Monday, October 29, 2012

New Biomarker May Allow Earlier Diagnosis of Mesothelioma

Mesothelioma can be difficult to diagnose and early diagnosis is even more challenging due to the long latency period and similarity of symptoms to many common ailments. Researchers of the New York University Langone Medical Center have identified a new biomarker, the protein fibulin-3, which may allow for earlier diagnosis, higher efficiency of treatment and a more optimistic prognosis.

Researchers compared fibulin-3 levels from plasma and effusion samples from 142 patients with mesothelioma, 136 cancer-free individuals who had been exposed to asbestos, 93 patients with effusions not due to mesothelioma, and 91 patients with cancers other than mesothelioma.

Effusion fibulin-3 levels were significantly higher in patients with pleural mesothelioma than in patients with effusions not due to mesothelioma.  The fibulin-3 levels were able to distinguish patients with mesothelioma from those with benign effusions due to other cancer types or non-diagnosed persons who had been exposed to asbestos with a sensitivity of 100% and a specificity of 94.1%.

In 18 patients, fibulin-3 levels fell after surgery, the biomarker could prove to be an efficient tool for not only earlier diagnosis, but also monitoring mesothelioma patient’s response to therapy or disease progression. Click here to read the abstract of this study.

Tuesday, October 16, 2012

Pacific Meso Center’s 5k Walk & BBQ—A Rousing Success!

This past Sunday, the Pacific Mesothelioma Center hosted the Inaugural 5k Walk & BBQ at Paramount Ranch in Agoura Hills to raise awareness about mesothelioma and to pay tribute to those who have fought the disease or are still fighting. PMC’s sole aim is to discover new treatments for malignant pleural mesothelioma and to improve mesothelioma victims’ lives and longevity.

More than 200 family members, friends, and colleagues gathered in the Old West Town, formerly the site of numerous westerns filmed during Hollywood’s Golden Age, and set off for the hills for the scenic 5K walk/hike/run. The sun was high and the way steep, but our determination won out over the 90 degree weather and our efforts were well rewarded with some of the best BBQ in the West and the musical stylings of Karen Tobin and her country band.

PMC’s original fundraising goal was $25,000. At last count, this event has raised a whopping $66,900 and the donations are still coming in! The top fundraising team was no other than the McCarthy clan with their team Irish Stampede, in loving memory of Gerald McCarthy.

Team Evens in honor of Randy Evens

Also supporting the cause was Team Evens which was made up of family and friends of Randy Evens. Team Evens included Randy's wife Ginny and daughters Laura and Diana.  Team Evens was proud to boast that no matter the distance, they would keep on walking to get the word out and to chase down a cure. There were other great friends and gracious clients of ours also in attendance, including: the Ganoe family and friends, the Belvedere family and friends, the Jarvis family and friends and Kay Simmons-Gilpatrick.

It was admirable to see these families band together to honor their loved ones and give something back to help future victims. I tip my hat to thee. And my sore feet.

Dr. Cameron Proposes IMIG Consensus Statement on the Role of Surgery in Mesothelioma Treatment

Recently several hundred doctors and scientist from all over the world with an interesting in mesothelioma met in Boston to discuss, among other things, the role of surgery in treating meso patients (the "IMIG" group).

Earlier, a paper had been published out of the UK that questioned the merits of extrapleural pneumonectomy (EPP)  as compared to chemotherapy alone (the trial didn't offer pleurectomy/decortication).  The IMIG group pointed out various flaws in the design and operation of the trial.  In particular, the clinical trial, the first of its kind anywhere, had terrible trouble over a period of three years recruiting the 50 patients it needed for a pilot trial. The MARS group's plan was to follow up the pilot study with a full blown and statistical meaningful mega-trial of 670 patients. They never got there. 

Of the 50 meso patients they did recruit, many of those did not complete the arm of the study they started (ie. surgery only or chemo only), or they crossed over (from surgery to chemo, or vice versa) during the trial. 

The MARS authors to their credit did acknowledge this deal-breaker problem. They went so far as to question whether a clincial trial of this kind was ever feasible at all in the real world, where patients simply don't want to be "guniea pigs" even in the greater interests of medical advancement. A clinical trial of this scope has never even been attempted in the US.

In the US, patients have many choices, and it remains "muddy" what the best option is across the board for the "average" meso patient.  Dr. Cameron and Dr. Sugarbaker have publically disagreed over which surgery is "better" - ie. EPP vs Pleurectomy/Decortication. However, both agree today that the role of surgery is to remove as much tumor as you can see (what Dr. Sugarbaker has coined "complete macroscopic resection" (MCR)).  Dr. Cameron has been a long time advocate of pulling up his sleeves and pulling out a much tumor as he can see, without watching the clock, noting that "negative margins" was and always will be a pipedream for a meso surgeon.

I encourage you to read the draft proposal submitted by Dr. Cameron, which is based on an earlier draft proposed by Dr. Sugarbaker.  Although there are stylistic differences, both agree that surgery should be performed along with adjuvant care to attack the unseen tumor cells that remain in the body after surgery.

As Dr. Cameron tactfully writes: "The exact surgical procedure should be based on disease distribution, surgeon preference and experience, and institutional experience and should be performed with a morbidity and mortality consistent with published literature." 

As a patient, before making your decision (e.g., chemo only? What chemo? Surgery? What operation? By whom and where?),  the IMIG Group has also recommended that you follow these important guidelines:

  • Pathological diagnosis including histologic subtype should be established by tissue biopsy.
  • Clinical staging be performed prior to initiation of therapy and should include PET with lymph node sampling and/or MRI as indicated.
  • The type of surgery (EPP, P/D, etc) should be based on clinical factors as well as individual surgical judgment and expertise.
  • Complete surgical stating should include hilar and mediastinal lymph node removal.

To review a complete text of Dr. Cameron's proposed IMIG consensus statement, please click here.  The IMIG board will review all comments and submit the final approved version for publication in a suitable journal with collective authorship.  Doctors as well as patients need and deserve this kind of up-to-date education. We applaud Dr. Cameron and Dr. Sugarbaker, as well as all the other doctors, who have participated in this project.