Friday, February 22, 2013

Johnson Family Advances Mesothelioma Research with $500,000 Pledge to The Pacific Meso Center

February 13, 2013, The Pacific Meso Center accepts the very generous pledge of $500,000 from the family of John Johnson to help build an innovative research and clinical care program between PMC and the Department of Veterans Affairs with the purpose of improving the way veterans are diagnosed and treated at the VA. “We want to help other families get diagnosed as early as possible, so that patients have a fighting chance to survive,” said Sue Johnson, widow of John Johnson.

The Johnson family encourages action with matching pledges to support the proposed Admiral Zumwalt Mesothelioma Research and Treatment Program, named in honor of Admiral Elmo Zumwalt, who died from mesothelioma nearly twelve years ago, and all Veterans fighting this horrible disease.

Click here for official press release of Pacific Meso Center.

Thursday, February 21, 2013

Standardizing Surgical Treatment in Malignant Pleural Mesothelioma

As published in the Annals of Cardiothoracic Surgery November 2012 issue.

Malignant pleural mesothelioma (MPM) affects each individual uniquely, and due to the rarity of the disease, trending widespread results to treatment can be difficult. This is due to the fact that most of our knowledge of MPM results from retrospective studies performed by single-institutions and prospective phase I or II trials typically involve a small numbers of patients. In addition, staging of MPM can be difficult and in many cases inaccurate due to the parameters of current imaging technology.

When operating on any tumor the goal is always to remove as much of the tumor as possible, this is especially difficult because of the areas MPM manifests such as the lining of the lungs and other organs. In MPM, patients typically undergo either an extrapleural pneumonectomy (EPP) or a pleurectomy decortication (PD), and are then treated with radiation or chemotherapy or both directly after surgery in an attempt to kill off any remaining tumor cells.

In an attempt to standardize MPM treatment protocol, the International Mesothelioma Interest Group (IMIG) and the the International Association for the Study of Lung Cancer (IASLC) collaborated to address the deficiencies in the staging of MPM. With the goal of improving the staging system for MPM, the Mesothelioma Domain was established. The previous system for staging was based only on data collected involving surgically treated patients. The Mesothelioma Staging Project will include data from surgically and non-surgically treated patients.

Based on a multinational survey performed, the following terminology was recommended for the Mesothelioma Staging Project:
  • Extrapleural pneumonectomy (EPP): en bloc resection of the parietal and visceral pleura with the ipsilateral lung, pericardium, and diaphragm
  • Extended pleurectomy/decortication (EPD): parietal and visceral pleurectomy to remove all gross tumor with resection of the diaphragm and/or pericardium.
  • Pleurectomy/decortication (P/D): parietal and visceral pleurectomy to remove all gross tumor without diaphragm or pericardial resection.
  • Partial pleurectomy: partial removal of parietal and/ or visceral pleura for diagnostic or palliative purposes but leaving gross tumor behind.

The purpose of the IASLC making these recommendations is to set a framework for publications which will allow better understanding of procedural trends and to standardize surgical classifications of MPM, not to necessarily govern the language used by individual surgeons.

Another area needing further definition is macroscopic complete resection (MCR) which is the complete removal of a tumor. MCR is difficult in MPM due to the locale, and often trace amounts of the tumor are left behind after surgery. Determining the exact amount of residual tumor is difficult and not all surgeons agree that MCR is accomplished if any tumor is left behind, no matter how small. A scoring system for other malignancies has been developed based on the amount of tumorous tissue remaining and is referred to as the Completeness of Cytoreduction Score (CC score).  A similar gaging system would be beneficial in regards to MPM as leftover tissue after surgery directly correlates to survival and continued treatment.

Additionally, lung cancer patients undergo lymph node sampling at the same time as the cytoreductive surgery to assess lymph node involvement. MPM involves the same lymph nodes affected in lung cancer, but also ones not typically affected in lung cancer. The Mesothelioma Domain of the IASLC Staging Committee is currently devising a lymph node map for MPM which will allow for a more detailed prognosis and accurate staging of the disease.

Our understanding of MPM continues to develop and research is becoming more prioritized as knowledge of the disease becomes more commonplace. Establishing a standardized approach to MPM will not only allow researchers to discover clearer parallels among studies, but also assist in developing a widespread protocol for diagnosis and treatment.

Click here to view the full article.

Wednesday, February 20, 2013

3rd International Symposium on Lung-Sparing Therapies for Malignant Pleural Mesothelioma

The office of Continuing Medical Education at the David Geffen School of Medicine at UCLA and The Pacific Meso Center at the Pacific Heart, Lung & Blood Institute is holding the 3rd International Symposium on Lung-Sparing Therapies for Malignant Pleural Mesothelioma (MPM), on Saturday, May 18th at the Sheraton Delfina Hotel, Santa Monica. 

Dr. Robert Cameron Director of the UCLA Mesothelioma Comprehensive Research Program and Chief of Thoracic Surgery at the West Los Angeles VA Medical Center will lead the symposium again this year. Mesothelioma experts from the United States and as far afield as Italy will gather to discuss the latest treatments and research for MPM.

For Further information and to reserve your place, please click here, or call 310-794-2620.

Friday, February 15, 2013

Grand Opening of Pacific Meso Center’s Research Laboratory, Los Angeles, CA

Dr. Robert Cameron with oncologist 
Dr. Olga Olevsky both of whom are
a part of UCLA’s Comprehensive 
Mesothelioma Program and 
members of PMCs Scientific
 Advisory Board 
On February 13, 2013, Pacific Meso Center officially opened their new research laboratory whose sole focus will be on the development of innovative therapies and treatment for malignant pleural mesothelioma (MPM). This lab is the first free-standing laboratory in the world dedicated to the study of MPM.

The PMC research lab team is headed by surgical oncologist and cardiothoracic surgeon Robert B. Cameron, M.D., one of the foremost experts in the field of mesothelioma research and treatment. Dr. Cameron is also the director of the UCLA Comprehensive Mesothelioma Program at the David Geffen School of Medicine at UCLA, Chief of Thoracic Surgery at the West Los Angeles VA Medical Center, and a long-time proponent of lung-sparing surgery for MPM.

In addition to Dr. Cameron, the team at PMC is comprised of a remarkable group of distinguished physicians and scientists all bringing forth years of experience in their respective fields to the lab.

Research scientist Raymond Wong, Ph.D. has a background in molecular microbiology and immunology and has spent the past decade in the research and development of novel immunotherapy strategies to improve the medical outcome of life-threatening diseases. Dr. Wong is currently researching the role of immunotherapy in the possibility of therapeutic cancer vaccines for mesothelioma. If a predictive model for drug prevention of MPM were found, someday we may be able to vaccinate pre-disposed individuals.

Research scientist Raymond Wong, Ph.D. 
Dr. Wong is also researching novel uses for cryotherapy which in the past has typically been used to address any new tumor recurrences after a patient has undergone surgery. Dr. Wong’s objective is to investigate the possibility of using liquid nitrogen to freeze any remaining tumor cells while the patient is still on the operating table. While surgeons may attempt to remove all visible tumor, the reality is that there is always microscopic cancer cells which remain and can potentially grow again. This tactic could potentially serve a similar role to post-surgical radiation and be an added assurance against tumor spread.

Molecular biologist Irina Ianculescu, Ph.D. has a background in genetic, molecular and cellular biology and is applying molecular biology techniques to the understanding and treatment of mesothelioma. Recent discoveries of the disease-specific genetic mutations in MPM offer the potential for individual targeted therapies that could lead to improved treatment and the possibility of turning mesothelioma into a chronic rather than fatal disease. Further advances in our understanding of the molecular biology of MPM are likely to emerge in the near future as genetic study becomes more commonplace.

Dongmei  Hou, M.D., Ph.D. whose current research is focused on hyperthermia therapy, chemotherapy, and immunotherapy has conducted a study using established cell lines and the response of thermal therapy and cisplatin. The results have shown promising results and will soon be ready for clinical trials.

Researchers at PMC are also working to find new options for pre-detection and early diagnosis, one such method under development is a non-invasive breath screening test that will be able to detect the pre-disposition to mesothelioma from the microscopic molecules carried in a person’s breath. Early detection not only offers a better response to treatment, but can add substantial value to quality of life and in many cases prolong survival.

In addition to the physicians and scientists, PMC is led by Executive Director Clare Cameron whose primary goals are to raise awareness and to create the financial success necessary to find better treatments and a cure for MPM. The newest addition to PMC is Medical Liaison Savannah Cline, RN, BSN who serves as a valuable resource to mesothelioma patients by giving them treatment information and a better understanding of the disease by providing a web-presence through her webinars, blogs, website content.

Pacific Meso Center (PMC) is a division of the Pacific Heart, Lung & Blood Institute (PHLBI), a 501(c)(3) non-profit medical research organization established in 2002, and is focused on both the treatment and prevention of MPM.

Click here for official press release of Pacific Meso Center.

Monday, February 11, 2013

Is EPP Superior to Supportive Care in the Treatment of Malignant Pleural Mesothelioma?

As published in the Annals of Cardiothoracic Surgery February 2011 issue.

The question of whether extrapleural pneumonectomy (EPP) is superior to supportive care, in terms of morbidity, symptom control and survival, in the treatment of patients with malignant pleural mesothelioma (MPM) is examined by reviewing 14 papers best demonstrating the evidence to answer this question. After relevant outcomes and results were tabulated, this study concludes that EPP confers no advantage to chemotherapy and palliative treatment in terms of survival and symptom improvement.

According to the study, the median survival was 13 months, 5.7% perioperative mortality rate and 9.1% 30-day mortality rate. There was a high morbidity rate of 37% during surgery due to the following factors: atrial fibrillation, empyema and supraventricular arrhythmias. Disease recurred in 73% of patients at a median time of 10 months. Median hospital stay was 13 days and intensive care unit stay was 1.5 days. At three months post-surgery, improvement in symptoms was achieved in 68% of patients, with significant advantages observed in patients with epithelial MPM compared to non-epithelial MPM.

Management of MPM may include the use of chemotherapy or surgery with palliative intent. However when the EPP is used with curative intent, studies show that is likely to fall short of expectations. The clinical bottom line to this study is that EPP is a highly morbid operation with high perioperative mortality and recurrence rate. Although a number of retrospective studies have shown a small benefit in survival with EPP, there is consensual agreement that even in subgroups with the best prognostic indicators, such as epithelial histology or negative lymph node metastasis, EPP still results in high complication rates with minimal symptomatic improvement. 

The MARS trial, which clearly demonstrates the detrimental effects of conducting EPP surgery compared to conservative management, is especially significant. This study also reported that lung-sparing radical decoration surgery tends to produce higher median survival rates compared to palliative surgery.

Click here to view the full article. 

Friday, February 1, 2013

The Rationale for Multimodality Therapy Incorporating Lung-Sparing Surgery

As published in the Annals ofCardiothoracic Surgery November 2012 issue.

Although historically, extrapleural pneumonectomy (EPP) was the preferred surgical approach to the management of malignant pleural mesothelioma (MPM), physician and patient preferences have contributed to an increased number of lung-sparing pleurectomy/decortication (P/D) surgeries now being performed. Given the growing body of research and when patients face the option of a less extensive surgery that is equally or more effective than the EPP, has caused this dramatic impact in thoracic surgeon practice patterns.

The P/D involves resection of the pleura but leaves the uninvolved lung intact. It is already associated with less morbidity during surgery and increased life-expectancy. The EPP has been well studied in the multimodality paradigm and has shown that many patients are unable to tolerate post-operative radiation and/or chemotherapy. Given these challenges, many investigators are exploring how best to incorporate P/D into a multimodality treatment program. 

This study examined the value of EPP versus P/D in a retrospective analysis of 667 patients. Early data suggests that since adjuvant therapy is more tolerable in P/D patients, multimodality therapy with P/D is associated with improved survival. Treating MPM patients with intact lungs with pleural intensity modulated radiation (IMRT) is feasible and safe and is associated with encouraging survival rates in this retrospective cohort. 

In conclusion, MPM patients clearly benefit from a multimodality approach, but the optimal combination of surgery, chemo and radiation merits more investigation. As more patients undergo P/D surgery instead, the EPP-centric multimodality paradigm is shifting to integrate this trend. Researchers are also currently evaluating a novel paradigm of preoperative chemo followed by P/D and pleural IMRT in a prospective phase II trial.

Click here to view the full article.