Monday, September 24, 2012

Cause-Specific Mortality in Relation to Chrysotile-Asbestos Exposure in Chinese Cohort

The dangers of chrysotile asbestos continues to remain a contentious topic,
especially among defendants who argue that chrysotile is a “safe” fiber.
Chrysotile represents 95% of all asbestos ever used and is currently the
only type of asbestos commercially being used in the world. Its uses include
textile products, friction and heat resistant materials, cement and rubber
products.  China happens to be one of the biggest consumers of asbestos and
have consequently experienced an alarming rate of asbestos-related disease
and asbestos-related death among exposed workers.

In this study, scientists evaluated a group of 577 workers from a
chrysotile-textile plant in China from between 1972 to 2008. Their analysis
indicated that exposure to chrysotile asbestos was closely associated with
excess mortality from cancer and respiratory diseases compared to an
occupational control group and the Chinese national level. Furthermore, the
study found that increased mortality was associated with the amount of
chrysotile exposure, number of exposure years, age at first exposure year
and other variables, such as smoking history and birth year.

In summary, chrysotile asbestos continues to be highly carcinogenic to
humans as illustrated by the study's cohort's increased mortality from lung
cancers and nonmalignant respiratory diseases which resulted exclusively
from chrysotile asbestos exposure. Click here to view this study.

Friday, September 21, 2012

Sarcomatoid Predominant Malignant Pleural Mesothelioma: An Institutional Approach and Experience

As presented by Dr. Robert Cameron at the 11th International Conference of the International Mesothelioma Interest Group (iMig)  
Boston, MA – September 11-14, 2012

Sarcomatoid-predominant malignant pleural mesothelioma is an especially difficult tumor to control. Thoracic surgeons at UCLA seeking to improve the poor prognosis that comes with this incredibly aggressive cancer looked at the treatment of non-mesothelioma pleural sarcomas, which is typically treated with chemotherapy followed by surgery and radiation.

Doctors identified four patients with sarcomatoid-predominant malignant pleural mesothelioma who had received pre-operative therapy before undergoing the lung-sparing pleurectomy/decortication procedure. Three of these patients utilized Ifosfamide/Adriamycin and one patient Cisplatin/Pemetrexed/ Veglin. Three-fourths of these patients were found to have pathological responses with 80-99% necrosis, or tumor death, which is not often seen with standard Cisplatin and Pemetrexed.

Multimodality approaches that utilize Ifosfamide/Adriamycin seem to be the optimal treatment strategy for sarcomatoid-predominant malignant pleural mesothelioma patients. In addition, patients who originally are not eligible for surgery may become so if they see 80% or higher necrosis and remain free of metastatic growth following chemotherapy. Click here to view this abstract.

Thursday, September 20, 2012

Thermal Therapy in the Treatment of Malignant Pleural Mesothelioma

As presented by Dr. Robert Cameron at the 11th International Conference of the International Mesothelioma Interest Group (iMig)  
Boston, MA – September 11-14, 2012

Thermal therapy has been used in cancer therapy for decades and hyperthermic chemotherapy perfusion, specifically, has been used in the treatment of mesothelioma but without data as to the optimal conditions.

In a study performed at UCLA, doctors sought to define in vitro the most effective strategy for the use of thermal therapy in pleural mesothelioma. They exposed three human mesothelioma cell lines to varying hyper and hyperthermic conditions using either a standard metabolic MTS absorbance assay or a standard clonogenic (which is a microbiology technique for studying the effectiveness of specific agents on the survival and proliferation of cells). Each cell line was then expanded and exposed to varying combination of hyperthermia, hypothermia and/or chemotherapy – using chemotherapy agents cisplatin, gemicitabine, and/or pemetrexed.

Their findings show that thermal therapy appears to be most effective when using hypothermia rather than hyperthermia, and chemotherapy appears to be most effective when using two drug combinations over one individually. Click here to view this abstract. 

Wednesday, September 19, 2012

The Timing of Chemotherapy in the Multimodality Treatment of Malignant Pleural Mesothelioma

As presented by Dr. Robert Cameron at the 11th International Conference of the International Mesothelioma Interest Group (iMig)  
Boston, MA – September 11-14, 2012

Chemotherapy used in multimodality treatment of malignant pleural mesothelioma is typically performed within 4-6 weeks prior to or after surgery, and various strategies have been used with regard to the timing of chemotherapy within a multimodality treatment.

Doctors at UCLA identified 121 patients who had undergone the pleurectomy/decortication surgery followed by adjuvant radiation therapy and received chemotherapy only after the first recurrence of the disease. The results of receiving delayed chemotherapy were comparable or better to those reported for “trimodality” therapy including the recent MARS trial. These findings suggest that a more rational and conservative approach to multimodality treatment of patients with malignant pleural mesothelioma may be warranted.

Multimodality Therapy is the combination of surgery, radiation, and chemotherapy; and for malignant pleural mesothelioma patients eligible for surgery, is almost always associated with the longest survival rates. Survival of patients who receive this type of treatment varies from 16 to 22 months, depending on the staging, type of surgery, cell type, as well as other factors. Click here to view this abstract.

Tuesday, September 18, 2012

Percutaneous Outpatient Cryoablation for Localized Recurrent Pleural Mesothelioma Following Lung-sparing Pleurectomy and Decortication Surgery

As presented by Dr. Robert Cameron at the 11th International Conference of the International Mesothelioma Interest Group (iMig) 
Boston, MA – September 11-14, 2012

Recurrence for patients with malignant pleural mesothelioma is extremely high following surgery, most patients are ineligible for repeat surgery and management of mesothelioma is among the most challenging of cancer therapies. Many of our clients have experienced good results with post-surgery cryoblation therapy. (including Martha MunozPatricia Crawford and Sylvia Ramirez

Cryoablation for localized recurrent malignant pleural mesothelioma following surgery can be performed safely as an outpatient procedure. It is a minimally invasive procedure, which uses a needle to target argon gas directly to the tumor killing the cells it touches in a relatively safe and quick manner. It can be performed on multiple lesions at a time and is also a safe and relatively quick method to control pain and improve the patient’s quality of life.

Doctors at UCLA have published a promising study with the International Mesothelioma Interest Group which identifies 24 UCLA patients who have received one or more cryoablation treatments for localized recurrence of malignant pleural mesothelioma following surgery with or without adjuvant therapy. The patients in the study were found to have a minimal morbidity rate of 5.6%, a very high efficacy rate of 95.3%, and an impressive overall survival rate of 36.1 months.

Currently only a handful of centers specialize in the use of cryoablation in the management of mesothelioma, most notably diagnostic radiologists, Dr. Fereidoun Abtin and Dr. Robert Suh at UCLA.

Meso Empowerment Exclusive: Dr. Cameron shares his brilliant insights on breakthrough moments at IMIG Conference in Boston or, Galileo is Smiling

Dr. Robert Cameron
iMig 2012
Dr. Robert Cameron, thoracic surgeon and mesothelioma specialist, was kind enough to provide us with his tweets as he attended the recent IMIG conference in Boston. His “boots on the ground” tweets were simply too compelling to leave alone so we followed up and asked him to elaborate

If you’re reading this, you’re no doubt aware of Dr. Cameron’s pioneering efforts to re-introduce “rationality” to the macho “bigger is better” mentality that unfortunately has tended to dominate meso surgery in the US. Although his pleurectomy/decortication (P/D) model is now becoming not only accepted but strongly endorsed, it wasn’t always this way.

I remember vividly at a meeting among surgeons 12 years ago where his fellow surgeons literally shussed Dr. Cameron when he tried to speak up against powerful, East Coast-driven forces who decreed that their big gnarly “extra-pleural pneumonectomy” (EPP) was as unassailable as a papal decree. For years, Dr. Cameron toiled away, mainly in the dark, while the spotlight remained brightly fixed on the “curative” EPP. But he never lost faith.  Like so many myth busters of lore (Galileo comes to mind), Dr. Cameron’s belief that removing the tumor and sparing the lung was the only rational way.

I can’t speak for Dr. Cameron, but for this cancer warrior, it feels good that his brethren have finally embraced the P/D on which Dr. Cameron based his career and his passion.

Here’s a few of the good doctor’s tweets and the follow up.

Enjoy the read and keep questioning, searching, learning and leaning towards the light.

*   *   *   *   *  

IMIG 2012: for the future of treatment of mesothelioma: the future is clearly immunotherapy!

Why is Dr. Cameron so optimistic? Let’s ask.

Dr. Cameron: Although we are only just now learning how to harness the power of immunotherapy, there is already evidence from decades ago that something as simple as stimulation with IL-2 into the pleural space can result in survivals that have rivaled "trimodality therapy" with median survivals as long as 28 months.

Furthermore, the immune system when it does work has been shown in other cancers, such as melanoma and renal cell carcinoma, to eradicate even bulky disease. We are now on a new learning curve with better understanding not only of what it takes to stimulate an immune response but what it takes to reverse the tumor-mediated escape mechanisms present at the actual tumor site. With the accelerated development in this field that has happened over the last few years, we should make good progress in the near future.

*   *   *   *   *  

IMIG 2012: Steven Albelda confirms that immunotherapy is a very promising treatment for mesothelioma.

Dr. Steven Albelda
iMig 2012
No need for explantion here. Dr. Cameron’s succinct appraisal speaks for itself. Good news! I remember years ago when I was a director on MARF feeling proud to help sponsor Dr. Abelda’s futuristic benchwork research. Smart guy. Good guy. Glad Dr. A is on the team.

David Sugarbaker: "Can't we all just get along and operate on mesothelioma?"

Funny question, coming from the Pope of the EPP himself who for years dominate the conversation, owned the paradigm, and didn't give much heed to his few naysayers. Let’s face it, we love a title fight between heavyweights, so I couldn’t resist asking Dr. C for his reaction to the EPP’s loudest and most cocksure advocate sudden plea for tolerance. Is Dr. S presuming that surgery, no matter what form it takes, must be bedrock of every treatment regimen for meso?

Dr. Cameron: Despite the continued lack of randomized prospective trials showing exactly what, if any, benefit that surgery offers, Sugarbaker must be feeling the heat of all the mounting data that EPP is not necessary.  In my view, he’s now trying to deflect that argument and avoid controversy by calling on all surgeons regardless of which operation you perform to tell medical oncologists and pulmonologists that surgery forms the cornerstone of treatment.

*   *   *   *   *  

IMIG 2012: David Sugarbaker admits that "EPP has no superiority" as an operation over pleurectomy and decortication

Dawgies! Is this one of those “Yes, the earth revolves around the sun” belated acknowledgements? So, Dr. C, why is this such a big deal (picture me feeding the tiger a little red meat).

Dr. Cameron:  “You're kidding right? Most of the posters at this meeting were people trying to do EPPs because they are all under the impression that the "data" shows that it is better.  [Which unfortunately means that for too many ‘get her done’ surgeons with yank-the-lung-it is the earth continues to be the center of the universe….].

*   *   *   *   *  

IMIG today: Sugarbaker admitted that he is now doing 2/3 pleurectomies for mesothelioma....a huge change from a few years ago

This is a radical reversal. We asked Dr. C if he knew whether the Titan of Tri-modal had ever publically debunked or disparaged PD for meso?

Dr. Cameron: “I’m not sure he’s ever disparaged the P/D for meso directly but he has said that the only curative operation for the disease was the EPP. “

*   *   *   *   *  

Pac Meso Center’s Presentation: "The timing of chemotherapy in the multimodality treatment of malignant pleural mesothelioma" received praise from IMIG.

Congratulations!  To read the abstract of this presentation (by Dr. Cameron), please click here.

Note, it was great to learn that the other surgeon who helped form MARF back in the day (1999), Dr. Harvey Pass, one of the most talented, gifted and intelligent doctors on the planet, complemented the presentation and agreed that chemotherapy may not be such a crucial part of "trimodality" therapy (patient ALWAYS want to avoid chemo; losing their hair, nausea, vomiting, etc.) Thank you Dr. Harvey Pass, one of my heroes in the topsy-turvy turbulent Mesoworld.

Our Presentation: Percutaneous outpatient cryoablation for localized recurrent pleural mesothelioma was likely the highlight of IMIG meeting

This is great news. My law firm is particularly proud of this since cryoablation has been used successfully on several of my meso clients (including Martha MunozPatricia Crawford and Sylvia Ramirez) who were relieved and impressed with it’s ease, efficiency and results.

The Pacific Meso Center is currently writing two papers that will be published soon. Consequently, since journals won’t publish anything that’s already been publically circulated, the PMC cannot a this time post it’s powerpoint slides on the internet. Dr. Cameron did however reveal, happily, if not surprisingly, that Dr. Sugarbaker mentioned cryoablation specifically as one of the highlights of info being presented. High praise from the High Priest of Meso! And well should the Big Guy be impressed – preliminary data show that the practice for recurrent patients was effective in 95% of the cases.

*   *   *   *   *  

David Sugarbaker TOTALLY BACKS OFF his beloved EPP to "MCR" Macroscopic Complete Resection, which is code for pleurectomy and decortication

We asked Dr. C to flesh out what this means for the typical meso patient. The backstory of course is that Dr. C has always pointed out that total eradication of all tumor is a pipe dream and they only reasonable goal was the removal of all “visible” tumor? (Note to patients – make sure your surgeon is wearing telescopic lens gear).

Dr. Cameron:  Yes, that’s been my common sense approach, but the EPP crowd never embraced this until now. This basically recognizes that what I have said for decades is actually now widely accepted and people like even Dr. Jablons who abandoned P/D for EPP were bowing to peer pressure not acting on data.”

Well, dear readers, hope you enjoyed the ride. It’s been fun. Please drop us a line if you want to learn more. In the meantime, praise hope!

Sept. 18, 2012
Roger G. Worthington

Monday, September 3, 2012

California Measure Imposing Reasonable Limits on Length of Plaintiff Depositions Moves Closer to Becoming Law!

The Worthington Law Firm has long advocated for reasonable limitations on the length of time that asbestos companies can question asbestos cancer patients. At this time, there is no state-wide rule that limits the amount of time that asbestos company lawyers can question asbestos cancer patients in the context of a pre-trial discovery depositions.

This “anything goes” policy has led to wide-spread abuse. Asbestos company lawyers have typically prolonged depositions well over 20 to 30 hours, over the course of 10 to 15 days – even when the patient’s doctor has warned of the deleterious impact of such interrogation.

Finally, on August 29, 2012, at the urging of plaintiffs attorneys, California lawmakers passed a bill that would impose state-wide limits on the length of plaintiff depositions.  The general rule would limit defense questioning of a plaintiff to seven hours of total testimony. In asbestos illness cases where a physician attests that the plaintiff’s illness raises substantial medical doubt of survival beyond six months, defense questioning would be limited to two days of no more than seven hours of testimony each day, or 14 hours of total testimony.

The Worthington Firm, along with other plaintiffs attorneys, had pushed for a limit of seven hours across the board, or at least for all asbestos cancer cases, similar to the rule that applies in Federal Court and many states such as Texas. While this was rejected by the legislature, we would nevertheless consider this new law just, fair and humane measure to curb abusive and deleterious deposition practices.

Under existing law, asbestos company lawyers are entitled to assume that depositions are limitless. If the new law is passed, 14 hours will be the presumed limit in most cases, with the ability to seek even shorter limits on a case-by-case basis with a doctor’s declaration.

The bill now moves on to Governor Jerry Brown who has not taken a position on the matter. It is hoped that Governor Brown will realize how the absence of California law on this subject has permitted defense attorneys to needlessly and cruelly capitalize on the physical frailties of injured plaintiffs.

We strongly urge Governor Brown to sign the bill into law. 

Governor Brown can be reached online at, and his mailing address is c/o State Capitol, Suite 1173, Sacramento, CA 95814. We encourage you to drop a note to Gov. Brown urging him to support a bill that will curb deposition abuse.