The Importance of Prognostic Factors in Mesothelioma

As published in the Annals ofCardiothoracic Surgery November 2012 issue.

There is no doubt that malignant pleural mesothelioma (MPM) needs better non-invasive and accurate prognostication (the ability to predict medical outcomes of a treatment or disease) for several reasons, including but not limited to the following: a median survival of 12 months with first line therapy; a median survival of 24 months when treated in a multimodal approach; a staging system currently undergoing a major update, not to mention the diffuse nature of the disease and its variable biology.

Better prognostication in MPM would mean the ability to better differentiate among patients, hopefully at the time of diagnosis. For patients with a poor prognostic, either palliative therapy or no therapy may be appropriate. If prognostic factors indicate that long term survival is possible, aggressive treatment or novel protocols would be justified.

Typically, prognostication in MPM has been approached by studying many variables, usually one at a time and at many centers, all with limited numbers of patients. This is approach is problematic because prognostication cannot function in a vacuum and the majority of these findings remain unsubstantiated in other MPM populations. For example, Although MPM patients tend to be older individuals who are frequently functionally impaired and may have difficulty with aggressive therapy, there is still a significant number of MPM patients with a favorable biology in a multimodal approach, who benefit from intense therapy.

Such variables that can be studied can be purely clinical, such as patient demographics that are frequently combined with standard laboratory values including white blood cell count or platelet count. Other scientists have focused on radiologic parameters by examining CT and PET scans.

Some of the most advanced research being accomplished today uses a molecular pathologic approach, by studying genomics, microRNA, epigenetics or proteomics in order to define single or combinations of candidate prognostic biomarkers from tissue or blood. The future of prognostic biomarkers in MPM will most likely involve a multi-institutional consortium of centers which will harvest tissue, blood and other specimens in a protocol using the same standard operating procedures in order to minimize extraneous differences which could lead to false positive results.

As new research platforms develop, it will be crucial to make sure that an ongoing registry which incorporates solid demographics as well as documentation of specimen archiving be available to the mesothelioma community. At this time the National Mesothelioma Virtual Tissue Bank fulfills that role in the United States, and is adding new sites to ensure that substances and tissues for MPM prognostication will be available for continuing research.

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Analysis of the Updated IASLC Staging Database for Mesothelioma Patients

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

In collaboration with the International Mesothelioma Interest Group (IMIG), the International Association for the Study of Lung Cancer (IASLC) decided to update the staging system for malignant pleural mesothelioma (MPM) by developing a large international database.

It is widely known that an accurate staging system is essential for assessing the benefit of new MPM therapies. However until the mid-1990s, no such evidence-based staging systems existed and few utilized the TNM (tumor, node, metastasis) system which was developed to achieve consensus on one globally recognized standard for classifying the extent of the cancer spread by using the size and extension of the primary tumor, its lymphatic involvement and the presence of metastases to classify the progression of cancer. Eventually these revisions, including adopting the TNM system, were incorporated and accepted by the UICC (International Union Against Cancer) and the AJCC (American Joint Commission on Cancer) as the international MPM staging system.

This article succinctly reviews information from analyses of the IASLC database which is currently the largest multicenter and international database in MPM and identifies areas in which the current staging system should be revised.

As IASLC and IMIG investigators continue to expand their database, they expect the data gathered will more accurately reflect the clinicopathological and treatment-related prognostic factors which significantly influence overall survival based on the TNM staging system, tumor histology, gender, age and type of operation. 

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Johnson Family Pledges $500,000 to Help Early Detection and Treatment of Veterans

LOS ANGELES, CA. On the same day that a new California law takes effect which humanely limits the time defense lawyers can depose mesothelioma plaintiffs to 7 hours, the John Johnson family, whose personal tragedy helped galvanize the new law, announced their pledge of $500,000 for mesothelioma medical research.

Johnson Family.

"We want to help other families avoid what happened to ours," said Sue Johnson, whose husband John Johnson, a military veteran stricken with the asbestos-caused cancer, collapsed after a grueling deposition and died within 24 hours.

The Johnson family has pledged the donation to the Pacific Mesothelioma Center ("PMC"). They have asked that the donation be used to help initiate a collaborative research and clinical care program between the PMC and the Department of Veterans affairs.

"Dr. [Robert] Cameron did everything he could surgically to save John," said Mrs. Johnson, "but by the time he was diagnosed, he was already stage III. We'd like to help the VA find and use new ways to diagnose mesothelioma as early as possible, so that patients have a fighting chance to survive."

The money will be used to help launch of the Admiral Zumwalt Mesothelioma Research and Treatment Program within the Department of Veterans Affairs.  A key component of the proposed program is early detection.

"The Johnson family's generosity is truly amazing," said attorney Roger Worthington, of the Worthington & Caron law firm, who represents the Johnson family. "When the legal system failed the Johnson family, they stepped up and helped change the law. When the VA missed an opportunity to diagnose Mr. Johnson much earlier, the Johnson family again stepped up to improve the way veterans are diagnosed and treated at the VA."

John Johnson, USMC

The Admiral Zumwalt Mesothelioma Research and Treatment Program is an initiative proposed jointly by Mr. Worthington and PMC. "The family of Admiral Elmo Zumwalt, who died from mesothelioma nearly twelve years ago to the day, has expressed a desire to lend their father's name for a comprehensive program to help veterans," said Mr. Worthington, noting that nearly a third of Americans diagnosed with mesothelioma were exposed to asbestos while serving in the military.

John Johnson proudly served his Country as a member of the United States Marine Corps where, in the spirit of "Semper Fi,"  it is said: "Once a Marine, always a Marine. Commitment never dies." Through their efforts to improve the medical and legal options available to others diagnosed with mesothelioma, the Johnson family has ensured that John's commitment to Corps and Country will never die.

For more information, contact Worthington & Caron, PC.  Email: john@worthingtoncaron.com; Phone: 1-800-831-9399; Worthington & Caron, PC is  law firm located in San Pedro, California that has dedicated its practice to representing patients diagnosed with asbestos-related mesothelioma since 1990.