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.
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No plan, no more money. That’s the Philadelphia City Council’s message to its school district leadership following the recent closure of two schools because of asbestos issues.
Asbestos contamination is an ongoing and large-scale issue in Philadelphia’s aging school buildings.
“We’re not going to just give you funding if you’re not going to give us a plan,” Philadelphia Councilmember Anthony Phillips said at a recent news conference.
Council members put pressure on the district to provide a detailed and definitive plan to fix the toxic issues.
Philadelphia’s Education Committee Chair Isaiah Thomas said the school district continues to ask for more funds for public education. But it hasn’t provided a plan for how it will fix the physical and structural issues in its buildings.
“The recommendations we make and suggestions that we give, not saying they don’t listen to all of them, but far too often, the important ones fall on deaf ears,” Thomas said.
The school district is the only one in Pennsylvania that does not control its tax rates. Instead, it relies on funding from city hall and the state capitol to operate.
Schools Shut Down Due to Asbestos Issues
Two Philadelphia schools were shut down in March after inspections found toxic material in the buildings. One of the schools, Simon Gratz High School Mastery Charter located in the largely Black neighborhood of Nicetown-Tioga, was cleared to reopen just days later, but parents remain concerned about asbestos exposure.
“Thankfully there is testing, but the aftereffects? How many people are going to know it was affiliated with asbestos?” asked Danielle Mitchell of Nicetown-Tioga in an interview with WPVI-TV, an ABC affiliate in Philadelphia.
That school was built in 1925. It has already undergone one major renovation to remove asbestos, according to the Philadelphia Officer of the Controller database that tracks the nearly 2,300 asbestos abatement projects at the schools. A minor removal project at the school is slated to be completed by the end of March, according to the Asbestos Projects in the Philadelphia School District database.
Exposure to asbestos fibers can cause a range of illnesses, from a cancer called mesothelioma to chronic obstructive pulmonary disease.
Parents can educate their school-age children about the dangers of asbestos exposure at school and how to identify products that could contain the toxic substance. Asbestos is commonly found in floor and ceiling tiles as well as insulation applied to pipes, boilers, walls and ceilings of schools erected before 1980.
Funding To Remediate and Repair Asbestos-Filled Schools Could Reach Billions
The Philadelphia Inquirer published an investigation in 2018 about the environmental hazards inside the city’s schools. At the time, school officials estimated it would cost billions of dollars and take a decade to fix the issues.
Five years and several million dollars later, the school buildings are still in disrepair.
Approximately 80% of Philadelphia’s schools were built prior to 1978, a time when asbestos products were widely used in building materials such as adhesives, cement, roofing shingles, insulation, floor tiles and plumbing.
Pennsylvania Gov. Josh Shapiro recently proposed setting aside $100 million over five years to help fund school improvements across the state. City and state officials said it would cost billions to fix the schools in Philadelphia alone.
The current city budget allocates $1.3 billion in city taxes for school funding and provides another $270 million in the form of a grant.
“At the end of the day, a society is judged by how we treat our most vulnerable and that’s our elderly and our children,” Thomas said.
Public hearings about school funding will be held in May.
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A new study published in the Journal of Thoracic Oncology has evaluated the global burden of mesothelioma. The report analyzes trends by age, sex and geographic location to assess risk factors on a population level.
Northern Europe, Australia and New Zealand reported the highest incidence rates, according to the study. The age-standardized rate of mesothelioma was 0.30 per 100,000 persons, with the incidence rate much higher in males than in females.
Asbestos exposure is the primary cause of mesothelioma and is historically linked to several occupational environments. This rare type of cancer is highly lethal and can significantly impact a patient’s quality of life.
Recently, many developed countries have restricted or banned the use of asbestos due to its carcinogenic properties. Nevertheless, there are still a significant number of people exposed to asbestos in developing countries. In these areas, the use of asbestos is still widespread.
Asbestos Risk Around the World
The study analyzed data from the Global Cancer Observatory, Cancer Incidence in Five Continents Plus and Global Burden of Disease. The researchers used this data to determine the global incidence of mesothelioma and its risk factors.
They conducted a multivariable analysis for each country by sex and age. This allowed them to evaluate the associations between mesothelioma incidence and asbestos. They also calculated the average annual percentage change, or AAPC, to evaluate epidemiological trends.
Countries with higher human development index, gross domestic product per capita and asbestos exposure had higher mesothelioma rates. The study authors attributed these differences to the historical asbestos use during industrialization in these regions.
Differences may also indicate inequality in access to health care resources. Inaccessible or poor-quality health care creates a substantial disparity in the accuracy of diagnosis.
The report notes that the overall trend of mesothelioma incidence is decreasing. Among ages 50 to 74, five countries with higher gross domestic products reported decreasing trends. Germany had the most significant decrease, followed by the United States and Australia. In contrast, Iceland reported a considerable increase.
Brazil had the most substantial decrease in mesothelioma incidence in less-developed countries, and Bulgaria had the highest. While the incidence rate in males was higher overall, mesothelioma incidence in females is trending upward. This increasing trend may indicate increased environmental exposure to asbestos fibers.
Data Sources Complicate Findings
The study’s findings provide valuable insights into the epidemiology of mesothelioma. However, the researchers caution against multiple limitations of the study. They note that the estimated global mesothelioma cases might need to be revised. In lower-income countries, there is a potential under-reporting and misclassification of cancer cases.
These countries are more likely to have a substandard quality of cancer data, registry and analytical capacity. Another limitation is mesothelioma’s long latency period of 20 to 60 years. This window from exposure to diagnosis diminishes the accuracy of a mesothelioma diagnosis.
Study authors also noted that overestimation or underestimation of associations might be possible due to the type of analysis. There may also be changes in cancer registries for some countries, and direct comparison over time might not be appropriate.
Results from this report regarding disease burden, risk factors and mesothelioma trends from nearly 186 countries should not be overlooked. They highlight the need to continue reducing exposure to asbestos. The study’s authors suggest that implementing safety guidelines and protective equipment to protect workers from asbestos exposure is crucial.
These results also emphasize the importance of identifying and addressing potential risk factors for mesothelioma. The study’s findings suggest that further research is needed to explore the potential role of germline mutations and other environmental risk factors.
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Mesothelioma is a rare cancer most often caused by exposure to asbestos fibers. Our researchers at the University of Hawaii Cancer Center have discovered how asbestos causes mesothelioma, which we linked mainly to the protein HMGB1.
After several years of studying a unique mesothelioma epidemic in Cappadocia, Turkey, we noted that in certain families, up to 50% of family members developed mesothelioma. We demonstrated that susceptibility to mesothelioma was transmitted genetically from one generation to the next.
Following this discovery, several U.S. families with multiple mesothelioma cases contacted us and asked for help. Studying these families, we discovered their mesothelioma was caused by inherited germline mutations of a gene called BAP1, transmitted from one generation to the next. The chance of inheriting the mutation is 50%, and those who inherit the mutation are affected by this cancer.
Identifying mesotheliomas developing in carriers of germline mutations of BAP1 and possibly of other genes is essential. These patients have a significantly improved median survival of six to seven years from diagnosis because they respond well to therapy. Moreover, some patients survive 10 to 20 years and eventually die of other causes.
Discovering the Link Between BAP1 and Mesothelioma
Asbestos in the pleura or peritoneum encounters mesothelial cells and releases the HMGB1 protein outside the cell. HMGB1 attracts inflammatory cells and starts chronic inflammation. This inflammation persists over the years as asbestos fibers are not easily removed.
More asbestos fibers may also reach the pleura in workers professionally exposed to asbestos. Chronic inflammation increases the average rate of DNA mutations. Over the course of many years, this process may cause mesothelioma.
There is a 20- to 60-year latency period from exposure to asbestos to when mesothelioma develops. In mice, the daily administration of aspirin reduces HMGB1-driven inflammation and the incidence of mesothelioma.
Germline mutations are present in each cell of the body since birth. Individuals carrying germline BAP1 mutations are affected by the BAP1 cancer syndrome we discovered. Nearly 100% of them develop cancer, often multiple cancers, during their lifetime. About 30% of them develop mesothelioma. Other frequent cancers in carriers of germline BAP1 mutations are eye and skin melanomas, renal cell carcinomas, breast cancer and, less frequently, different cancer types.
BAP1 is the most frequent but not the only gene that, when mutated in the germline, can cause mesothelioma. In further studies prompted by our discovery of BAP1, we and other laboratories in the U.S. and abroad found that about 12% of mesotheliomas develop in individuals that carry germline mutations of BAP1 or other genes.
New Clinical Trials for Patients With BAP1
The U.S. National Cancer Institute has recently opened two clinical trials at its medical center in Bethesda, Maryland. Patients affected by mesothelioma carrying germline BAP1 mutations are eligible. They and their affected family members, those who inherited a BAP1 mutation regardless of whether they already developed cancer, receive free screening for early cancer detection.
Because they are at high risk of developing multiple cancers, this screening can be lifesaving. Moreover, if they require therapy, it is provided at no cost. The federal government covers travel and lodging. This is a terrific opportunity for mesothelioma patients and their families carrying germline BAP mutations to receive free, top-notch medical prevention and care in one of the most advanced hospitals in the U.S.
BAP1 Increases Mesothelioma Risk and Survival
In addition to the mutations in the germline of a fraction of mesothelioma patients, we discovered that 60%-70% of all mesotheliomas contain BAP1-inactivating mutations. Thus, BAP1 is the most mutated gene in mesothelioma, underscoring the importance of this gene in preventing mesothelioma.
Most of these mutations are acquired, which means they occur during the carcinogenic process that leads to the development of mesothelioma. Some are already present since birth in the germline.
Mesotheliomas that carry acquired BAP1 mutations tend to be associated with slightly improved survival compared to mesotheliomas that do not contain BAP1 mutations. However, when BAP1 mutations are present only in the tumor cells, survival does not approach the much more significant improved survival seen in patients who carry BAP1 mutations in their tumor cells and their germline.
On the one hand, carriers of germline BAP1 mutations are very susceptible to developing mesothelioma. On the other hand, most of them seem able to fight mesothelioma, living for several years. We hope that if we figure out how they fight cancer, we can help all patients fight mesothelioma and maybe all cancer.
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Nearly $60 million of a $72.5 million settlement reached in 2020 will go to the heirs of rubber workers sickened by asbestos-contaminated talc in Akron, Ohio. A probate court in Ohio is now handling the processing of claims for deceased plaintiffs.
Summit County Probate Judge Elinore Marsh Stormer oversaw a hearing about the settlement in February. BASF, the largest chemical producer in the world, agreed to the settlement over two years ago on behalf of its subsidiary Engelhard.
Engelhard was the major talc supplier for rubber companies from the 1950s until the 1980s. It owned Eastern Magnesia Talc, known as Emtal, which mined industrial talc in Vermont.
The company said for decades that its talc did not contain asbestos. Talc lawsuits revealed the company knew about the asbestos contamination for many years.
Rubber Workers Sickened by Asbestos-Contaminated Talc
Known as the “Rubber Capital of the World,” Akron is home to many rubber companies, including Firestone and Goodyear. Rubber companies used talc to prevent rubber products from sticking together or to machinery.
Rubber workers who sued Emtal between 1984 and 2011 over developing asbestos-related diseases qualified for settlement money. About 85% of the rubber workers who sued have died, which means their heirs now qualify for the payments.
Also involved in the 2020 class-action settlement was Engelhard’s law firm, Cahill Gordon & Reindel. Plaintiffs accused Engelhard and Cahill of fraudulent concealment, fraud and civil conspiracy for hiding tests showing asbestos in the company’s talc.
The class-action lawsuit claimed that Engelhard and Cahill “conspired to prevent thousands of asbestos-injury victims from obtaining fair tort recoveries for their injuries.”
Heirs Eligible for Settlement Payments
Settlement payments are based on the severity of the disease the rubber workers developed. The payments range from $4,000 to $300,000. Workers who developed mesothelioma will receive larger payments.
Marsh said these are the highest awards she has seen in her eight years as a probate judge. About 3,800 Akron rubber workers and their heirs may be eligible for payments. An estimated 90% of the payments will go to children and grandchildren.
Attorneys have hired a search company to help find heirs. They have been unable to locate heirs for about 500 rubber workers who died of asbestos-related diseases.
Local attorneys will keep the settlement money in a trust while they continue to discover heirs. Summit County Probate Court has a list of the rubber workers who are due payments. Heirs may search the list for a relative or family member included in the settlement.
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W.R. Grace has offered $18.5 million to settle the last of Montana’s claims for environmental damages caused by the company’s mining operations that spread asbestos throughout the town of Libby and surrounding areas.
Montana Gov. Greg Gianforte announced the offer on Jan. 10. He said the settlement would resolve the remaining environmental claims in W.R. Grace’s bankruptcy case for the Libby Asbestos Superfund Site in Lincoln County.
“After years of negotiation following Grace’s historic damage, Libby and communities in Lincoln County can more fully recover,” Gianforte said in a statement. “I look forward to the positive impact this settlement can bring to the people of Libby and Lincoln County.”
The state plans to use the funds to restore natural resources in the Lincoln County area. The Montana Natural Resource Damage Program would receive $18.5 million plus interest over 10 years.
Grace operated an asbestos-contaminated vermiculite mine in Libby from 1963 to 1990. Nearly 700 Libby residents have died of asbestos-related diseases, according to a 2021 study published in the Journal of Exposure Science & Environmental Epidemiology.
The study found a 15-fold increased risk of mesothelioma among Grace employees compared to Libby residents who did not work near the mine. Doctors have diagnosed about 2,400 residents with asbestos-related diseases since the town became contaminated.
Settlement Funds Earmarked for Asbestos Dam, Legal Costs
As part of the settlement, Grace will provide $6.2 million in trusts and bonds for the operation and maintenance of the Kootenai Development Impoundment Dam for the next 100 years. The dam holds asbestos-laden tailings from the mine. It is classified as a high-hazard-potential dam. By maturity, the trusts and bonds may be worth up to $300 million.
The company must pay the first $5 million of the settlement within six months of entering into the agreement. It must also pay up to $1.5 million for Montana’s costs associated with reaching the settlement.
Grace’s settlement agreement arises from a 2007 claim filed by the state of Montana in the company’s bankruptcy case. Grace took action to resolve the claim in June 2019 and mediation was ordered within a few months.
The proposed settlement is the result of a three-year mediation. It is in addition to a $5.1 million settlement Grace paid in 2008 to the Montana Department of Environmental Quality for operation and maintenance costs.
Offer Requires Bankruptcy Judge Approval
Grace has asked a Delaware federal bankruptcy judge to approve the settlement. Once approved, the settlement will discharge Montana’s environmental claim and allow Grace to fully exit bankruptcy.
Grace initially filed for bankruptcy in 2001 under the weight of more than 129,000 personal injury asbestos claims. The company mostly exited bankruptcy in 2014 when its reorganization plan received approval.
As part of the reorganization plan, Grace established a trust fund containing $3 billion to compensate victims. The trust handles claims from Libby residents and claims related to the company’s asbestos-contaminated Zonolite products, including attic insulation, spray-on insulation, plaster and cement.
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Research for a new type of mesothelioma treatment is underway at the Netherlands Cancer Institute. Scientists are exploring a novel combination of existing medications for patients with BAP1 genetic mutations.
More than half of all mesothelioma patients show alterations in the BAP1 tumor-suppressor gene. An altered BAP1 gene allows for vulnerabilities that make specific treatments more effective. The combination treatment led to about a four-week increase in median survival.
Researchers have previously only explored the combination of zoledronic acid and tazemetostat in single cells and animal models. This latest research shows promising results in reducing the growth of cancer cells in mice with mesothelioma.
Asbestos exposure is the primary cause of mesothelioma. Treatment options, such as chemotherapy and immunotherapy, are limited in how long they can extend survival. Targeting gene mutations with a particular combination of drugs could prove more effective.
“If these drugs also prove to work well in clinical trials, we can offer patients a new and hopefully better treatment option,” said Jitendra Badhai, one of the study authors.
Drug Combination Improves Survival in Mice
Study investigators treated mice with mesothelioma to determine the effectiveness of the new drug combination. The mice received either tazemetostat, zoledronic acid or a combination of both. The research team then monitored tumor volume over time.
The results showed that the combination of tazemetostat and ZA resulted in significant growth inhibition. The drugs were much more effective on BAP1-deficient tumors.
The researchers then tested the treatment in a different animal model. This model more closely resembles human malignancy with aggressive tumor formation. The study team monitored the mice until they showed respiratory distress and significant weight loss.
The combination treatment of ZA and tazemetostat resulted in a 4-week prolongation of median survival for a total of 95 days. The control survival was 70 days.
The study authors noted that treatment with single agents provided limited benefits. Tazemetostat at a concentration of 250 mg/kg twice daily led to a median survival of 72 days. ZA at 0.2 mg/kg once daily resulted in a median survival of 74 days.
Monitoring body weight during combination treatment showed no differences compared with control doses. The researchers noted that this result justifies dose-escalation in future mesothelioma clinical trials.
Researchers Are Optimistic
The researchers at the Netherlands Cancer Institute are optimistic about the combination of tazemetostat and ZA. The results from the new study could lead to a better mesothelioma prognosis for more patients.
“Identifying biomarker-based dependencies and exploiting them have a high potential to lead to new treatment options,” the study authors at the Netherlands Cancer Institute said. “Stratification of patients based on biomarkers could add much needed therapeutic strategies against this highly aggressive disease.”
The U.S. Food and Drug Administration has approved tazemetostat to treat some solid tumors and non-Hodgkin lymphoma. A clinical trial in May 2022 tested the drug on 70 patients with recurrent cancer and the BAP1 mutation. The median overall survival was 41 weeks. Less than 5% of the patients experienced severe drug-related side effects.
During the trial, participants had a disease control rate of 54.1% at 12 weeks and 32.8% at 24 weeks. Patients in the study received the drug in the second-line setting, meaning they had tried and failed previous therapies.
Tazemetostat blocks the enzyme EZH2. This enzyme inhibits the genes that restrict cancer tumor growth. Patients with BAP1 mutations have a higher expression of EZH2, leading to a more aggressive form of mesothelioma.
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A federal appeals court last week rejected an LTL Management bankruptcy filing, delivering a blow to the company’s plan to resolve thousands of talc lawsuits. The company is a Johnson & Johnson subsidiary.
The ruling effectively found the company’s bankruptcy was not filed in good faith. J&J said on Feb. 6 that it plans to appeal the U.S. Court of Appeals for the Third Circuit’s ruling.
“LTL initiated this process in good faith and our objective has always been to equitably resolve claims related to the company’s cosmetic talc litigation,” J&J wrote.
If denied on appeal, Johnson & Johnson will face more than 38,000 ovarian cancer talc lawsuits and more than 400 mesothelioma claims in the civil court system. It could take a couple of months for that process to begin, said attorney Lisa Busch, managing attorney of the asbestos bankruptcy department at Weitz & Luxenberg.
“There isn’t specifically a date certain yet. We hope in the next 30 to 60 days that we can get back to business as usual,” Busch told Asbestos.com.
The lawsuits claim Johnson & Johnson’s asbestos-contaminated talcum powder products caused mesothelioma and ovarian cancer.
J&J Bankruptcy Strategy Backfires
The appeals court ruled that only companies in financial distress may file for bankruptcy. Johnson & Johnson, valued at more than $400 billion, said its subsidiary filed for bankruptcy in good faith.
“What counts to access the Bankruptcy Code’s safe harbor is to meet its intended purposes,” Judge Thomas Ambro wrote in his opinion. “Only a putative debtor in financial distress can do so. LTL was not. Thus we dismiss its petition.”
Ambro’s ruling has created challenges for J&J’s restructuring strategy, which is known as the Texas Two-Step. The company formed LTL Management in 2021 to hold its asbestos-contaminated talc liabilities, but transferred few of its assets. Three days later, LTL filed for bankruptcy. The bankruptcy plan involved creating a trust fund to handle current and future talc lawsuits.
An attorney representing J&J said last year that a funding agreement could contribute as much as $61.5 billion to the trust. The company initially pledged $2 billion when it created LTL. The court found this funding agreement proved LTL was not in financial distress.
“LTL has a funding backstop, not unlike an ATM disguised as a contract, that it can draw on to pay its liabilities,” wrote Ambro.
Johnson & Johnson Faced Challenges at 2019 Hearing
Plaintiffs’ attorneys and the U.S. Department of Justice presented challenges to J&J’s Texas Two-Step at a hearing in September 2022. Attorneys representing the plaintiffs suing J&J targeted the company’s legal strategy.
They said that during the LTL bankruptcy process, J&J paid out billions of dollars to shareholders and for stock buybacks, which bankrupt companies are not allowed to do. The Texas Two-Step differs significantly from other bankruptcy cases involving asbestos liabilities.
“In all the asbestos bankruptcies before the Texas Two-Step happened, the entire company filed for bankruptcy,” said Busch. She added, “If you can show that your potential future liabilities outweigh your potential profits, you can get 534(g) protection.”
Section 534(g) of the Bankruptcy Code was created specifically so companies with big asbestos liabilities could file for bankruptcy and channel lawsuits into a trust fund. The U.S. Department of Justice got involved because it had concerns that other nonbankrupt companies and wealthy individuals would use the Texas Two-Step to avoid liability.
“If Johnson & Johnson can get away with this bankruptcy, what’s to stop any other company in America from doing the same thing?” asked Sean Janda, a lawyer representing a division of DOJ that oversees the administration of bankruptcy cases.
Asbestos-Contaminated Talc Issue Dates Back Decades
Unsealed court documents have revealed Johnson & Johnson knew about asbestos in its baby powder as early as the 1950s. In 1956, J&J asked Battelle Memorial Institute, a research laboratory, to analyze large deposits of talc from Italy. When J&J turned this talc into powder, it found abrasive material and wanted to know what it was.
The laboratory reported contaminates in the talc that included tremolite asbestos. Johnson & Johnson proceeded to buy numerous talc mines in search of a clean source.
In 1969, an internal company memo written by a J&J executive acknowledged that tremolite was commonly found in talc deposits and virtually impossible to eliminate. Johnson & Johnson failed to alert consumers or the U.S. Food and Drug Administration.
In 2018, the FDA found asbestos in a bottle of Johnson’s Baby Powder and a recall was issued. The company announced in August 2022 that it would stop talc-based baby powder sales worldwide by the end of this year. J&J is replacing the talc with cornstarch.
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For patients with mesothelioma cancer, immunotherapy is a promising new field. Results from a recent study at Rice University in Houston are exciting. Researchers are looking at ways the natural immune system can help fight this cancer.
The study examined the therapeutic effects of interleukin 2, a form of immunotherapy for mesothelioma. IL2 is a protein that regulates white blood cells. It does this through cytokines, a type of signal that affects other cells.
Researchers studied these effects in mice. After one week of treatment the tumor burden in the mice fell 80%.
“This study provides support for the clinical evaluation of this IL2-based delivery system,” the authors wrote. Continued research with IL2 treatments in humans could lead to a new standard for mesothelioma therapy.
Using Cytokines Increases Effectiveness
Cytokine factories are delivery systems that invoke innate immune cells to fight tumors. Each drug “factory” consists of thousands of drug-producing cells contained in a microscopic gel-like bead. The study investigators used mice to model the efficacy of IL2 cytokine factories.
“The rapid clinical course of malignant mesothelioma necessitates the development of highly effective treatment modalities that are safe and fast-acting,” the researchers wrote. These factories enabled 150 times higher IL2 concentrations in localized areas.
“IL2 cytokine factories led to the eradication of aggressive mouse malignant mesothelioma tumors and protection from tumor recurrence,” the authors concluded. Almost 90% of mice treated with at least 1.5 μg survived more than twice as long as mice that did not receive treatment.
After one week of treatment, tumor reduction in 19 of 26 mice was greater than 45% percent, regardless of the dose. More than 91% of mice treated with at least 2.5 μg had a greater than 75% reduction in tumor burden in one week. All mice treated with 5 μg had a 90% reduction in tumor burden.
Interleukin 2 Activates the Immune System
IL2 is one of the only cytokine cancer therapies the FDA has approved and is critical in activating the immune system against infection and disease. The mouse model used in the study demonstrated improvements to the IL2 delivery system.
IL2 immunotherapy creates a rapid response of T cells. These immune cells destroy tumor cells and develop antibodies against recurrence. Delivering IL2 via a cytokine factory is beneficial for patients who have not responded to other immunotherapies.
The researchers could control IL2 dosing through the density of engineered cells suspended in capsules. They found that as the cell concentration per capsule increased, the amount of released IL2 also increased. The method provided dose-dependent control without loss of cell viability.
The study authors noted they did not observe any significant deviations in body weight over time. This suggests that the therapy was well tolerated. The authors also noted that the treatment increased the effectiveness of anti-PD1 checkpoint therapy.
Benefits for Pleural and Peritoneal Patients
The data suggests that this therapy has the potential to be a safe and effective treatment for mesothelioma patients. Feasibility for both peritoneal mesothelioma and pleural mesothelioma was tested.
To test the feasibility for peritoneal patients, researchers implanted the therapy in the intraperitoneal space in mice. IL2 cytokine factories require only limited access to the target site.
In pleural testing, researchers found the local concentration was at least 100 times greater than the systemic concentration, or whole body concentration. This is critical for reducing the side effects as medication “leaks” out of the cancer region.
Precautions were taken to test toxicity in the liver, kidney and lungs. IL2 therapy can often cause adverse effects in these systems. They found no significant cellular changes in any of these organs at the end of their study. The treatment also did not show substantial effects on insulin or glucose levels.
Findings suggested that extended treatment wouldn’t pose a safety issue to patients. The results showed that the capsules didn’t continue to deliver cytokines after treatment completion. The dosage concentration peaked by day four and declined as scar tissue formed on the capsule. More than 80% of the capsules could be retrieved, highlighting the stability of the cytokine factories at body temperatures.
Importance of Clinical Trials
While the authors noted that their results suggest “that the cytokine factories were well tolerated by the host immune system,” this study took place in mice. Drug safety testing is necessary before clinical use.
The Rice University researchers highlighted ways that the treatment could translate to a clinical setting. In the study, they examined the feasibility of dosing in multiple locations.
Because pleural mesothelioma, for example, has a 5-year survival rate of less than 10%, researchers underscored the importance of promising treatment for this aggressive and rare cancer. “The continued occurrence of malignant mesothelioma necessitates the clinical assessment of new, effective treatments,” researchers noted.
Asbestos exposure is the primary cause of mesothelioma, which can develop in the chest, abdomen, heart or testes. The current standard of treatment includes surgery, chemotherapy and radiation. “The potential of the IL2 cytokine factory described here to ease the global burden of malignant mesothelioma highlights the urgency of its evaluation in clinical trials,” the authors concluded.
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Patients with recurrent mesothelioma cancer often have few options. A new study by the Hyogo College of Medicine in Japan may have a potential answer.
This study tested the safety and efficacy of two drugs following mesothelioma surgery after cancer recurrence. The combination of immunotherapy drugs nivolumab and ipilimumab, known by the brand names Opdivo and Yervoy, was recently approved for mesothelioma.
The new treatment led to a 6-month survival of 87% in pleural mesothelioma patients. The 12-month survival rate was 74.2%.
“Nivolumab with ipilimumab has promising efficacy in treating recurrent MPM [malignant pleural mesothelioma] in the postoperative setting,” the authors wrote.
The authors also noted a higher rate of adverse events than in prior studies.
Asbestos exposure can cause mesothelioma, an aggressive form of rare cancer. Mesothelioma can develop in the chest or abdomen. In rare cases, it can also form in tissues that line the heart and testes. With treatment, about 40% of patients live one year or more after diagnosis.
“This combination is expected to improve the treatment results in patients with MPM,” the authors wrote. “To our knowledge, no prior clinical studies have investigated nivolumab with ipilimumab in patients with recurrent MPM after primary curative-intent surgery.”
Effective Results, Frequent Side Effects
The study reviewed Hyogo College of Medicine patients between January 2004 and October 2022. Patients all had pleural mesothelioma and had multimodal therapy. Their treatment included chemotherapy before or after surgery. Most patients underwent a pleurectomy and decortication surgical procedure. In some cases, patients also had radiation therapy.
Between June 2021 and July 2022, researchers treated 41 patients with nivolumab and ipilimumab. The dosage was 360 mg of nivolumab administered by IV every three weeks. Patients received 1 mg/kg of ipilimumab every six weeks by IV.
The study participants underwent evaluation every six to 12 weeks via radiological imaging. The treatment led to a partial response in 18 patients. This means their tumors had a measurable decrease in size. Researchers reported stable disease, or no change in tumor size, in 13 patients.
Only 10 patients had an increase in tumor size or number during the study period. The objective response rate was 43.9%, and the disease control rate was 75.6%. Median progression-free survival was 7.3 months. This means patients survived for over seven months without an increase in their cancer.
At the end date of the study, 20 of the 41 patients still had an ongoing response. In other words, their treatment was effective even after the mesothelioma clinical trial. Common side effects were an inflamed pituitary gland and adrenal insufficiency. Other adverse effects included colitis and hyperthyroidism.
“While our patients experienced a high frequency of AEs [adverse events], most of the AEs were manageable with treatment protocol-specific guidelines,” the study authors said. “This protocol provides a novel treatment option for recurrent MPM when few options are available.”
Future Benefits of Opdivo and Yervoy
In October 2020, the U.S. Food and Drug Administration approved Opdivo and Yervoy for mesothelioma. The guidelines allow the drugs as a first-line therapy for pleural mesothelioma patients who are not eligible for surgery.
The combination was the first new mesothelioma drug regimen in over 15 years. It is still only the second FDA-approved systemic therapy. Clinical trials are necessary to expand the benefits of these medications to more patients.
“Combination therapy with nivolumab and ipilimumab is an important treatment option for recurrent MPM after P/D [pleurectomy and decortication],” the researchers wrote.
They cited a prior study, called MERIT, that evaluated nivolumab as a second-line therapy for mesothelioma. The study consisted of 34 patients with a median survival of 17.3 months.
CheckMate 743 was the clinical trial that led to the FDA approval of Opdivo and Yervoy. In that study, the overall response rate was 39.6%. Patients also had a significant increase in overall survival compared to chemotherapy.
The Hyogo researchers stressed the importance of treatment for cancer recurrence in a previous trial. In that study, the median survival for patients treated for recurrent cancer was 24.1 months. Patients who received supportive care had a median survival of 4.2 months.
The researchers are optimistic that this treatment could have further benefits.
“Nivolumab with ipilimumab [had] promising efficacy but was also complicated by serious AEs,” they wrote. “Further multi-institutional studies to evaluate long-term survival, prognostic factors and development of AEs with this protocol deserve consideration.”
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Select patients diagnosed with mesothelioma cancer in both the thoracic and abdominal cavities still can achieve an extended survival if their treatment center performs the preferred types of aggressive surgery, according to a recent study at Baylor College of Medicine in Houston.
Patients undergoing bicavitary cytoreductive surgery that includes the lung-sparing, extended pleurectomy and decortication had a median survival of 58.2 months, the study found. The Journal of Thoracic and Cardiovascular Surgery published the results online in December.
“Long-term survival can be achieved with an aggressive, staged surgical approach,” study authors wrote. “For patients with localized disease that is amenable to multimodality therapy with resection, prolonged survival can be achieved.”
Mesothelioma is a rare and aggressive cancer that is caused by exposure to asbestos. It typically comes with a poor prognosis and is rarely diagnosed in both the chest and the abdomen.
Aggressive mesothelioma surgery in one cavity can be overwhelming, and having two back-to-back surgeries is almost unheard of outside of select mesothelioma specialty centers such as Baylor.
“Reports of bicavitary CRS [cytoreductive surgery] are limited,” the authors wrote. “Our series is the only non-case report of patients who underwent staged resection of chest and abdominal mesothelioma.”
Mesothelioma Surgeries Produced Different Results
From 2014 to 2021, 440 patients with mesothelioma were evaluated at Baylor College of Medicine. Only 14 of those (3%) underwent the two-stage chest and then abdominal operations. Of the 14 bicavitary patients, eight underwent the extended pleurectomy decortication and six had the extrapleural pneumonectomy.
For the abdominal surgery that followed, all 14 underwent a standard peritonectomy and hyperthermic intraperitoneal chemotherapy, another specialty procedure known as HIPEC.
Six of the patients received chemotherapy between the two operations and five received adjuvant chemotherapy after each operation.
Median overall survival, for the entire cohort, was 33.6 months, with a five-year survival rate of 20%.
The objective of the retrospective study was to determine whether the latest extended pleurectomy decortication surgery or the older, lung-sacrificing extrapleural pneumonectomy was more effective as part of bicavitary resection. The results were not even close.
From the date of the second surgery, median overall survival was only 13.5 months for those undergoing the EPP, but 58.2 months for those having the extended P/D. The median progression-free survival was 12.9 months vs. 26.3 months for EPP and ePD groups, respectively, following the first surgery.
Dr. David Sugarbaker Pioneered EPP Surgery
Results of the study are one reason Baylor – like many specialty centers treating mesothelioma –has moved away from the once-groundbreaking EPP surgery that was made popular by the heralded thoracic surgeon and mesothelioma specialist Dr. David Sugarbaker.
Sugarbaker, who became known as Mr. Mesothelioma during his more than two decades at Brigham and Women’s Hospital in Boston, came to Baylor Medical Center in 2014 as director of The Lung Institute. He died in 2018.
“The choice of operative procedure reflects a shift from EPP to ePD in our institution that is similar to many mesothelioma centers,” authors wrote. “EPD is now our standard approach for the majority of patients.”
Earlier studies involving only pleural mesothelioma in the thoracic cavity had shown similar survival times when comparing the two surgeries, but a quicker recovery and a lower morbidity rate with the ePD.
In this study, there were no immediate deaths following the first surgery, and all 14 patients proceeded to the second surgery. There were two patients – both starting with the EPP – who died within 90 days of the abdominal surgery.
“When considering bicavitary cytoreductive surgery for mesothelioma, we would recommend only performing ePD and avoiding EPP in this cohort of patients,” authors concluded.
Baylor Medical Center thoracic surgeon Dr. R. Taylor Ripley was the lead author of the study. One of the co-authors was surgical oncologist Dr. Paul Sugarbaker, brother of Dr. David Sugarbaker and a pioneer in advancing treatments for peritoneal mesothelioma. He last served at MedStar Washington Hospital Center.
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Residents of the United Kingdom have been among the growing number of personal injury plaintiffs filing lawsuits in U.S. courts, attributing their diagnoses of mesothelioma cancer to asbestos-contaminated talc.
That should come as no surprise. With the world’s highest per capita incidence rate of mesothelioma, the UK is contributing to the changing face of asbestos litigation in America.
While mesothelioma traced to occupational asbestos exposure among men is dropping, nonoccupational exposure leading to mesothelioma among women is rising.
Asbestos-contaminated talc, sometimes found in health and beauty products, is part of the reason for the growing trend. The burgeoning number of cases linked to talc in recent years – the first court case came in 2016 – has helped spark the increase in international product liability filings.
Cases Linked to US Products
“You may think that living in the UK, you are not able to file a case within the U.S. court system, but that’s not entirely true,” attorney Daniel Wasserberg, asbestos litigation specialist from New York City, told The Mesothelioma Center at Asbestos.com. “If you have [asbestos] exposure that relates back to American-branded companies or to products manufactured here in the United States, you may be able to avail yourself of a courtroom in the United States.”
Wasserberg has particular expertise dealing with the issue of asbestos-contaminated talc, which has been found in baby powders, body powders, a wide range of makeup, creams and moisturizers.
Some cases of contaminated talc involve UK residents who bought products while on vacation in the U.S. Others involve American products sold outside the country. Johnson & Johnson, which faces many contaminated talc cases, manufactures its products in several different countries.
According to the UK’s Health and Safety Executive, an estimated 450 to 500 women there are diagnosed annually with mesothelioma. There also is a 7% annual increase projected each of the coming years, much of it stemming from contaminated talc.
“We are seeing more and more talc manufacturers become defendants in the asbestos litigation,” Wasserberg said. “They are very much part of a newer wave of the asbestos litigation. The talcum powder litigation is here to stay.”
Johnson & Johnson Leads Talc Litigation
Johnson & Johnson is the biggest name in talc litigation, with close to 40,000 talc lawsuits still pending. Although the company has continued to insist its products are safe, litigation from talc lawsuits, in settlements and verdicts, has exceeded $3 billion, according to the company.
J&J announced in August 2022 that it would discontinue selling its iconic talc-based Johnson’s Baby Powder in 2023, and is now using a cornstarch-based formulation. It stopped the sale throughout the U.S. and Canada in 2020, citing the avalanche of lawsuits.
Other cosmetics giants facing litigation include Avon, Chanel, Clinique and Estee Lauder. Avon, for example, was recently ordered by a California jury to pay more than $52 million – $10.3 million in punitive damages, in addition to the $40 million in actual damages – to a woman who said her mesothelioma was caused by asbestos-contaminated talc.
Only a small percentage of contaminated talc cases involve mesothelioma, a rare cancer caused almost exclusively by asbestos exposure. The majority of the cases involve ovarian cancer or other serious health issues.
The talc contamination stems from where the two naturally occurring minerals are found near the Earth’s surface, often in close proximity to one another.
Although testing for contamination is done, the different methods of testing have varied widely. Often at issue in court has been the lack of a warning on the products where asbestos contamination is possible.
“Attorneys [including our firm] have had success bringing these cases to American courts and getting good results,” Wasserberg said. “People generally think of personal injury lawsuits as being a local practice, but that’s not always the case with asbestos. A claimant may be surprised that their case can be heard here.”
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A California jury awarded $52.1 million to an Arizona woman diagnosed with mesothelioma cancer. The multimillion-dollar verdict combines damages against cosmetics giant Avon and a forklift manufacturer.
Attorneys for Rita-Ann Chapman said she had been using Avon talc products contaminated with asbestos for much of her life. Chapman is 76.
She blamed additional secondhand asbestos exposure on forklift maker Hyster Company. Her husband Gary handled asbestos products while working at Hyster.
Chapman won her case in California Superior Court earlier this month.
Mesothelioma is a rare cancer. Inhalation or ingestion of asbestos fibers is the primary cause of the incurable condition.
Although occupational exposure once dominated asbestos litigation, the field is widely expanding today with the recent discovery of asbestos-contaminated talc products. Chapman’s combined award is a look at the future and past of asbestos litigation.
Avon Kept Asbestos Contamination Secret
Avon, famous for its door-to-door saleswomen known as “Avon Ladies,” sold a variety of cosmetics, including body and face powders.
Jurors concluded Avon management knew of the talc contamination but failed to warn consumers of the serious health risks, and deliberately kept them secret. Actual damages were listed at $40.8 million, with an additional $11.3 million in punitive damages. Jurors blamed Avon for 90% of Chapman’s cancer.
According to court records, Avon faced almost 200 talc lawsuits in 2021. Although the company has continued to say its products are safe, it announced in 2020 that it would stop using talc in its products.
Avon said it will appeal this latest verdict.
“We are disappointed by this verdict and will vigorously pursue all available avenues to appeal,” the company said in a statement. “Avon is confident that it has strong grounds for appeal and will continue to defend its position.”
Secondhand Asbestos Exposure at Hyster
The involvement of Hyster Company in the lawsuit stems from Chapman handling the work clothes of her husband, who worked at a Hyster forklift manufacturing plant.
He worked with clutches, gaskets and brakes made with asbestos. The naturally occurring mineral strengthens products, but it is also carcinogenic.
Chapman’s husband often brought home the microscopic asbestos fibers on his clothes, which she would regularly wash.
Johnson & Johnson Leads Talc Lawsuits
The verdict against Avon was not a surprise as talc-related cases are becoming more common. Companies such as Chanel, Revlon, L’Oréal and Justice are facing litigation involving contaminated talc.
Johnson & Johnson, with its iconic baby powder, is the giant of the industry. It faces more than 30,000 lawsuits. Most cases involve ovarian cancer. Only a small percentage are mesothelioma legal claims.
The company already has spent more than $3 billion in settlements and verdicts. Johnson & Johnson created a new subsidiary in 2021 that immediately filed for bankruptcy protection to limit its future talc liabilities.
A federal judge in New Jersey approved the controversial strategy, but it’s now in federal appeals court.
J&J, a leader in the field, stopped the sale of its talc-based Johnson’s Baby Powder in the U.S. and Canada in 2020, citing the avalanche of lawsuits.
Talc and asbestos are naturally occurring minerals. Asbestos veins often run through talc deposits, making contamination possible during the mining process.
Although testing for contamination has been done for years, different testing methods have produced varied results.
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A recently published study from the United Kingdom has shown that legacy asbestos lingering in commercial and residential construction is more dangerous than expected.
In what is believed to be the largest study in the world of legacy asbestos, researchers found that almost two-thirds of it had aged enough, or was damaged enough, for fibers to become airborne and put people at risk.
An estimated 1 million samples were collected in a six-month period across Great Britain as part of the study, completed by the National Organisation of Asbestos Consultants and the trade group Asbestos Testing and Consultancy.
What they found was alarming. The observations were shared at a Parliamentary event in London earlier this month, bringing attention to an asbestos management strategy – similar to what the U.S. has– that is flawed.
“We weren’t looking for this, but when we looked at the data the figures leapt out at us. Asbestos left in the buildings as ‘safe’ was actually now in a damaged state,” said NORAC Chairman Jonathan Grant. “When asbestos is damaged it may create a risk to occupants by releasing fibers which, if inhaled, can lead to irreversible cancer.”
EPA’s Risk Evaluation Key for U.S.
Asbestos can lead to a variety of health problems, including malignant mesothelioma, a cancer with no cure that is caused almost exclusively by the inhalation or ingestion of the toxic fibers.
The UK banned asbestos in 1999, but legacy asbestos remains – like in the U.S. – in most construction that was done before the 1980s.
Although heavily regulated, asbestos is not banned in the U.S. entirely. The U.S. Environmental Protection Agency is in the midst of finalizing its Risk Evaluation for Asbestos as part of the Toxic Substances Control Act.
Part 2 of the Risk Evaluation, which involves legacy asbestos, is expected to be finished by the end of 2023 and could lead to a complete ban of the toxic mineral and a more complete strategy for handling it.
Eliminating Legacy Asbestos
Earlier this year, the UK had discussed a long-term plan that would remove asbestos from all buildings within a 40-year timeframe, but that plan was rejected by legislators as too costly.
“It’s an impossible situation,” said Kevin Bampton, chief executive officer of the British Occupational Hygiene Society in London. “Developers, social housing landlords, schools and hospitals don’t want to have asbestos removed from property [because it is costly], but clearly the management strategies in place are not working.”
An estimated 2,700 cases of mesothelioma are diagnosed in the UK annually, one of the highest per-capita rates in the world. Some European countries that banned asbestos more than a decade ago are moving forward with plans to have it removed from all structures in the future.
Current Asbestos Regulation Falls Short
In the U.S., the mining of asbestos stopped more than two decades ago, and the importation of asbestos has dropped dramatically.
In recent years, the chloralkali industry has consumed all raw asbestos being imported into the U.S., where it is used for semipermeable diaphragms to make chlorine.
A small number of products made with asbestos are still imported – vehicle friction items, sheet gaskets, brake blocks, etc. – but the biggest threat to the public today is the legacy asbestos.
The general perception, though, is that if left undisturbed, asbestos used earlier in construction is not a threat. That theory is now being seriously challenged in the UK.
There is potential legislation being discussed that would require an asbestos survey of any commercial or residential building being sold, if it was built before 1999. There is currently an ongoing asbestos inspection of all schools in the UK, which is not being done today in the U.S.
“Nobody should be selling a building with a toxic substance hidden in it that the buyer doesn’t know about,” Grant said. “At the same time, when we upgrade our homes and heating systems, we don’t want to expose workers, or the building occupants, to fatal risk. It’s applying the same common sense to asbestos that we do to other hazards.”
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An immunotherapy combination given before aggressive surgery has shown impressive effectiveness in extending survival for pleural mesothelioma patients in a recent phase II clinical trial at Baylor College of Medicine.
The combination of immune checkpoint inhibitors durvalumab and tremelimumab showed an ability to effectively alter the intratumoral immune system and make surgery more effective.
This randomized clinical trial compared the use of durvalumab alone – already shown to be effective in other cancers – to both the two-drug combination and to using no immunotherapy before mesothelioma surgery.
Clinical Cancer Research published the randomized trial findings Dec. 5.
“These data indicate that neoadjuvant durvalumab plus tremelimumab orchestrates de novo systemic immune responses that extend to the tumor microenvironment and correlate with favorable clinical outcomes,” study authors concluded.
Clinical Trial Begun by Dr. David Sugarbaker
The clinical trial opened in May 2016, due in part to the earlier arrival of legendary thoracic surgeon and mesothelioma pioneer Dr. David Sugarbaker as the new director of the Lung Institute at Baylor College of Medicine. Sugarbaker died in 2018 when patients were still being enrolled.
Twenty-four patients who were screened and eligible for either the pleurectomy and decortication or extrapleural pneumonectomy surgery joined the trial. It included both epithelioid and the tougher-to-treat sarcomatoid types of mesothelioma.
Nine were randomized to just durvalumab, 11 to the immunotherapy combination, and four were given no immune checkpoint inhibitors. Evaluation of the randomized patients was at 34.1 months.
Progression-free and median overall survival for those receiving only durvalumab was 8.4 months and 14 months, respectively. Those receiving no checkpoint inhibitors had similar results.
Patients treated with the mesothelioma immunotherapy combination far exceeded both progression-free and median overall survival measurements of the monotherapy group. No survival results were recorded at the time of study publication because three of the 11 patients were still alive.
“In patients with resectable MPM [malignant pleural mesothelioma], we show that a single cycle of durvalumab and tremelimumab delivered in the neoadjuvant setting profoundly reorganizes the immune contexture of MPM tumors,” authors wrote.
They said the data showing lower rates of recurrence and longer survival are supported by the regimen’s impact on systemic immunity.
Synergy Powers Immunotherapy Combination
The effectiveness of the combination is based on the way the drugs complement one another. Both are created with human antibodies that essentially unmask the cancer cells and allow a patient’s own immune system to attack in different ways.
Durvalumab produces an antibody designed to negate the PD-L1 protein that often blocks the immune system from killing the cancer cells. The drug, also known by the brand name Imfinzi, is approved by the U.S. Food and Drug Administration to treat bladder cancer and certain lung cancers.
Although tremelimumab was ineffective by itself in an earlier trial with mesothelioma, it has shown considerable promise as a complementary agent with other cancers. It works by blocking a protein called CTLA-4, which is something that durvalumab does not do.
In the trial, the combination was administered by intravenous infusion two weeks before surgery was scheduled. Immediately after surgery, patients received intraoperative chemotherapy.
Mesothelioma Study May Lead to FDA Approval
Although immunotherapy has advanced the treatment of pleural mesothelioma, its effectiveness has been inconsistent and minimal.
In 2020, the FDA approved the immunotherapy combination of Opdivo and Yervoy for first-line treatment after it showed a four-month survival improvement over standard chemotherapy.
The most effective treatment is still the multimodal combination of surgery, chemotherapy and radiation, but the majority of those patients still only survive less than two years. Less than a third of those diagnosed with pleural mesothelioma even qualify for surgery.
A potential advancement such as this latest combination of immunotherapy as a pre-surgical treatment has attracted considerable attention, making the next FDA approval a little closer.
“Neoadjuvant ICB [immune checkpoint blockade] appears safe and feasible in patients with MPM. [It] results in pathological tumor responses and has a potentially favorable impact on survival,” authors concluded.
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Sooner is better when it comes to aggressively treating peritoneal mesothelioma cancer with a combination of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.
Waiting could cost a patient months of survival. Rejecting surgery could cost them years.
The Journal of Gastrointestinal Surgery published a study in November that showed for the first time to what degree a delay in having the mesothelioma surgery, or not getting it at all, can affect overall survival for patients.
Results of the mesothelioma study were presented earlier this year at the annual Society for Surgery of the Alimentary Tract meeting in San Diego.
Surgeons and oncologists from Abramson Cancer Center at the University of Pennsylvania, Sidney Kimmel Medical College in Philadelphia and the University of Colorado Hospital in Aurora co-authored the study.
“These findings reinforce the important role timely surgery can play in patients with peritoneal mesothelioma,” surgical oncologist and co-author Dr. Giorgos Karakousis, of Abramson Cancer Center, told The Mesothelioma Center at Asbestos.com.
Mesothelioma Life Expectancy Rises With Surgery
Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, also known as CRS-HIPEC, has become an effective treatment of choice for mesothelioma specialists in recent years.
This latest life expectancy simulator looked at 1,000 cases of peritoneal mesothelioma in three different categories: timely treatment (fewer than four weeks after diagnosis), delayed treatment (4-24 weeks after diagnosis) and no treatment.
Based on analytic findings, the average life expectancies from time of diagnosis were:
| TREATMENT TIMING |
LIFE EXPECTANCY |
| Timely (fewer than 4 weeks from diagnosis) |
5.24 years |
| Delayed (4-12 weeks) |
4.8 years |
| Delayed (13-24 weeks) |
4.37 years |
| No Treatment |
2.11 years |
Despite the life expectancy differences, authors estimate three out of five patients who are potential candidates for the combination do not receive it. They cited limited access to mesothelioma specialists, or oncologists still not knowledgeable enough about the advantages and eligibility qualifications to recommend it.
“Patients with a new diagnosis of peritoneal mesothelioma should seek early referral for consideration at a center with specialized expertise,” Karakousis said.
Mesothelioma Specialists Are Crucial
Peritoneal mesothelioma is a rare cancer caused by an ingestion or inhalation of toxic asbestos fibers. It starts in the thin layer of tissue lining the abdomen, but it can take decades before obvious symptoms appear.
The majority of oncologists in the U.S. rarely see cases of mesothelioma. The study highlighted the importance of finding a mesothelioma specialty center for optimal care.
Peritoneal mesothelioma is considered more treatable than pleural mesothelioma, which develops around the lungs and has a shorter median survival. There is no definitive cure for either type of mesothelioma.
An accurate diagnosis is difficult, which often adds to the delay in finding an effective mesothelioma treatment. Early symptoms often are the same as other abdominal issues, including fatigue, fever, loss of appetite, nausea and abdominal pain.
The majority of patients diagnosed with mesothelioma are treated only with standard chemotherapy, followed by palliative care.
Eliminating Missed Treatment Opportunities
The CRS-HIPEC procedure is complex and can last as long as 12 hours. The lengthy, detailed mesothelioma surgery attempts to remove all visible cancer cells, which can be spread throughout the abdomen and involve numerous organs.
HIPEC, which immediately follows the cytoreductive surgery, involves circulating heated chemotherapy throughout the abdominal cavity. The intent is to kill any microscopic tumor cells that evaded the surgeon. The chemotherapy circulates for up to 90 minutes before being drained.
Authors of the recent study concluded that there continue to be missed opportunities to maximize survival with peritoneal mesothelioma, and offered this study to educate patients and clinicians.
“To date, there have been no randomized controlled studies evaluating the surgical management of MPM [malignant pleural mesothelioma], and where such trials do not exist, [this] model may offer utility for clinicians,” the study concluded.
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