UCLA Now Offering Multi-Disciplinary Clinic Where Patients Can Meet With Surgeon and Oncologist Specializing in Mesothelioma at the Same Consult

Patients who are diagnosed with mesothelioma often feel overwhelmed and stressed. An aggressive tumor has been growing in their body and time is of the essence in order to effectively treat it. But before proceeding with a treatment, many questions need to be answered:

• Am I a candidate for surgery?
• If so, what surgery is best for me (EPP vs. PD)?
• Should I have chemotherapy instead of surgery?
• Should I have chemotherapy AND surgery?
• If so, should I have chemotherapy before or after surgery?
• If chemotherapy, what agents should I receive?

Under typical circumstances, getting reliable answers to these questions which require input from doctors with specialized knowledge in two disciplines, surgery and oncology, can be a difficult and time-consuming process. Furthermore, because of the rarity of the disease, there are many opportunities for misinformation to de-rail the process.

As part of its Comprehensive Mesothelioma Program, which brings together doctors from various specialties in a collaborative “team” approach to treating pleural mesothelioma, UCLA is now offering a weekly multi-disciplinary clinic to help patients avoid the pit-falls, challenges and delays that are often encountered in determining a treatment plan.

Common Pit-Falls, Challenges and Delays

1.  "You’re not a candidate for surgery because the tumor is too diffuse"

Most patients are diagnosed with pleural mesothelioma via a biopsy performed at a local hospital. The surgeon performing the biopsy is often a general surgeon and, even if a thoracic surgeon, does not have significant experience in the diagnosis or treatment of mesothelioma. There are many instances where the surgeon performing the biopsy advises the patient that he or she is not a candidate for surgery because the tumor is too diffuse or has spread over most of the lung. As a result, the patient is referred only to an oncologist and is presented with chemotherapy as the only treatment option.

A similar result occurs where a pulmonologist or oncologist with limited experience treating mesothelioma reviews a CT scan revealing tumor that has spread over most of the lung and determines that the patient is not a candidate for surgery.

Doctors who specialize in the treatment of pleural mesothelioma will explain that mesothelioma is, by its very nature, a diffuse tumor which spreads throughout the thin pleural lining that  surrounds the lung. Most surgeons who specialize in treating the disease will conclude that a person is a candidate for surgery so long as the tumor remains confined to the pleural space (i.e. it has not invaded the lung or the chest wall), even though it is covering much of the lung.

2.  "Reflex" Response: Alimta/Cisplatin Chemotherapy

In 2004, the FDA approved pemetrexed (Alimta) in combination with Cisplatin for the treatment of pleural mesothelioma. Alimta/Cisplatin remains the only FDA approved chemotherapy drug combination for the treatment of mesothelioma. As a result, many general oncologists that are not experienced in treating mesothelioma reflexively prescribe Alimta/Cisplatin without informing patients about other treatment options.

Doctors more experienced in treating mesothelioma are aware that: a) the FDA’s approval of Alimta/Cisplatin was limited to “use with patients who are not eligible for surgery”, b) in pre-approval trials Alimta/Cisplatin showed only a 41% partial response rate and an increased median survival rate of only 2.8 months, with the best results seen in patients with epithelial cell-type, and c) more recent published trial data reveals that a combination of surgery, radiation, and chemotherapy is almost always associated with the longest survival times. 

Alimta/Cisplatin is administered once every three weeks for a total of six rounds. With follow-up CT-scans, the treatment process typically lasts approximately six months. With the limited response and increased survival rates, many physicians believe that this is too much time to “invest” in this particular treatment when other treatment options are available for treating this aggressive disease.

3.  "Tic-Toc" and "Can we talk?"

Even if a patient is fortunate enough to work with knowledgeable doctors who are willing to consider a full range of available non-surgical and surgical treatments, the mere act of seeing doctors from the various specialties can be extremely time-consuming.

Doctors, especially specialists, are very busy and it often takes many weeks to get an appointment. Furthermore, most experienced mesothelioma specialists will want to review all medical records and radiology scans before recommending a treatment. Some will even want to have the biopsy pathology slides re-tested by pathologists they trust in order to get an accurate read on the specific cell-type of the tumor. The burden of collecting and transmitting all of these materials frequently falls on the patient and the patient’s family.

The process of preparing for and seeing various specialists can easily take a couple of months to complete and often results in different opinions and recommendations regarding treatment. For example, an oncologist recommending chemotherapy and a surgeon recommending surgery. While the oncologist and surgeon may be in communication with the pulmonologist or internist that referred the patient, the oncologist and surgeon frequently don’t speak directly to each other. Accordingly, the patient is left to make a very important medical decision in a relative “vacuum.”

Furthermore, once a decision is made and the patient proceeds with the chosen treatment, the specialist’s involvement typically ends once the treatment is completed. The patient then returns to the pulmonologist for the next step, which is often a referral to another specialist—starting the  process all over again!

UCLA’s Multi-Disciplinary Clinic Brings Patients Together With Expert Surgeon and Oncologist to Make “Team” Decisions Regarding Treatment

In furtherance of its team approach to treating mesothelioma, UCLA’s Comprehensive Mesothelioma Program recently began offering a multi-disciplinary clinic where patients can meet with both a thoracic surgeon and an oncologist who specialize in treating pleural mesothelioma.

The multi-disciplinary clinic is offered Wednesdays at the Pacific Thoracic Surgery office located at 10780 Santa Monica Boulevard, Suite 100, in Los Angeles, California. At the clinic, patients are seen in consultation by thoracic surgeon Dr. Robert B. Cameron and oncologist Dr.Olga Olevsky .

Dr. Cameron is the director of UCLA’s Comprehensive Mesothelioma Program, chief of thoracic surgery at the West Los Angeles Veterans’ Administration Medical Center and Scientific Advisor for The Pacific Meso Center. Dr. Cameron has been treating pleural mesothelioma patients for over 20 years, is the innovator of the lung-sparing Pleurectomy/Decortication surgical procedure and is widely recognized as one of the world’s foremost experts in mesothelioma treatment and research.

Dr. Olevsky is a board certified oncologist and the oncology specialist of the UCLA Comprehensive Mesothelioma Program. She is extremely knowledgeable about the various chemotherapy agents which are producing the best results for epithelial, sarcomatoid and bi-phasic cell types of mesothelioma.

At the multi-disciplinary clinic, patients are able to meet with both Dr. Cameron and Dr. Olevsky who work together to customize a treatment plan based on such factors such as the patient’s age and condition and tumor cell type, location and staging. Patients and accompanying family members are welcomed to be part of a thorough open discussion with Dr. Cameron and Dr. Olevsky regarding surgical and chemotherapy options, as well as other treatments such as radiation, cryoablation and immunotherapy offered by the UCLA Comprehensive Mesothelioma Program. The goal is, of course, to take the guesswork and frustration out of a very complex decision making process.

For patients who decide to proceed with the treatment recommended by Dr. Cameron and Dr. Olevsky, both doctors will continue to supervise all aspects of treatment from that point forward. Patients are closely monitored with follow-up examinations every three months and are referred as necessary to other specialists that are part of the Comprehensive Mesothelioma Program.

The patient-centered approach to care provided by UCLA’s multi-disciplinary clinic is aimed to save patients time and anxiety in making informed decisions about mesothelioma treatment, allowing them to proceed with treatment as early as possible and focus on getting well.

For more information about the multi-disciplinary clinic, contact Nurse Savannah Cline of the Pacific Meso Center at (310) 478-4678 or scline@phlbi.org.

Avid Surfer and Former Drywaller Awarded $26.6 Million by Los Angeles Jury

San Pedro, CA, March 20, 2013—Asbestos cancer litigation law firm Worthington & Caron, P.C. today announced a verdict in the case of a 62 year-old former drywaller diagnosed with mesothelioma, a cancer caused by asbestos. The Los Angeles Superior Court jury that heard the case returned its verdict Tuesday, awarding $26.6 million to Mike and his wife.

Mike testified that he worked as a drywaller in northern Southern California from 1967, while he was still attending Madison High School, through 1993—with frequent breaks for extended surfing trips to Hawaii and Mexico. He worked at countless residential and commercial jobsites during the construction “boom” that occurred in north county in the 1970s, the same time that cancer-causing asbestos was used in many construction products including joint compound, fire-rated drywall, caulk, stucco, roofing mastic and asbestos cement pipe.

“With all the trades working on top of each other trying to finish one job and move on to the next, it was always dusty,” Mike recalled, “It wasn’t until I became a lead maintenance mechanic at UC San Diego and attended a class on job safety in 2003 that I learned that so many of the materials used on the jobs back then contained asbestos.” 

The case (LASC case # BC486980) was filed on June 20, 2012 by Worthington & Caron and co-counsel Simon, Greenstone, Panatier & Bartlett. Over 30 defendants were named in the case. Settlements were reached with a number of defendants prior to trial. Stucco manufacturer, Highland Stucco and Lime Products, Inc., the sole remaining defendant at trial, argued that other companies and even Mike himself were responsible for his exposure to asbestos. But the jury ultimately assessed blame on Highland for its role in subjecting Mike and other members of the public to its dangerous products.

“I was surprised to learn at trial just how much asbestos was in stucco,” Mike stated, “even though I rarely worked hands-on with the stuff, I was exposed to dust when the bags were dumped into large mixers and when we had to scrape off areas of over-spray that came into the homes through windows and doors.”

Mike is grateful for the jury’s award and for the hard work of his legal team, but would gladly trade it for the return of his health. Prior to his diagnosis in May 2012, Mike enjoyed his job at UCSD and had no plans of retiring. He also continued to indulge his life-long passion for surfing, hitting the waves on the iconic surf breaks of north county in Southern California two or more times a week.

After receiving his diagnosis, Mike sought treatment with thoracic surgeon Dr. Robert Cameron, Director of the Comprehensive Mesothelioma Program at the UCLA Medical Center in Los Angeles. Mike underwent the lung-sparing pleurectomy/decortication surgery performed by Dr. Cameron in July 2012. Thereafter, he underwent six weeks of radiation under the direction of UCLA radiation oncologist Dr. Michael Selch. “I was one of the first patients to get radiation with UCLA’s new Tomo-Therapy equipment”, Mike said, “Dr. Cameron and his team are on the cutting edge when it comes to treating meso. There are world-renown medical centers in Southern California, but for mesothelioma, the experts are at UCLA." 

Mike recognizes that asbestos companies like Highland have historically refused to support research into cures for mesothelioma, “they would rather pay attorneys to blame guys like me who were exposed to their products for causing our own illness!” Mike vows to support mesothelioma research conducted at the Pacific Meso Center under the direction Dr. Robert Cameron: “I’ve personally benefitted from Dr. Cameron’s research supported by patients before me affected by this disease. Now it’s my turn. With a little luck, I’ll be around long enough to benefit from the research they do with my support."

Fifteen Year Old’s Test Strip Invention Holds Major Potential for Earlier Diagnosis of Mesothelioma

Jack Andraka

Within the past year, sixteen year old Jack Andraka’s life as changed drastically from that of a typical high school student to that of an inventor, scientist and cancer researcher. After a close family friend died of late stage diagnosed pancreatic cancer, Jack began researching the disease using Google and Wikipedia to learn as much as he could with the belief that there must be something out there that could allow for earlier diagnosis. The current tests used for pancreatic cancer are over 60 years old.

Symptoms of pancreatic cancer are not very specific to the disease. They include fatigue, weight loss, nausea and loss of appetite, all symptoms of any number of ailments as well as most types of cancer. Small tumors on the pancreas are also difficult to detect with CT or PET scans due to its location between the stomach and spine.

After three months of research, Jack came across a study identifying mesothelin as a biomarker for pancreatic cancer. Mesothelin (MSLN) is a protein present on normal mesothelial cells which line the internal organs and are present throughout the entire body.

Pancreatic cancer and mesothelioma have a few things in common, both tend to be diagnosed late stage, both are difficult to treat due to that fact and as a result, both come with a very poor prognosis. Both are also forms of cancer with an over expression of the protein MSLN.

It was when Jack was learning about carbon nanotubes (CNTs) in Biology class that he had his ah-ha! Moment though. CNTs are extremely small particles and because of their unique electrical and chemical properties, they present very exciting opportunities for scientific research. Jack thought that he could lace antibodies to CNTs so that they would react to MSLN.

Jack sent his proposal to 199 professors before receiving approval from Johns Hopkins professor, Dr. Anirban Maitra. Dr. Maitra gave Jack use of his lab to develop a filter paper test strip dipped in CNT’s which when exposed to a blood sample, the MSLN in the blood binds with the antibodies to form larger molecules thus changing the paper strip’s electrical properties.

The test is potentially 100% accurate, costs about three cents, takes about five minutes and is over 100 times more sensitive than current tests. It has already been tested and proven accurate in blind human trials.

Earlier diagnosis of mesothelioma holds the potential to turn the fatal disease into a chronic one. Pacific Meso Center is currently working to develop a breath test that will be able to detect a person’s pre-disposition to mesothelioma from the microscopic molecules carried in a their breath.

Jack received the Gordan E. Moore award at the Intel International Science and Engineering Fair for his invention, earning a $75,000 prize and has been contacted by multiple companies about potentially licensing or commercializing his idea.

To read more about Jack and his amazing journey:

http://www.forbes.com/sites/johnnosta/2013/02/01/cancer-innovation-and-a-boy-named-jack/

http://blog.ted.com/2013/02/27/an-early-detection-test-for-pancreatic-cancer-jack-andraka-at-ted2013/

http://apps.societyforscience.org/intelisef2012/project.cfm?PID=ME028&CFID=28485&CFTOKEN=10931553

http://www.intel.com/content/www/us/en/education/competitions/international-science-and-engineering-fair/winners.html?cid=cim:ggl

Worthington & Caron Law Firm to Support 3rd International Symposium on Lung-Sparing Therapies for Mesothelioma

Mesothelioma experts will gather on Saturday, May 18, 2013 at the Sheraton Delfina Hotel in Santa Monica, California for the 3rd Annual International Symposium on Lung-Sparing Therapies for Malignant Pleural Mesothelioma. 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. Dr. Cameron has been a leading innovator and proponent of lung-sparing treatments for mesothelioma for 20 years.

The distinguished faculty at this year’s meeting will include experts from Pittsburgh and Philadelphia, Pennsylvania, Bethesda, Maryland and as far away as Aviano, Italy, with additional experts in a wide range of medical and scientific fields. The seminar, which offers continuing medical education credit, is primarily designed for physicians, but is also open to physicians-in-training, nurses, students, and mesothelioma patients, families and friends who want to learn more about the disease.

At the 1^st and 2^nd International Symposia, the distinguished faculty reviewed the results of recent studies and shared their own experiences treating the disease. It was concluded that, especially with advancements in adjuvant therapies, mesothelioma patients should no longer be subjected to lung-amputating EPP surgery which had become commonplace for many physicians. 

This year’s symposium will once again bring some of the best scientific and medical minds together to advance the treatment of mesothelioma. According to symposium chair Dr. Robert Cameron: "Research and practice over the past several years have continued to evolve, working to improve cancer outcomes without unnecessarily sacrificing the affected lung. Clearly, it is best for the patient to treat mesothelioma as a chronic illness while preserving the function of both lungs."

The Worthington & Caron Law Firm is proud to once again serve as a sponsor for this unique symposium which focuses on rational lung-sparing surgical and non-surgical therapies for treating pleural mesothelioma. The firm has donated $50,000 for this year’s symposium, matching its contributions of the same amount for the first two years’ symposia. "A one-size fits all approach to mesothelioma simply hasn't worked," said attorney John Caron of Worthington & Caron, who have been representing mesothelioma patients since 1989. "We applaud Dr. Cameron's efforts to assemble the world's brightest doctors to take a fresh look at how to convert this nasty tumor into a chronic, treatable disease." 

For a copy of the seminar program, including the schedule, list of speakers and their bios, logistical information and the enrollment application and fees, please click here.

For additional information, please contact Clare Cameron, Executive Director of the Pacific Meso Center at the Pacific Heart, Lung, Blood Institute, at 310-478-4678 or email her at  ccameron@phlbi.org

Green Tea Compound Found to be Effective in Killing Mesothelioma Cells

Green tea is made from the leaves of the Camellia sinensis plant and its history dates back 5000 years. There is an old Chinese legend that says a man, Shien Non Shei, was  walking one day when he curiously tasted the juices from a leaf of a plant and felt it had special medicinal properties and decided to create a drink by mixing it with water. In 1191, Zen priest Eisai wrote the book, Kissa Yojoki (Book of Tea), which describes how drinking green tea can have a positive effect on the five vital organs and lists the tea's medicinal qualities.

For centuries Green tea has been used in the prevention and treatment of a long list of ailments including heart disease, diabetes, stroke, and cancer. The majority of studies attempting to document these proclaimed health benefits have proved inconclusive due to individual lifestyle factors and variations in environment. However, the results of a recent study published in the February 23, 2013 issue of the medical journal Cancer Cell International reveal that a compound found in green tea is effective in killing mesothelioma cancer cells.

In the study, Japanese researchers sought to identify the effects of  the polyphenol Epigallocatechin-3-gallate (“EGCG”), a potent antioxidant abundant in green tea, on malignant mesothelioma. Researchers administered varying doses of EGCG ranging between 10 µm to 500 µm on five human mesothelioma cell lines at intervals of 24 hours. Researchers demonstrated that EGCG caused cell death in all five cell lines by inducing reactive oxygen species (“ROS”) production, which impaired the mitochondrial membrane potential. Lower doses of EGCG actually protected the cells from ROS, but higher doses of EGCG promoted ROS within the mesothelioma cells causing apoptsis (cell death).

Chloroquine is a very potent drug used in the prevention of malaria, but has also been found to possess anti-tumor properties. Researchers applied chloroquine with the EGCG in an attempt to maximize EGCG’s potential and found that, when combined, autophagy (the breakdown of cellular components) was enhanced.

It should be recognized that the study involved direct delivery of EGCG to mesothelioma cancer cells—and did not attempt to determine the impact of drinking green tea on patients diagnosed with mesothelioma. However, the possibility of EGCG becoming an applied therapy along with surgery, radiation and chemotherapy grows as research continues.

The brand Green Tea Hydra boasts of containing the highest EGCG content per serving on the market at 265mg. Matcha Powder (powdered green tea) is said to contain more EGCG than regular dry leaf green tea. EGCG can also be found in green tea extract and in capsule form. There are even green tea patches which are claimed to provide the body with about 300mg of polyphenols per dose - the equivalent of about 30 cups of tea!

The proclaimed benefits of drinking green tea are endless – whiter teeth, cavity prevention, weight loss, clearer skin, lowering cholesterol, reduced risk of heart disease and cancer, prevention of diabetes and stroke – it is used as a stimulant, a diuretic, an astringent to control bleeding and help heal wounds - the list goes on.

However, EGCG can also inhibit the effects of some cancer treating drugs, so it is strongly advised to consult your doctor before beginning any self-administered therapies.

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