm, says he concentrates on the fight. “I do have moments where I despair, but I don’t allow myself to stay there,” he says. Aggressive treatment appears to be the key to improving survival, Dr. Pass says. Rosinski and Brauch, both of whom have pleural mesothelioma, went through a punishing combination of chemotherapy, surgery and radiation.
In 2001, Brauch participated in a clinical trial at Brigham and Women’s Hospital in Boston. In a surgical procedure called an extrapleural pneumonectomy, or EPP, doctors removed Brauch’s right lung and its lining as well as the lining of his heart and diaphragm followed by chemotherapy and radiation. Many doctors consider EPP the greatest chance for survival, but it can have serious side effects, such as internal bleeding, respiratory failure and deep vein thrombosis. Rosinski had the less aggressive surgery known as a pleurectomy, in which surgeons remove the tumor, the lining of the lung and chest wall and possibly the lining of the heart and diaphragm if affectd
 "While
it's always nice to be quoted, it's even better to be quoted correctly.
The statement attributed to me was in reference to the future and not
the current situation. Today, within the framework of a long-term, multi-modal
treatment plan, surgery is still thought to be the most beneficial therapy
for malignant pleural mesothelioma, notwithstanding the debate as to
the extent of the optimal surgical procedure." Dr. Robert
Cameron, Chief of Thoracic Surgery, UCLA Medical School (10/04/06) |
As for chemotherapy, Alimta® (pemetrexed) plus cisplatin is the current treatment of choice for pleural and peritoneal mesothelioma because of its proven ability to improve survival. Alimta acts by inhibiting cellular proteins that stimulate cancerous cells to grow. Approved in 2004, it is the first and only drug currently approved for the treatment of malignant mesothelioma.
Clinical studies of Tomudex® (raltitrexed), a drug in the same class as Alimta, also have shown improved response rates and survival times when given with cisplatin compared with cisplatin alone. Other promising agents in testing include Gemzar® (gemcitabine) plus cisplatin and newer agents such as Zolinza™ (vorinostat), the preliminary studies of which suggest an improvement in the survival of patients who did not respond to other drugs. Antiangiogenic agents, such as Avastin® (bevacizumab), may also be effective in treating mesothelioma.
Dr. Pass and others are also searching for biomarkers in the blood that could signal the arrival or return of cancer. Mesothelioma cells overproduce certain proteins, and tracking those could help doctors diagnose the disease earlier and better monitor patients after treatment.
What’s Next
Scientists think they have found a link between mesothelioma and a DNA virus called simian virus 40 (SV40), which contaminated polio vaccines during the 1950s and 1960s. “Tens of millions of Americans were exposed,” says Adi Gazdar, MD, a pathologist and cancer specialist at the University of Texas Southwestern Medical Center in Dallas. He was skeptical when researchers first suggested people with SV40 might be particularly vulnerable to mesothelioma, but Dr. Gazdar says subsequent research—including his own—has been compelling. “We all agree that the major cause is asbestos, but perhaps SV40 makes some contribution,” he says, adding that a better understanding of the role the virus plays could possibly lead to new treatments.
Brauch keeps an eye on all ongoing clinical trials and research. One year after his surgery, a routine monitoring protocol showed a “hot spot” in his chest. By April 2006, it was the size of an orange and had wrapped around his esophagus next to his heart. Today, Brauch is recovering from another experimental treatment—surgical resection followed by brachytherapy. Surgeons removed as much of the tumor as possible and covered the rest with a tiny blanket of material seeded with radioactive iodine.
Brauch misses “that sense of freedom that you have when you’re expecting to live a long, healthy life.” But by his measure, aggressive treatment has already worked, giving him a longer life than many expected, and despite residual pain, the ability to play an occasional game of golf and shop with his wife of 35 years.
The Scandal of Restricted Treatment for Asbestosis
The Times June 30, 2006
Dr Thomas Stuttaford
Once again, we are being hamstrung in treating a devastating disease.
Asbestos was a wonder fibre of the first half of the 20th century. It was a great insulator; protective clothing was made from it; it revolutionised the construction industry and car brake pads. During the war, no kitchen was complete without asbestos mats that saved power by being inserted between the bottom of a kettle or saucepan and the source of heat.
And then asbestos, the wonder material, revealed its dark side. There are, it was found, a host of unpleasant conditions that can follow the inhalation of asbestos fibres. People don’t have to work in a haze of asbestos debris to suffer, and the exposure needed to cause serious trouble varies from person to person and depends on the type of asbestos.
Inhalation of asbestos may, like the inhalation of other silicates, cause interstitial lung fibrosis. Asbestosis, the lung fibrosis from asbestos, may also affect the pleura (the coverings of the lung) and cause them to develop thickened plaques that give rise to effusions. In time, an effusion a collection of fluid will restrict the efficiency of the lung. These non-malignant problems caused by asbestos fibres induce symptoms similar to those that once plagued miners. Patients with asbestosis may become breathless, develop a hacking, dry cough and suffer increasing tiredness and general malaise until they are finally disabled.
If asbestosis is the dark side of this heat-resistant and structurally useful material, there is an even darker side. Asbestos may cause mesothelioma, an especially sinister malignancy, many years after exposure to it and when it may have been inhaled only in tiny amounts. The disease develops in the pleura, the body’s weakest point so far as asbestos is concerned.
Although the response of the pleura is not necessarily related to the amount of asbestos inhaled, there is one worrying statistic: 10 per cent of those who have worked with asbestos are likely to develop a mesothelioma at some subsequent point.
It is not only asbestos workers who may have an unexploded bomb ticking away on their pleura. Wives who washed the clothes of those workers, or even gave them a hug each evening on their return from shipyards or building sites, are at risk.
Even children whose only contact with asbestos was playing with Dad have been known to develop mesothelioma in middle age. By then some desk-bound urban accountant or company director brought up in an industrial area may succumb.
This was illustrated by the case of a 60-year-old City solicitor who had played in a bomb-damaged factory yard over 40 years earlier. When he developed a persistent cough, hoarseness and chest pain he was investigated without delay. His doctors assumed at first that their patient was paying the price for smoking, but further investigation soon showed that he had a mesothelioma. He lived for only 18 months.
When the twin towers were destroyed, one anxiety was that terrorists had unleashed a dirty bomb on New York, and the dust over Manhattan would include silicon fibres. Would there be an epidemic of mesothelioma in years to come? New Yorkers were spared. But the average period between an exposure to asbestos and the appearance of symptoms is 30 years. Before trouble arises, a generation may have passed since a sailor slept beneath lagged pipes, a plumber worked with asbestos, or a junior doctor brushed against the lagged pipe that lined the underground passages linking his hospital living quarters to the wards.
Asbestos is again in the news. NICE, the body that determines policy on prescribing, has decreed that the cost of treating mesothelioma is too great, and its advantages too short-lived, for patients to be given the only treatment that affects the course of the disease: mesothelioma is slowed in 87 per cent of patients by using a combination of Alimta pemetrexed and cisplatin. On average, there is an increased life expectancy of 23 to 40 per cent. As mesothelioma is such an aggressive cancer, this often represents a matter of months.
But it is only by using drugs that they become cheaper and better understood. Pemetrexed was shown to have anti-cancer properties as recently as 2000; time may prove that it is useful for other cancers, such as those of the colon, head and neck.
Many of those now dying developed the disease because they or their relatives were in jobs of national importance before the dangers of asbestos were realised. Society owes them a particular debt.