We Can Help

The costs of mesothelioma can be overwhelming. They can include income loss, expensive treatments that may not be covered by health insurance, plus pain and suffering for you and for your family. Because the disease is preventable – and because it is usually caused by someone else’s negligence – legal options may be available to help regain these costs. Asbestos lawyers focus their practice on knowledgeably and effectively bringing to justice companies that exposed employees and the public to asbestos products. A mesothelioma attorney can help you consider your options and file a claim against the company responsible for your asbestos-related illness. More than one company may be responsible. A mesothelioma attorney identifies all companies at fault. Mesothelioma lawsuits have helped thousands of people receive financial assistance. A lawsuit can result in much-needed money to help reduce financial hardships during an illness and can also provide a more stable future for your loved ones. A lawyer specializing in asbestos litigation can help you seek compensation for expenses related to illness caused by asbestos exposure.

Asbestos Health Screenings in Libby, Montana, Expanding

Highly specialized asbestos exposure health screenings in Libby, Montana, have gone mobile.

In an effort to identify lung abnormalities at their earliest stage, the groundbreaking Center for Asbestos Related Disease – known as CARD – has begun touring the state, offering its services to those unable or unwilling to travel.

The efforts have been well received.

Libby is a small town in rural northwest Montana that is home to one of the largest human-made environmental disasters and longest-running asbestos cleanup project in American history.

Although restoration is all but complete in the scenic and charming mountainside community, the damage done by mining in the area still lingers in many who lived through the toxic times.

Libby has the highest percentage of asbestos-related lung disease – and resulting respiratory disease – in the U.S. The contamination stemmed from 70 years of asbestos-contaminated vermiculite mining that affected people in Libby and throughout Lincoln County.

Asbestos Is Gone but Problems Remain

Although the mining ended in 1990, lingering asbestos remained a serious problem for another 20 years. And those affected by asbestos diseases such as mesothelioma cancer can take 20-60 years to begin showing obvious symptoms.

CARD is a specialized medical center and community nonprofit in Libby that was formed in 2000. It is dedicated to the diagnosis and long-term care of patients with asbestos-related diseases who have been such a part of Libby area health care concerns for decades.

An estimated 800 residents are screened annually at the CARD medical clinic. Of those, health officials say 25% have been diagnosed with an asbestos-related condition. 

The most common diseases are asbestosis, pleural plaques, pleural effusions, COPD, mesothelioma and atelectasis. Asbestos exposure also can lead to lung cancer, laryngeal cancer and ovarian cancer.

In total, more than 2,400 people – about 15% of the total population of Lincoln County – have been diagnosed at CARD with respiratory diseases related to the asbestos contamination. Many of those are still being monitored at the CARD center.

“It’s a long-term issue here,” former CARD medical director Dr. Brad Black told The Mesothelioma Center. “People sometimes forget that, and don’t understand the lag time between long-ago exposure and disease today. It’s something you always have to be aware of here.”

CARD Now Traveling Across Montana

This summer, for the first time, CARD didn’t wait for residents to come to the clinic to be tested. CARD is now on tour, traveling through the state to offer assistance to those who need it, particularly Libby residents who moved away.

For the first mobile clinic in June, CARD went to Billings, Montana – 500 miles away – and screened 13 people. In Missoula, 200 miles away, 33 people came for the testing in July. 

The next mobile clinic is scheduled for Oct. 10-12, in Kalispell, Montana, which is 90 miles from Libby. Future dates in future cities will be announced soon. There is talk of also going out of state.

Free screening is available to anyone who spent at least six months in Lincoln County, at least 10 years ago.

Asbestos-Related Disease Screening Is Extensive

The screening process includes a chest X-ray, spirometry breathing test, full physical exam, a CT scan of the chest if deemed necessary, and a complete blood workup. All tests will be read by a CARD medical provider who is trained in identifying early symptoms of asbestos diseases.

CARD staff includes doctors, physician assistants, nurses, respiratory therapists and researchers, all specialists in asbestos diseases.

The clinic has expanded to include academic research that has led to worldwide diagnostic and treatment advances for asbestos diseases.

An estimated 700 residents from the Libby area have died of asbestos-related diseases during the past half-century, some of whom once worked in the mine and many others who did not.  

This extensive early testing for asbestos diseases is vital to successful treatment. Mesothelioma cancer, for example, often doesn’t show obvious symptoms until in its latter stages when mesothelioma treatment is limited and often ineffective.  

Less than a third of those diagnosed with mesothelioma are even eligible for mesothelioma surgery – which has proven to be the most effective treatment – because the disease is often too far advanced. 

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ADAO Asbestos Prevention and Awareness Conference Runs Sept. 16-17

Medical specialists, environmental experts and mesothelioma cancer survivors will be among those gathering for the 17th annual International Asbestos Awareness and Prevention Conference, to be held Sept. 16-17, at Emory University in Atlanta.

The world is invited to watch and learn with a free livestream, which is once again embracing the “Where Knowledge and Action Unite” theme.

“Our conference is, and always has been, about serving people,” said Linda Reinstein, president of the Asbestos Disease Awareness Organization, which hosts the conference. “There should never be a barrier to education, especially when it comes to lifesaving public health information.”

Reinstein co-founded ADAO in 2004 when husband Alan Reinstein was first diagnosed with malignant mesothelioma, a terminal cancer caused by asbestos exposure.

She has spent the past 18 years working tirelessly toward eliminating asbestos disease and has become one of America’s most persistent voices for asbestos awareness.

“It’s about bringing prevention to the forefront,” she told The Mesothelioma Center at Asbestos.com. “We’re making a difference.”

Asbestos Conference Features Global Experts

More than 40 experts from seven countries will gather throughout the two days – many of them virtually – to discuss preventing and treating asbestos diseases, along with policy efforts around the world to finally ban asbestos.

Among the experts will be highly regarded thoracic surgeons Dr. Raja Flores and Dr. Andrea Wolf, mesothelioma specialists at Mount Sinai Hospital in New York City.

“Over the years, I’ve seen the devastating effects of mesothelioma,” Wolf said. “I am grateful to ADAO for the opportunity to share this on a large scale at this weekend’s meeting.”

Livestreaming the event is free, but registration is required.

Friday features the Arts, Advocacy and Action Festival, focused on the impact storytelling has on raising awareness of toxic asbestos and preventing exposure.

David Boraks, a journalist with WFAE, the National Public Radio affiliate in Charlotte, North Carolina, will deliver the keynote address. Boraks’ reporting has documented higher levels of asbestos exposure in poorer communities.

Others scheduled to speak include Tony Rich, an industrial hygienist and environmental technician; Lee Loftus, a former insulator/asbestos worker; and Fernanda Giannasi, a civil and safety engineer.

Academic Panel Discussions Offer Opportunities to Learn

Saturday will feature an academic conference highlighted by four 90-minute panel discussions that include many of the experts who have gathered for the event.

ADAO Saturday Panel Discussions
Session I

Progress and Challenges from the Frontline, with moderator Dr. Celeste Monforton.

Session II

Medical Advancements: Diagnosing and Treating Mesothelioma and Other Asbestos-Related Diseases, with moderator Dr. Arthur Frank.

Session III

Prevention: Legacy Asbestos: What is it? Where is it? What Do I Do? with moderator Richard Lemen, Ph.D.

Session IV

Global Ban Asbestos Action, with moderator Brent Kynoch.

Wolf, who will be receiving the prestigious Dr. Irving Selikoff Award for her commitment to the cause, will be part of the Medical Advancements session. Dr. Melissa McDiarmid will also receive the Selikoff Award.

Dr. Raja Flores to Speak on Legacy Asbestos

Thoracic surgeon Flores will be part of the Legacy Asbestos session, which is particularly pertinent to ADAO, whose recent lawsuit against the U.S. Environmental Protection Agency is pushing the country closer to an asbestos ban.

The lawsuit led to a court order for the federal agency’s current ongoing evaluation of the risks posed by legacy asbestos, a key topic for Saturday.

With asbestos highly regulated today in the U.S. and no raw asbestos being mined or imported into the country, legacy asbestos in the U.S. is what most people believe is the biggest threat today.

Legacy asbestos is found most everywhere throughout the U.S., particularly in older commercial and residential structures. It becomes a threat as it ages and becomes more brittle, particularly in renovation projects.

The EPA was forced to make legacy asbestos a significant part of its much-anticipated Risk Evaluation for Asbestos Part 2, which must be completed by 2024.

“Legacy asbestos is going to drive the message forward that asbestos is a known carcinogen. There is no safe level,” Reinstein said. “We must ban it now.”

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Asbestos Found in Talc-Based Tiger Brands Baby Powder

Johnson & Johnson isn’t the only market leader struggling with the issue of asbestos-contaminated talc in its baby powder.

Tiger Brands, the largest food producer in South Africa, has recalled its Purity Essentials Baby Powder as a “precautionary measure,” after trace amounts of asbestos were detected in test samples.

The recall was announced Sept. 8, less than a month after Johnson & Johnson informed company shareholders that it was ending the worldwide sale of its talc-based product in 2023.

Tiger Brands, one of the largest packaged goods companies on the continent, is expected to continue selling its talc-based baby powder once the recall has been completed. Its products also can be found in Cameroon, Kenya, Zimbabwe, Nigeria, Chile and Mozambique.

“I can assure you that the testing that we did was unrelated to anything linked to J&J issues,” Tiger Brands Chief Operating Officer Noel Doyle said. “While we found trace levels of asbestos in the raw material, we’ve acted to recall everything that’s on the market, despite the fact that previous testing did not show any trace levels.”

Asbestos in Talc Has Prompted Lawsuits

Asbestos, a toxic, naturally occurring mineral, is found near the Earth’s surface, often close to where talc is mined. Talc is coveted as one of the world’s softest minerals.

Johnson & Johnson stopped selling the talc-based version of its baby powder in the U.S. and Canada after becoming the target of close to 40,000 talc lawsuits, most claiming that use of the product caused serious health problems, including ovarian cancer. A small number of cases claim the asbestos contamination led to mesothelioma cancer.

Although J&J shareholders voted in May against ending the worldwide sale of the talc-based powder, company executives overruled them while continuing to insist the product was safe.

Since 2020, Johnson & Johnson has been transitioning to a cornstarch-based baby powder, which Tiger Brands already is using, along with its talc-based product.

The majority of companies today have moved away from talc-based powders, according to Women’s Voices for the Earth, a nonprofit based in Montana that is focused on toxic chemicals and gender justice.

In recent years, scientific studies of Johnson’s Baby Powder have been mixed. Some have shown that women who use the product regularly increase their risk of ovarian cancer. Other studies have not shown a risk.

Talc Asbestos Lawsuits Continue

The U.S. Food and Drug Administration discovered small traces of asbestos in Johnson’s Baby Powder samples in 2019, which prompted a partial recall and helped fuel the rise in lawsuits.

Less than a year later, Johnson & Johnson suspended sales of the product in the U.S. and Canada, but insisted the stoppage was in response to exaggerated reports of contamination and legal ramifications.

This latest recall by Tiger Brands is expected to accentuate the efforts against J&J, which continues to say its product is asbestos-free.

To fend off the lawsuits and absorb its talc liabilities, though, Johnson & Johnson created a new subsidiary earlier this year, LTL Management LLC, which immediately filed for bankruptcy.

The J&J talc bankruptcy filing, which was approved by a federal judge in New Jersey, was designed to limit legal exposure and includes a trust fund worth an estimated $3 billion.

That filing has temporarily suspended most of the lawsuits but is being challenged in court and looked at by Congress. 

According to its own financial reports, Johnson & Johnson has already spent close to $1 billion in legal fees and $3.5 billion in settlements and verdicts.

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Kaiser Study Shows Benefits of Mesothelioma Specialty Centers

Patients diagnosed with pleural mesothelioma are better managed and survive longer when treated at an integrated specialty center, according to a study by Kaiser Permanente that compared its own performance before and after making the transition to specialty care.

Doctors at the Kaiser Permanente Northern California health care system found a dramatic improvement once more specialized and standardized treatment was established for mesothelioma patients.

The Journal of Thoracic Disease published the results of the findings in August.

Mesothelioma patients at Kaiser were three times more likely to receive treatment for this cancer than before the transition. The rate of aggressive mesothelioma surgery went from 6% of patients to 22%.

After the mesothelioma specialty center was established, patients were evaluated and diagnosed more accurately, understood more clearly and treated more aggressively, according to the study.

Median overall survival rates of those undergoing multidisciplinary therapy increased by an average of 12 months, compared to the majority of patients who opted for a more hands-off, hospice approach before the changes were made.

“The takeaway from this study is that mesothelioma patients today really need to get a medical opinion at a center that has expertise in handling this cancer,” study co-author and thoracic surgeon Dr. Jeffrey Velotta told The Mesothelioma Center at Asbestos.com. “Too many don’t. Too many patients today are just not getting the appropriate treatment, and in this day and age, that’s crazy. It is happening too often.”

Mesothelioma Study Makes Before/After Comparisons

Kaiser’s study involved 368 adult mesothelioma patients from Jan. 1, 2009, to Dec. 31, 2020, some before and some after the regionalization of Kaiser Permanente that involved specialized surgical teams and multidisciplinary reviews of treatment options.

The first group included 171 mesothelioma patients from 2009 to 2014, a period in which a low volume of surgeries were performed at two different sites by two different surgeons.

A second group had 197 mesothelioma patients from 2015 through 2020, which was after the move to one thoracic surgeon, a mesotheliomas specialist, at one site. It included a team of multidisciplinary specialists and a tumor board that met weekly to review cases.

In the first group, just 43.9% of the patients received any treatment at all. Only 10 of the 171 patients underwent surgery.

In the second group, 63% of the patients opted for treatment and 44 of the 197 underwent aggressive surgery.

Median survival of the patients opting for surgery went from 16.7 months to 22.6 months, respectively, in the two groups.

“One of the highlights of our regionalization program was that significantly more eligible patients for multimodality treatment did indeed undergo optimal treatment, compared to preregionalization,” the authors wrote.

Many Mesothelioma Patients Go Without Treatment 

Mesothelioma, which is caused by exposure to asbestos, is a rare cancer with no cure that is often only diagnosed in its later stages. Oncologists rarely see it and generally deliver a grim prognosis without many treatment options. Too often, patients are told that mesothelioma treatment side effects are not worth the little difference they would make.

“That ‘do-nothing’ attitude is all too common. When I came here in 2014, I was shocked. You still see it at a lot of centers today,” Velotta said. “People need to get treatment. You can do well with mesothelioma. You just have to go to a place that knows how to treat it.”

In recent years, Velotta has built a reputation as one of America’s top mesothelioma surgeons. Kaiser Permanente also has become a West Coast leader in the field of mesothelioma, particularly with the specialty center Velotta has helped build at Oakland Medical Center, the flagship hospital.

His success has come as no surprise, having trained at  Brigham and Women’s Hospital in Boston under legendary thoracic surgeon Dr. David Sugarbaker, a mesothelioma treatment pioneer.

“Treatment is not going to be easy, but nothing about mesothelioma is easy. Even if you don’t have surgery, there are other good options today,” Velotta said. “The majority do well with surgery. We’ve had success here. That’s why I still find it hard to believe how many people are still going undertreated.”

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Study: ‘Drug-Factory’ Technology Kills Mesothelioma Tumor Cells in Mice

Tiny, drug-producing beads implanted in the chest cavity could one day provide a powerful platform that would change the way mesothelioma cancer is treated.

In a recent study, researchers from Rice University and the Baylor College of Medicine demonstrated the implants’ impressive effectiveness in mice, raising hopes of a possible breakthrough for this tough-to-treat cancer.

Researchers have already met with the U.S. Food and Drug Administration, and hope to open a clinical trial to begin testing the procedure’s effectiveness on mesothelioma patients by the second half of 2023. Clinical Cancer Research published the latest study Aug. 22.

“There is a lot of work left to be done, but we are definitely excited about the potential and encouraged by the clinical work already done,” Rice University bioengineer Omid Veiseh, whose lab invented the novel technology, told The Mesothelioma Center at Asbestos.com. “This could shift the paradigm [of treatment].”

New Technique Delivers Drugs Directly to Tumors

Drug-producing beads, which are no larger than the head of a pin, can be programmed to produce continuous high doses of genetically engineered interleukin-2, a natural compound that activates white blood cells to fight tumors. Researchers have dubbed the process “drug-factory” technology.

The FDA already has approved the technology with interleukin-2 for a clinical trial involving ovarian cancer. It is scheduled to open near the end of 2022.

For the study of mice with mesothelioma, beads were loaded with thousands of cells and implanted with minimally invasive surgery alongside the tumors and inside the pleural lining that surrounds the lungs.

In the first group, tumor burden was reduced by an average of 80% after only one week of treatment. In more than half of the mice, the implants completely eliminated the tumors.

A second group of mice received a combination treatment of the same interleukin-2 and a checkpoint inhibitor drug, which works by training the immune system to recognize and destroy cancer cells.

In that second group, tumor burden was eliminated in all seven animals, none of which exhibited any recurrence in the following weeks of observation.

“It is very hard to treat mesothelioma tumors in mice, like it is in human beings,” said thoracic surgeon Dr. Bryan Burt, a mesothelioma specialist at Baylor University and the study co-author. “And what our data show is that delivery of these immunotherapy particles, regionally, to these mice that have mesothelioma, has very provocative and very effective treatment responses.”

Continuous Drug Dosage Is Critical

The key, according to authors, is the ability to produce the continuous drug doses alongside the tumors. Immunotherapy drugs by themselves have shown only sporadic effectiveness for patients when given systemically. They have worked especially well only for a small percentage of patients.

“We’ve been working on this technology for a while,” Veiseh said. “This combination does a more effective job of using the immune system to kill the tumors.”

It was Veiseh’s earlier work using his technology with ovarian cancer at Rice University that first caught the attention of Burt and Dr. Ravi Ghanta at Baylor.

“They were really impressed by the preclinical data we had in ovarian cancer,” Veiseh said.  “And they asked the question, ‘Could we actually leverage the same system for mesothelioma?’”

The answer came with the mice model, which is leading to clinical trials.

In addition to showing potential to eliminate tumors, this early study suggests that the drug combination and its delivery method also could be effective at training T cells to reactivate the immune system when mesothelioma recurrence occurs.

“I’ve not seen these mesothelioma tumors in mice be eradicated – with such efficacy – as we have in this mice model,” Burt said. “The local delivery of relatively high doses of immunotherapy to that pleural space is a very attractive way to treat this disease.”

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Major Section of Libby Asbestos Superfund Cleanup Completed

Twenty years after being placed on the U.S. Environmental Protection Agency’s National Priorities List, the Libby, Montana, asbestos Superfund site continues its slow but steady climb toward total restoration.

The EPA announced earlier this month that cleanup of another major section had been completed, the fourth of a sprawling, eight-unit project that began in 2002.

Operable Unit 6, as this one is officially called, includes railyards owned and operated by BNSF Railway, one of the largest freight railroads in North America. It also encompasses 41 miles of railroad right-of-way through Libby and adjoining Troy, Montana.

A Superfund designation is defined as a federal public health emergency. This Superfund site is the largest asbestos cleanup project in the U.S. and part of the longest-running manmade environmental disaster in American history.

“This milestone marks half of the operable units being deleted from the National Priorities List, and demonstrates the progress the EPA and our partners have made in the cleanup and restoration of properties in Libby,” EPA Region 8 administrator KC Becker said as part of the announcement.

Asbestos Remediation Ongoing

Contamination of the Libby area stemmed from the mining of vermiculite that began almost 100 years ago. Vermiculite is a naturally occurring mineral once used in building insulation and as a soil conditioner.

The vermiculite and the entire Libby mine, which was bought by W.R. Grace in 1963, was contaminated with a highly toxic type of asbestos called tremolite, which was spread across the entire region through the mining operation and the dust it produced.

Ongoing cleanup in the Libby area has cost federal taxpayers about $600 million, according to various estimates.

In 2021, cleanup completion involved all roadways and major highways in and between Libby and Troy. Restoration of most all commercial and residential properties already has been done.

Contamination Leaves Mesothelioma Legacy

Although the mine was closed in 1990 – after almost 70 years of operation – it left behind a grim legacy and a rural population with disproportionate cases of mesothelioma cancer, which is caused by asbestos exposure. Lincoln County, where Libby is located, has the highest asbestos-related mortality rate in the U.S.

Most of the asbestos is gone now, or buried out of reach, but the aftereffects remain. An estimated 500 people in the area – both miners and residents – have died from asbestos diseases. Thousands more have been sickened through the years.

Libby’s Center for Asbestos Related Disease Clinic remains busy, caring for and monitoring almost 2,500 people, either current or past residents.

Those numbers remain high, even with most asbestos gone, because of the long latency period – between 20 and 60 years – between exposure to the toxic fibers and obvious symptoms of disease.

Libby Restoration Moves Past Halfway Point

Final restoration of three of the remaining four units is almost done and completion announcements are expected to follow soon. Only the unit with the actual mine site will need several more years of work.

Although still involved, the EPA relinquished oversite of the Superfund site to the Montana Department of Environmental Quality in 2019. The two governmental agencies will continue to address contamination concerns throughout the area.

“The deletion of Operable Unit 6 from the National Priorities List is another accomplishment for the Libby Asbestos Superfund site and for Lincoln County,” said Matt Dorrington, construction bureau chief for the department. “It’s always a celebratory day when DEQ and EPA can announce that a portion of a Superfund site is cleaned up.”

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Blood Serum Diagnostic Test for Mesothelioma Explored in Study

One of the biggest obstacles to treating pleural mesothelioma cancer effectively is its often late-stage diagnosis. A recent study shows encouraging signs that those days could be ending.

Novel diagnostic testing using blood serum and infrared spectroscopy is being explored to better characterize and differentiate mesothelioma in its early stages from other lung diseases and benign effusions.

The study is being conducted by scientists and doctors in Ankara and Istanbul, Turkey, spread through various hospitals and university medical centers within the region. Biochimica et Biophysica Acta – Molecular Basis of Disease will publish the study in October 2022. Science Direct released an online version June 23.

“As the symptoms of mesothelioma usually take decades to become noticeable, timing is the worst aspect of this disease,” co-author Dr. Feride Severcan, Altinbas University Faculty of Medicine, told The Mesothelioma Center at Asbestos.com. “An early diagnosis from easily collected blood serum is a very valuable approach, increasing the chance of successful treatment and survival rate.”

Early Diagnosis Allows for More Treatment Options

Because of mesothelioma’s typical late-stage diagnosis, less than 25% of pleural mesothelioma patients even qualify for aggressive surgery and the most effective multimodality treatment.

The majority of patients diagnosed with pleural mesothelioma receive only standard chemotherapy and have a median survival of 12 months. Most are not diagnosed for at least 30 years after first being exposed to toxic asbestos fibers, the primary cause of the disease. 

Mesothelioma is a rare cancer that is diagnosed in an estimated 3,000 people annually in the U.S. Dry cough, slight shortness of breath, fatigue, muscle weakness, hoarseness and difficulty swallowing are common early symptoms of mesothelioma, but these are also similar to signs of other benign or malignant diseases. The average age at diagnosis is 74.

A mesothelioma diagnosis is often a drawn-out process that usually starts with imaging studies, including chest X-rays, CT, MRI and PET scans. It eventually moves to more invasive surgical procedures such as a thoracentesis to obtain a biopsy sample and a thoracoscopy for a pleural tissue biopsy.

“It would be critical to find new diagnostic approaches, which are accurate, preferably noninvasive, rapid, low-cost, operator independent and able to create reliable information,” Severcan said. “An early and accurate diagnosis of MPM [malignant pleural mesothelioma] is essential to decreasing the morbidity rate.”

Study Accuracy Rate Is Promising

The study started with blood serum samples, regardless of pleural fluid status, which typically doesn’t occur until the later stages of disease. The tool being used is called an attenuated total reflectance-Fourier transform infrared spectroscopy, or ATR-FTIR, that can help analyze even small amounts of blood serum.

Samples were obtained from 25 patients with malignant mesothelioma, 31 with lung cancer, 26 with nonmalignant pleural effusions and 30 healthy individuals to serve as a control group. The aim was to differentiate between lung cancer, benign effusions, healthy tissue and mesothelioma through various biomarkers.

For the four different groups, a linear discriminant analysis was obtained with an 87.5% accuracy rating, showing promising potential.

The results demonstrated the biomolecular composition and structural differences between the four groups of serum samples. 

“Based on FTIR measurements, the molecular fingerprints of serum samples can be obtained and the structural and compositional changes in the components of that fluid can serve as biomarkers for early signs of the disease,” Severcan said.

Essentially, the testing could result in an early diagnosis of mesothelioma prior to obvious symptoms. It could be done easily for high-risk, asbestos-exposed populations. The noninvasive approach would likely be welcomed by anyone who had a history of exposure.

If utilized, the approach could help identify the disease and start the mesothelioma treatment process sooner, when success is more likely.

“An early diagnosis from easily collected blood serum is a very valuable approach,” the authors concluded. “In the absence of reliable noninvasive diagnostic tests today, there is a critical need. Our study can be a guide for future studies.”

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Mesothelioma Clinical Trial Studies Keytruda, Lenvatinib Combination

A possible second-line treatment for pleural mesothelioma may be on the horizon after a phase II clinical trial showed impressive efficacy with early returns from the Netherlands Cancer Institute in Amsterdam.

The single-arm, open-label clinical trial involved the combination of pembrolizumab, an immunotherapy drug known by the brand name Keytruda, in combination with lenvatinib. Synergy between the two cancer drugs was impressive.

Results of the clinical trial were presented earlier this week at the IASCL 2022 World Conference on Lung Cancer in Vienna, Austria.

“We are really pleased with the combination,” co-investigator Li-Anne Douma, who made the presentation, told The Mesothelioma Center at Asbestos.com. “The results thus far were far better than expected.”

Early Results Show Survival Benefits

The trial involved 38 patients whose unresectable mesothelioma had begun progressing after standard-of-care chemotherapy. They enrolled between March 5, 2021, and Jan. 31, 2022.

Each received Keytruda intravenously every three weeks and lenvatinib orally once a day. They remained on treatment until unacceptable toxicity or disease progression. Many are still being treated.

Early results cited in the presentation included a median overall survival rate of 11.4 months and a median progression-free survival rate of 5.7 months, although Douma cautioned that those numbers were preliminary and only a rough estimation. 

“I would like to avoid conclusions being drawn too early,” she said.

Lenvatinib Can Block Tumor Growth

Although success with Keytruda has been celebrated with some cancers, its response rate as a monotherapy has been only 20% with mesothelioma, accentuating the need to find an effective drug partner to provide the needed synergy.

The objective response rate of the Keytruda/lenvatinib combination was an impressive 58%.

In 2020, the U.S. Food and Drug Administration approved the use of Keytruda for certain metastatic tumors, including certain cases of mesothelioma, but the search for an effective combination continues.

Lenvatinib has shown it can block tumor growth by targeting specific proteins Keytruda can’t reach. It has been effective with only select cancers and is known as precision medicine.

The drug, which is already FDA approved, has been used successfully with Keytruda for the treatment of endometrial cancer. Lenvatinib is prescribed alone to treat hepatocellular carcinoma, a type of liver cancer. It is used in other combinations to help treat renal cell carcinoma.

Searching for Second-Line Mesothelioma Treatments 

The need for second-line treatments of unresectable mesothelioma is ongoing. The average life expectancy of someone with the disease is 12 to 21 months.

Pleural mesothelioma is a rare cancer caused mostly by long-ago inhalation or ingestion of asbestos fibers. It is diagnosed in an estimated 3,000 people annually in the U.S.

The FDA approved the immunotherapy combination of Opdivo and Yervoy in 2020 for first-line treatment, adding to standard-of-care chemotherapy. Neither treatment, though, has shown an ability to be effective long-term for most patients.

“Despite many trials and a list of recommendations, there is still no standard treatment in the second line,” Douma said. “The need to find a standard treatment is high.”

She said this latest trial combination could potentially fill the void, but that larger trials are needed. 

The median age in Douma’s trial was 70.5 years, and 89.5% of the patients had epithelioid mesothelioma, the most treatable type of mesothelioma. 

Ten of the 38 patients reported treatment-related side effects that ranged from serious to minor. They included hypertension, hoarseness, fatigue, diarrhea and anorexia. Dose reductions or discontinuation of lenvatinib were required by 76% of the trial participants.

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Johnson & Johnson Ends Worldwide Sale of Talc-Based Baby Powder

Against the wishes of its shareholders, Johnson & Johnson announced Aug. 11 that it would end the worldwide sale of talc-based Johnson’s Baby Powder in 2023.

The company had already discontinued the sale of the talc-based version of its iconic baby powder in the U.S. and Canada in 2020 when it became the target of thousands of lawsuits. Most claimed J&J’s talc was contaminated with toxic asbestos and causing serious health problems, including mesothelioma and ovarian cancer.

Instead of using talc, the company will transition to a cornstarch-based product, which already is being sold in several countries around the world.

This latest announcement comes just four months after Johnson & Johnson stockholders rejected a proposal that would have ended the worldwide production and distribution of the product.

Company executives overruled its shareholders with this decision.

“We continuously evaluate and optimize our portfolio to best position the business for long-term growth,” the company statement said. “This transition will help simplify our product offerings, deliver sustainable innovation, and meet the needs of our consumers, customers and evolving global trends.”

J&J Still Insists Talc Is Safe

Despite the new worldwide stoppage, Johnson & Johnson continues to insist the product is safe to use and poses no health risks.

Scientific studies of talc-based Johnson’s Baby Powder have been mixed. Some have shown that women who use the product regularly increase their risk of ovarian cancer. Other studies have not shown a risk.

“Our position on the safety of our cosmetic talc remains unchanged,” the statement said. “We stand firmly behind the decades of independent scientific analysis by medical experts around the world that confirms talc-based Johnson’s Baby Powder is safe, and does not contain asbestos, and does not cause cancer.”

The courts have ruled otherwise at times.

In 2021, the U.S. Supreme Court rejected a request by Johnson & Johnson to overturn a Missouri state court ruling from 2018 that awarded 22 women a combined $2.1 billion in damages caused by talc products.

Earlier this year, however, a New York State Supreme Court reversed a 2019 decision that awarded a woman $120 million in damages for ovarian cancer she claimed was caused by talc contaminated with asbestos in the Johnson & Johnson product she used.

Johnson & Johnson also claimed its product was safe in 2020 when it ended the sale of talc-based powder in North America amid the avalanche of legal cases, attributing the change to falling demand and “misinformation.”

The stoppage also was prompted by the U.S. Food and Drug Administration, which discovered small traces of asbestos in baby powder samples taken in 2019.

Avalanche of J&J Lawsuits Still Pending

Johnson & Johnson is one of America’s richest companies, with a market share estimated at $500 billion.

There are close to 40,000 talc lawsuits pending today from consumers and cancer survivors claiming the talc products are causing health problems. Only a small number of those involve malignant mesothelioma, a rare cancer caused almost exclusively by the inhalation or ingestion of microscopic asbestos fibers.

According to its own financial reports, J&J was facing $3.5 billion in talc-related litigation and settlements in 2021. It also had set aside almost $4 billion to handle future cases.

Prompted by the U.S. Supreme Court rejection of its request to overturn the Missouri billion-dollar ruling in 2021, J&J created a new subsidiary, LTL Management LLC, to absorb all its talc liabilities and limit its legal exposure.

The subsidiary immediately filed for bankruptcy while listing assets at $10 billion. The controversial move, which allows a company to separate assets from liabilities, would create a trust fund to more easily resolve the thousands of lawsuits.

Future of J&J Litigation Unclear

After considerable debate, the bankruptcy strategy was approved early in 2022 by a federal judge in New Jersey.

The bankruptcy filing, which would involve a trust fund worth an estimated $3 billion, has left almost all of the pending lawsuits on hold.

J&J’s reorganization process is still being appealed by plaintiff lawyers in a federal appellate court and is currently being scrutinized by Congress. The controversial bankruptcy strategy, which was legalized 30 years ago, has been tried only a handful of times by other companies looking to avoid huge liabilities.

This latest move to end all sales of talc-based products could play a role in determining outcomes of future court cases, but only if the bankruptcy filing is prohibited.

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Camp Lejeune Veterans Win Justice

On Wednesday, Aug. 10, President Joe Biden signed the comprehensive Honoring Our PACT Act of 2022 into law, allowing military veterans and families harmed by contaminated water at Marine Corps Base Camp Lejeune to file lawsuits against the federal government.

The Camp Lejeune Justice Act of 2022, which focuses on four decades of water contamination, is just one part of the much broader PACT Act, which expands access to health care and disability benefits for veterans harmed by toxic exposures around the world.

Biden lauded the bipartisan support for the PACT Act at the signing.

“There are a lot of issues we can disagree on, but there are issues we can work together on, and this is one of those issues. We have fought for this for so many years,” he said. “This law is long overdue. We finally got it done together.”

Biden spotlighted the critical support this legislation offers survivors and noted that as commander in chief he believes his role “includes always fighting for the care and benefits you more than earned and more than deserve. Got it done and God bless you all.”

The legislation specifically says that in any health care or disability lawsuit regarding contaminated water at Camp Lejeune, the U.S. government may not assert any claim to immunity that would typically be available.

All legal action against the government must be filed through the United States District Court for the Eastern District of North Carolina, the jurisdiction covering the base.

“I am urging veterans of those decades of war to promptly file for your claims,” Biden said. “The VA will move as quickly as possible to resolve your claim and get you the benefits and the care you have earned.”

To determine if you are eligible to file a lawsuit for compensation after being exposed to water contamination at Camp Lejeune, visit: www.camplejeunelawsuits.org.

Military Bases Dangerous Everywhere

For decades, U.S. military bases throughout the country – and the world – have been plagued by nearby problems with toxic hazards, such as burn pits, radiation, asbestos and Agent Orange, leading to a wide range of serious health problems.

This legislation will cover rare conditions and chronic illnesses stemming from exposure to toxic chemicals in the line of duty, which could include an estimated 3.5 million veterans.

President Biden signs PACT Act into law
President Joe Biden signs the PACT Act into law in front of supporters at the White House.

Asbestos products – the primary cause of mesothelioma cancer – have been particularly troubling for veterans everywhere. Veterans account for an estimated 33% of all those diagnosed with mesothelioma within the U.S.

The contaminated water, though, has been the biggest concern at Camp Lejeune for many years.

From 1953 to 1987, an estimated 900,000 veterans, family members and nearby civilians were potentially exposed to unsafe water at Camp Lejeune, according to the U.S. Centers for Disease Control and Prevention. Those numbers include National Guard and Army Reserve, as well as active-duty personnel.

Contamination Led to Trouble  

The CDC linked contamination at Camp Lejeune to various sources, including underground storage tanks, a dry cleaning firm located off base and nearby industrial spills.

Among the toxic compounds found in the water over the years were benzene, perchloroethylene (PCE), trichloroethylene (TCE) and vinyl chloride.

The contaminated water in and around Camp Lejeune has caused at least eight serious medical conditions. They are:

  • Liver cancer
  • Aplastic anemia and other myelodysplastic syndromes
  • Parkinson’s disease
  • Adult Leukemia
  • Bladder cancer
  • Kidney cancer
  • Non-Hodgkin lymphoma
  • Multiple myeloma

Contaminants in the water at Camp Lejeune also increased the risk of childhood cancers and serious birth defects, according to the CDC’s Toxic Substances & Disease Registry.

Eligibility to take legal action is wide-ranging. Any veteran or family member (including in utero exposure) who resided, worked or was otherwise exposed to the water at Camp Lejeune for at least 30 days between Aug. 1, 1953, and Dec. 31, 1987, could qualify.

Punitive damages may not be awarded under the law.

Streamline the VA Process

The Veterans Administration has been providing disability benefits for veterans and their families for many years, stemming from the Camp Lejeune contamination. Due to various reasons, however, the VA denies most of those filing for benefits, leading to considerable frustration.

According to CBS News, the VA said its overall approval rating on claims from Camp Lejeune water contamination is only 17%.

The PACT Act of 2022 is expected to streamline the VA process of rewarding veterans, increase the list of presumptive conditions that will be included for compensation and expand medical care eligibility.

“This is long overdue, and hopefully will lead to more acknowledgment of the hazards that veterans were exposed to during service, including asbestos exposure, Agent Orange and burn pits,” said Aaron Munz, former U.S. Army Captain and director of the Veterans Department at The Mesothelioma Center. “The PACT Act will finally make it easier for veterans and families exposed to toxic chemicals at Camp Lejeune to access medical and financial assistance.”

The Congressional Budget Office estimates that the Honoring Our Pact Act will cost $278.5 billion over the next decade.

Patients and families affected by the contaminated water at Camp Lejeune must file within two years.

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Specialty Centers Treating Mesothelioma Lead Best Hospitals Rankings

Mesothelioma specialty programs played a significant role in determining the latest U.S. News & World Report Best Hospitals for Cancer Care annual rankings.

For the eighth consecutive year, MD Anderson Cancer Center in Houston was ranked No. 1, followed by Memorial Sloan Kettering in New York; Mayo Clinic in Rochester, Minnesota; Dana Farber/Brigham and Women’s in Boston and UCLA Medical Center in Los Angeles.

“This ranking is a reminder of our responsibility to those we serve, and it drives our unwavering commitment to our mission to end cancer,” said Dr. Peter WT Pisters, president of MD Anderson. “We are proud to be ranked as the nation’s leader in cancer care.”

All of the centers in the top five have elite mesothelioma specialty programs and excel in the treatment of this rare cancer with no definitive cure.

The 2022-2023 lists were released July 26. MD Anderson has been ranked No. 1 or No. 2 for cancer care every year since 1990. More than 900 hospitals were evaluated for this category.

“These rankings identify the top centers for complex oncology care that other hospitals might see rarely, if ever,” said Ben Harder, chief of health analysis and managing editor at U.S. News & World Report, the nation’s leading authority on hospital rankings. “Our evaluations are relevant to patients with mesothelioma.”

U.S. News & World Report’s Top 10 Best Hospitals for Cancer

These cancer specialty centers placed in the top 10 on the U.S. News & World Report Best Hospitals for Cancer list.

  1. University of Texas MD Anderson Cancer Center, Houston
  2. Memorial Sloan Kettering Cancer Center, New York City
  3. Mayo Clinic, Rochester, Minnesota
  4. Dana-Farber/Brigham and Women’s Cancer Center, Boston
  5. UCLA Medical Center, Los Angeles
  6. Cleveland Clinic, Cleveland
  7. City of Hope Comprehensive Cancer Center, Duarte, California
  8. Hospitals of the University of Pennsylvania-Penn Presbyterian, Philadelphia
  9. Northwestern Memorial Hospital, Chicago
  10. Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital, St. Louis

These are the cancer centers where treatment advances for mesothelioma are made, often stemming from the latest clinical trials. Memorial Sloan Kettering, for example, currently has 18 mesothelioma clinical trials that are either in the recruiting or active stages.

Find a Mesothelioma Cancer Center
Access top mesothelioma cancer centers that have experience treating this rare disease.

Rankings Help Mesothelioma Patients Find Expert Care 

Cancer care is one of 15 specialties in which hospitals are ranked. The lists are beneficial particularly for patients with rare and life-threatening conditions – such as mesothelioma – where it is imperative to find a treatment center that excels in handling high-risk, complex cases not often seen at most hospitals.

Among the other specialties ranked are gastroenterology and GI surgery, orthopedics, cardiology and heart surgery, urology, and neurology and neurosurgery.

Rankings were based upon a wide range of factors, including four major categories: 

  • Professional Recognition
  • Key Programs and Staff
  • Outcomes and Patient Experience
  • Conditions/Procedures Applicable to Cancer

Survival rates for particularly challenging patients were also considered.

Mesothelioma Specialty Centers with Celebrated Oncologists Make Top 20

At each of the top-rated cancer hospitals are experts with experience in the most effective multimodal therapies, leading to extended survival. There also are mesothelioma specialists – both celebrated surgeons and oncologists – at the Top 10 hospitals who are well known for excellence in care throughout the mesothelioma community.

They include surgeons Dr. David Rice (MD Anderson), Dr. Prasad Adusumilli (Memorial Sloan Kettering), Dr. Raphael Bueno (Brigham and Women’s) and Dr. Robert Cameron (UCLA), and medical oncologists Dr. Arvind Dasari (MD Anderson) and Dr. Aaron Mansfield (Mayo Clinic).

Top 11-20 Best Hospitals for Cancer

Rounding out the list are 10 additional specialty centers with cancer expertise. They include:

Cancer was just one of the specialties on which hospitals were judged. A much broader Best Hospitals Honor Roll ranking also was done, acknowledging the delivery of exceptional treatment across several areas of care. Many of the same facilities were near the top.

The Mayo Clinic in Minnesota was ranked No. 1 on the Honor Roll, followed by Cedars-Sinai Medical Center in Los Angeles, NYU Langone hospitals in New York City, Cleveland Clinic, Johns Hopkins in Baltimore and UCLA Medical Center in Los Angeles.

Data used in the rankings was provided by the American Hospital Association, Centers for Medicare & Medicaid Services, medical specialists and various professional organizations.

The rankings will be published in U.S. News & World Report’s Best Hospitals 2023 guidebook, available from the U.S. News Online store.

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Study Suggests Relationship Between Stromal Tumors and Mesothelioma

Early identification of peritoneal mesothelioma cancer – when it is most effectively treated – may become more common after a recent study revealed a potential link to gastrointestinal stromal tumors.

A single-center retrospective review by the division of surgical oncology at University of California San Diego Moores Cancer Center identified a previously underrecognized, synchronous co-occurrence between the two rare diseases.

Annals of Surgical Oncology published the case series in July, which found that one in every 17 patients undergoing resection for gastrointestinal stromal tumors, known as GISTs, also had peritoneal mesothelioma cells nearby.

“There is certainly more work to be done in terms of better understanding the relationship,” surgical oncologist and co-author Dr. Jason Sicklick, GIST specialist, told The Mesothelioma Center at Asbestos.com. “I can’t say exactly where this will lead, but it’s more important now on the diagnostic side of things.”

The authors noted that the potential relationship between the two also could have an effect on future adjuvant therapy.

Rare Cancers Found in Close Proximity

GIST is a cancer that forms in the stomach and small intestines, indicated by a growth of nerve cells into the walls of organs. In the U.S. it is found in an estimated seven people per million and thought to be genetically caused.

Although earlier studies have shown that 14% to 33% of GISTs occur in patients with other malignancies, the relationship with mesothelioma has never been seriously explored.

Peritoneal mesothelioma is an even rarer abdominal cancer, found in an estimated two cases per 1 million people annually in the U.S. Mesothelioma is typically caused by the inhalation or ingestion of toxic asbestos, and is more likely to occur in people with the BAP-1 gene mutation.

The retrospective review at Moores Cancer Center involved 137 patients from 2010 to 2021 who underwent GIST resection. During surgery, eight of those patients were found to have peritoneal mesothelioma, only one of which had been previously diagnosed. All tumors were removed surgically.

At a median follow-up of 14 months, all eight were without GIST recurrence. Seven of the eight – those with papillary mesothelioma – remained without recurrence. One patient with malignant mesothelioma was diagnosed with recurrence after five months, even after cytoreduction and hyperthermic intraperitoneal chemotherapy treatment.

“Mesothelioma was one of the cancers that exhibited increased co-occurrence both before and after GIST diagnosis,” the authors wrote. “The high co-occurrence rates of GIST and PM relative to the independent incidence of each one suggest the potential for a local, nonindependent symbiotic relationship.”

GIST, Mesothelioma Relationship Likely Underreported

Median age of the patients with GIST diagnosis was 57 years. Seven of the eight were clinical patients of Sicklick’s. Four of the eight had a history of other malignancies or benign tumors. In six of the eight patients, the mesothelioma nodules were found close to the GISTs.

The authors believe the high percentage of co-occurrence of GIST and mesothelioma has been underreported nationally due to a lack of awareness among surgeons and a limited ability to evaluate patients for certain peritoneal-based cancers.

“Physicians should be cognizant of [the relationship] at the time of the operation,” Sicklick said. “And if small peritoneal implants are found, to not ignore them but think about removing them for diagnostic and potentially treatment purposes.”

When peritoneal mesothelioma is diagnosed early, it can be treated more effectively using cytoreductive surgery and intraoperative chemotherapy, leading to a survival of five to 10 years and beyond.

Too often, though, it is diagnosed in later stages, leading to less effective mesothelioma treatment, a quicker relapse and much shorter survival.

“In terms of an immediate, direct benefit from these findings, it’s hard to say,” Sicklick said. “At this point, the benefit isn’t in terms of a new drug, but in terms of decision-making.”

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WHO Reclassifies Firefighting as High-Risk Occupation for Cancer

The World Health Organization has reclassified firefighting to its highest level of occupational risk for cancer after extensive research confirmed an alarming level of malignant mesothelioma incidence.

The International Agency for Research on Cancer, which is part of WHO, found that firefighters had a 58% higher risk than the general population of developing mesothelioma, a rare cancer caused by exposure to asbestos fibers.

These findings led to the occupation being reclassified recently as “carcinogenic to humans,” earning it Group 1 status for cancer risk and confirming what many already believed.

“This really is a tragic moment – knowing for sure now that we’ve been working in such hazardous conditions,” said Canadian firefighter Alex Forrest, the only nonmedical, nonscientist on the IARC Working Group panel that submitted the report to WHO. “But this is also a historic moment, because we cannot fix a problem until we all agree that the problem exists.”

8 Countries Represented in IARC Study

Prior to this recent report, first published online by Lancet Oncology June 30, firefighting was classified in Group 2B as “possibly carcinogenic.”

“I had to take off my firefighter helmet and put on my medical community hat to do what I could to convince the working group to change the classification,” said Forrest, who believes the formal consensus will make it a safer profession.

In addition to Forrest, IARC’s research involved 24 scientists and medical professionals from eight different countries. It included four people from the U.S., representing the National Institute for Occupational Safety and Health and the National Cancer Institute.

This latest evaluation stemmed from 52 cohort and case-controlled studies and 12 case reports. More than 30 cohort studies following firefighters over time were conducted, spanning North America, Europe and Asia.

“The Working Group concluded that there was sufficient evidence in humans for mesothelioma and bladder cancer,” the authors wrote. “There was ‘limited’ evidence in humans for colon, prostate and testicular cancers, and for melanoma and non-Hodgkin lymphoma.”

Although there were positive and credible associations seen for those five types with “limited” evidence, lifestyle or physical characteristics could have influenced the malignancies, according to the study.

Mesothelioma Most Obvious Cancer Risk

The research involved seven studies specifically examining mesothelioma incidence in firefighters, leading to the 58% higher risk statistic. Surprisingly, there was a much lower risk for lung cancer among firefighters.

“The human cancer evidence for all other cancer types was ‘inadequate.’ Lung cancer incidence and mortality rates were lower among firefighters than in the general population in most studies, and in the meta-analysis,” the authors wrote.

Evidence of mesothelioma prevalence was no surprise, particularly for those fighting fires in older commercial and residential structures where asbestos-containing materials were used throughout. 

Asbestos, despite its toxicity, was used to strengthen and resist heat in all kinds of building materials. It was used in insulation, cement floors, roof shingles, siding, wall panels and ceiling tiles, among other products.

Despite an emphasis on improving personal protective equipment for firefighters throughout the past 20 years, exposure to asbestos fibers and other toxic chemicals still occurs on the job.

When buildings are burning, asbestos-containing materials release intense concentrations of the toxic mineral fibers into the air, where they linger for long periods of time.

Many of those being diagnosed with mesothelioma today could have been exposed decades ago because of the long latency period of this rare cancer, which can be between 20 and 60 years.

More Presumptive Asbestos Laws Coming

The new worldwide classification is expected to intensify the fight against cancer within the occupation, leading to more presumptive laws and making it easier for those injured to be adequately compensated, particularly in countries where the issue is not closely followed.

Within the U.S., laws vary by state over the type of workers’ compensation firefighters can receive. The Occupational Health and Safety Administration concluded almost a decade ago that firefighters were more than twice as likely to develop mesothelioma than the general population.

Not all states, though, include cancers officially as an occupational disease for firefighters. 

In Florida, legislation was passed in 2019 that extended health care benefits to firefighters diagnosed with 21 different types of cancer.

A year later, Florida passed additional legislation that provided more funding for departments throughout the state to buy high-tech equipment to better protect its firefighters and reduce exposure from cancer-causing contaminants such as asbestos.

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UK Approves Opdivo/Yervoy Immunotherapy for Pleural Mesothelioma

Patients with unresectable pleural mesothelioma cancer throughout the United Kingdom will now have the immunotherapy combination of Opdivo and Yervoy as an option after its recent approval by the National Health Service for first-line treatment.

The long-awaited approval comes almost two years after the U.S. Food and Drug Administration granted a similar approval of Opdivo and Yervoy. It brings new hope to a region particularly hard hit by this rare cancer caused primarily by exposure to asbestos.

Opdivo and Yervoy, known generically as nivolumab and ipilimumab, respectively, are manufactured by Bristol Myers Squibb.

NHS is the single-payer, publicly funded health care system in the United Kingdom and the second largest of its type in the world. Until now, only UK patients in a clinical trial or those paying privately were given the immunotherapy option.

“The NHS is delighted that this new drug combination will now be available for this aggressive type of cancer,” said Dr. Peter Johnson, national clinical director for cancer at NHS England. “Up to now, we’ve had limited options for treatment.”

The National Institute for Health and Care Excellence issued its final appraisal document recommending the immunotherapy combination in July. It was the first new recommendation for pleural mesothelioma in the United Kingdom in 14 years. 

Effectiveness of Drugs Have Been Mixed

For years, standard-of-care treatment for mesothelioma involved a chemotherapy combination with only short-term effectiveness.

Less than a third of those diagnosed with pleural mesothelioma qualified for a multimodality regimen that included aggressive surgery and radiation. Mesothelioma surgery is typically not an option because the disease is usually too advanced at the time of diagnosis.

Early reviews from the combination’s use in the U.S. have been mixed. For a small percentage it has been highly effective, but the majority have seen only a limited benefit.

Immunotherapy Clinical Trial Proved Survival Benefit

The U.K. recommendation was based heavily on an earlier international phase III clinical trial called CheckMate 743. It produced impressive effectiveness for a specific cohort of patients.

Opdivo and Yervoy are given intravenously, typically for 30 minutes, every three weeks for Opdivo and every six weeks for Yervoy.

In the trial, patients with the sarcomatoid or biphasic type of mesothelioma had a median survival of 18.1 months for those receiving the combination treatment compared to just 8.8 months for those getting standard chemotherapy. Sarcomatoid and biphasic constitute just a third of diagnosed mesothelioma cases.

With the most common epithelioid subtype, survival was 18.1 months with immunotherapy compared to 14.1 months for chemotherapy. The two-year survival advantage was 41% to 27%, respectively.

Most mesothelioma specialists agree this immunotherapy would be most effective in combination with other treatments.

“The nivolumab/ipilimumab combination is to be welcomed. However, it is far from perfect, too toxic for most patients without major protocol change,” Dr. Angus Dalgleish, St. George’s Hospital, University of London, told The Mesothelioma Center at Asbestos.com. “I would now add in a background anti-inflammatory such as LDN [low-dose naltrexone].”

Dalgleish published a mesothelioma case report in 2020 detailing his success with a novel treatment regimen involving a series of anti-inflammatories, including naltrexone, the vaccine IMM-101 and immune stimulation.

UK Hit Hard by Mesothelioma

There is typically a latency period of 20 to 60 years between exposure to asbestos and a diagnosis of mesothelioma. Despite instituting a ban on all asbestos products in 1999, the United Kingdom remains a per-capita world leader in mesothelioma cases, with an estimated 2,700 people still being diagnosed annually.

Officials attribute it to the long history of shipbuilding, an industry leader in asbestos consumption, and infrastructure reconstruction throughout England in the post-World War II period. 

This latest approval was met with considerable hope.

“We are extremely pleased with this long-awaited decision,” said Nick Maskell, professor of respiratory medicine at University of Bristol, England. “It is brilliant news for mesothelioma patients and their families. The decision to approve this provides a new routinely available standard of care for NHS patients.”

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Study: Those Exposed to Asbestos Should Not Take Beta-Carotene

Taking beta-carotene health supplements could increase the risk of lung cancer or death from cardiovascular disease for anyone who is regularly exposed to asbestos, according to a panel of medicine experts.

Based on existing scientific evidence, the U.S. Preventive Services Task Force concluded recently that the potential harms of beta-carotene supplements outweigh any benefits, particularly for those with occupational exposure to asbestos.

The task force, an independent group of medical volunteers, makes recommendations about clinical preventive services. In the same report, it also said vitamin E provided no benefit in preventing lung cancer or cardiovascular disease, rejecting a long-held belief.

Both beta-carotene and vitamin E are popular antioxidants taken for their potential health and anti-aging benefits. They are known for their ability to combat oxidative stress and inflammation, common contributors to heart disease and various cancers.

“The most serious harm identified was increased cardiovascular disease mortality and increased risk of lung cancer in persons who smoke, or had workplace asbestos exposure, associated with beta-carotene supplementation,” the report stated.

Beta-Carotene Warning Comes from Credible Source

The well-respected task force, which is not government affiliated, includes doctors from Harvard Medical School, Mayo Clinic, Albert Einstein College of Medicine and Tufts University School of Medicine, among others.

Before publishing its final recommendation statement on June 22 – which was an update to one made in 2014 – the task force reviewed an additional six clinical trials involving beta-carotene and nine trials with vitamin E.

Asbestos exposure by itself can lead to serious health problems, including mesothelioma cancer, asbestosis or lung cancer. Asbestos is a naturally occurring mineral that was once used ubiquitously for its ability to resist heat and strengthen most anything with which it was mixed. Unfortunately, it also is toxic when its microscopic fibers are inhaled or ingested.

Workplace exposure, although not as common today as it was decades ago, still occurs in construction, shipyards and renovation projects. Asbestos is especially prevalent in older structures, both commercial and residential.

Asbestos Disease Has Long Latency Period

The effects of workplace exposure to asbestos may take years to develop. It can take 20 to 60 years after exposure to airborne asbestos before mesothelioma or lung cancer is diagnosed, which puts many retirees at higher risk today if they are taking beta-carotene dietary supplements.

“For many of the vitamins and nutrients reviewed, there was little evidence of serious harms,” the authors wrote. “However, an important harm of increased lung cancer incidence was reported with the use of beta-carotene by persons who smoke tobacco or have occupational exposure to asbestos.”

Cardiovascular disease and cancer are the two leading causes of death annually in the U.S. Together, they account for almost half the deaths in the country each year, becoming the focus of this wide-ranging review of supplements by the USPSTF. 

The U.S. Food and Drug Administration does not have the authority to regulate dietary supplements for safety and effectiveness like it does with drugs.

“The U.S. Preventive Task Force concludes with moderate certainty that harms of beta-carotene supplementation outweigh the benefits for the prevention of cardiovascular disease or cancer,” the study concluded.

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