Don't Sit Back.. Attack!

Fighting words?

You bet. Over 20 years ago, "Don't sit back...Attack!" became my law firm's mantra. I never liked the word "victim," as it suggests powerlessness. Guess what? Folks poisoned by asbestos do have the power to strike back. It's been my job and calling to help asbestos cancer patients dig deep, bow up, and get "rough and rumble" justice.

My firm has been sponsoring bike racers, bike teams and bike race events for many years. This year I'm pleased to share with you that I'm racing for a team whose mission is to raise awareness on cancer treatments and preventions -- Breakaway from Cancer® (BfC). BfC is an initiative of Amgen, Inc, the biotech juggernaut. BfC has chosen to use bike races and rides as a vehicle for spreading the word that just as it takes a team to win a bike race, it also takes a team to help survive cancer.

BfC has agreed to sponsor a bike race I've been sponsoring for years -- The BfC Dana Point Grand Prix (DPGP). In 2011, we will have a cancer fundraiser the night before the race (April 30th, details to follow). A portion of the proceeds from the BfC fundraiser will be donated to the Pacific Meso Center.

For more information about the Breakaway from Cancer® Dana Point Grand Prix, click here.

To learn about the Breakaway from Cancer® masters bike racing team, click here.


Lets roll!

RGW

Study finds rogue gene attacks protein that stops cancer spreading

A breakthrough study published in the journal Oncogene reveals scientists at the University of East Anglia have discovered a “rogue gene,” that if blocked by the right drugs, may stop cancer in its tracks. The gene, called WWP2, is an enzymic bonding agent found inside cancer cells. WWP2 attacks and breaks down a naturally-occurring protein in the body which normally prevents cancer cells from spreading. Tests show that by blocking WWP2, levels of the natural inhibitor protein were boosted and the cancer cells remained dormant.

According to researcher Andrew Chantry, "The challenge now is to identify a potent drug that will get inside cancer cells and destroy the activity of the rogue gene." Once new drugs are developed, it is hoped that conventional therapies such as chemotherapy and radiotherapy could be used on primary tumors with no risk of the disease taking hold elsewhere or metastasizing.

The research team is currently working with other scientists to develop such a drug. Chantry believes drugs could be developed in the next 10 years that could be used to halt the aggressive spread of many forms of cancer. More...

Mesothelioma Patients May Benefit From Second Pemetrexed-based Chemotherapy

A new study conducted by a team of Italian researchers tested the effectiveness of pemetrexed-based chemotherapy (PBC) as a second-line treatment for mesothelioma cancer patients whose cancer shows at least a partial response to initial chemo. PBC is already effective for some patients, however no drugs have been approved yet for second-line treatment when the cancer continues to progress after first-line chemotherapy.

The study found that mesothelioma tumors shrunk or at least stopped growing in nearly half of patients (48%), and the median survival rate was 10.5 months after the treatment. Researchers also determined that the patients whose tumors stopped growing for at least 12 months after their first round of PBC treatment were more likely to respond well in the second round. Although the role of second-line therapy in mesothelioma needs further evaluation, this study suggests the possible therapeutic role of re-treatment PBC. More...

Study: Mesothelioma Significantly Underreported in Developing Countries

A new study published by the peer-reviewed journal Environmental Health Perspectives estimates the global magnitude of reported and unreported mesothelioma.

According to the study, it conservatively estimates that, globally, one mesothelioma case has been overlooked for every four to five reported cases. In particular, many developing countries, including some with a high cumulative use of asbestos, do not report mesothelioma. Russia, Kazakhstan, China, and India all rank in the top 15 countries for cumulative use of asbestos. Under diagnosing and/or underreporting may have occurred in these countries due to lack of awareness, knowledge and resources.

This study is the first to postulate a global estimate of “missed” mesothelioma cases based on the collective experience of countries with available data on asbestos use and the disease. Given that their estimation is based on asbestos use until 1970 and because many countries have increased asbestos use since then, those countries should anticipate a higher disease burden in the immediate decades ahead.

Since mesothelioma can be prevented by eliminating exposure to asbestos, the authors of the study propose that every country ban the mining, use, and export of asbestos on grounds of public health. They also propose that developed countries share experience and technology to enable developing countries to better diagnose, report, and manage mesothelioma cases.

Debunking the Myths About P/D

"The Question is, Why Wouldn't a Patient Choose P/D?"

In 1994, Dr. Robert B. Cameron began to develop his specific "radical" lung-sparing pleurectomy and decortication (P/D) surgical procedure as a more rational and less radical alternative to the popular radical extra-pleural pneumonectomy (EPP) surgical procedure for malignant pleural mesothelioma (MPM).

The data show that P/D is much safer than EPP. Surgical mortality (that is, when the patient dies during surgery) for P/D is only 3-4%. For EPP, surgical mortality is 5-7%, or almost twice as high. On top of fatalities, another two-thirds of EPP patients encounter serious surgical complications. Dr. Cameron’s surgical mortality numbers are below 1%.

P/D patients retain the use of both lungs, affording them a better quality of life. EPP patients are left with only one lung. With only on lung, the patient is vulnerable to threats to the remaining lung like infection, pneumonia or pulmonary restriction from prior smoking, asbestos scarring or the unshakeable threat of mesothelioma recurrence.

The only randomized trial for EPP (where the surgeon cannot bias the results through patient selection), revealed that patients who had EPP in fact did worsethan patients who avoided surgery altogether. Studies which have looked at both EPP and P/D reveal that P/D patients survive longer.

With P/D’s superiority overwhelmingly confirmed, the question is then, why wouldn't a patient choose a P/D over EPP? It seems that those clinging to the out-dated notion of performing EPP have tried to answer this question with a series of “myths” about P/D.

Over the coming weeks, Dr. Cameron, as the innovator of the P/D and the surgeon most experienced in performing it, will address in turn each of these "myths".

MYTH #1: “P/D Is Only Appropriate For Very Early Stage Meso.” January 3, 2011

Proponents of the EPP have been known to suggest that “P/D is fine for early-stage cases, but for a BIG tumor you need a BIG surgery.”

It is certainly true that lung-sparing P/D is more appropriate for early-stage cases than EPP. For a patient who is younger with less invasive tumor and a good long-term survival prognosis, there is simply no compelling reason to endure the risks and compromised quality of life associated with a radical lung amputation/EPP.

But just because P/D is more appropriate for early-stage patients does not mean that radical EPP is better for more advanced patients. Statistics reveal that P/D is also better advanced cases of pleural mesothelioma. In fact, many of those who argue that P/D is only appropriate for early-stage meso WILL NOT actually perform EPP for late-stage meso. They understand that EPP is too radical and difficult for late-stage patients and don’t want to harm their published survival statistics. They route their late-stage patients to P/D instead.

As a result, most studies comparing P/D to EPP show patients who were younger (less than 60) and relatively healthy going to EPP, and patients who were older (70 or above) and with more sickness going to P/D. Yet the overall survival for older, more advanced patients who had P/D was still BETTER than the survival for younger, less advanced patients who had EPP.

Click here for more information regarding malignant pleural mesothelioma and Dr. Cameron’s approach to treating the disease.

Who to Trust? Reading Medical Articles with A Grain of Salt

How much faith should we put in published, peer reviewed studies which show that a drug, vitamin, surgical technique or medical device produces a favorable result?

We certainly want to believe that a conclusion based on raw data generated in a properly designed test by objective scientists must be true and is therefore reliable.

A recent article in The New Yorker -- "The Truth Wears Off “ -- by Jonah Lehrer reminds us of the perils of putting all our faith in scientists who, like the rest of us, are fallible. Scientists, especially medical researchers, he contends, tend to select their data to confirm a preconceived thesis, especially if they want to publish their study in a prestigious journal

Once a "truth" gets established – e.g, cardiac stents work, PSA tests save lives, Vitamin E is good for you, hormone replacement therapy for menopausal women works, second generation anti-depressants are effective, etc -- it's hard to un-establish it. Few journals put priority on publishing studies that show that a drug or device had "no effect," a phenomenon which Lehrer calls "publication bias."

The writer's point is not that our medical journals are rife with scientific fraud. In the real world, scientists struggle with making sense of their data. If there are anamolies that don't seem to follow a pattern, they might get tossed out. Like anyone else, a researcher is wired to want to disregard what he or she doesn't want to see, or can't explain.

Once Touted, Now Doubted Vitamin E and D megadosing Cardiac Stents Hormone Replacement Avastin for Breast Cancer Baycol, Fen/Phen,Bextra Thalidomide for morning sickness Mastectomy PSA test Lobotomy Extra Pleural Pneumonectomy

As Lehrer observes: "The problem of selective reporting is rooted in a fundamental cognitive flaw, which is that we like proving ourselves right and hate being wrong." Quite simply, it feels good to prove a hunch. It feels even better, he notes, when the researcher has a financial interest in the outcome, or stands to advance his career.

The answer, Lehrer argues, is in properly designing studies and making sure the data are both transparent and rigorously gathered, even if they contradict the hypothesis. Moreover, before publishing, the scientist should lay out on the front end what's a sufficient level of proof. He also suggests the use of accessible databases (something near and dear to Dr. Cameron and the Pacific Meso Center).

Bringing the subject closer to home, for many decades now US doctors have been quick to tout the extra-pleural pneumonectomy (EPP) as the best treatment for mesothelioma. Studies, mainly out of the Brigham and Women's hospital, have been published to prove the point. Several years ago, a big clinical trial, financed by Eli Lilly, showed that the chemotherapy drug Alimta was superior to doing nothing. Alimta went on to become the "front line standard of care" for pleural meso patients.

As you read up on the treatment options available, and listen to experts, it’s wise to stay on guard. Ask yourself, was the research based on selective reporting (aka, "cherry picking" the patients who did well but casting out those who didn’t)? Have the data been made available for review? Have the conclusions been validated elsewhere? Was the clinical trial randomized? Were apples compared to apples (if that’s even possible!).

Note that there has never been a clinical trial in the US in which pleural mesothelioma patients were randomly selected for either an EPP, a Pleurectomy/Decortication, or no treatment. Putting the ethical morass aside (I don’t think a patient would be eager to participate in a trial in which he was forced to do nothing or have his lung amputed), even if there was a well designed study, clearly surgical technique could not be 100% replicated, and every patient is different (genetics, age, sex, staging, pre-existing conditions, tumor cell type, will to live, etc).

In the end, we wind up making choices based on trust. Do we trust the doctor and his team? Do we trust the "science" on which he bases his opinions? Does he admit what he doesn't know? Does he follow the current fad or stubbornly cling to a one-size-fits-all strategy? Does he have passion without the in-your-face zeal ? Does he have a possible conflict of interest where, for example, he's got an irrepressible financial or career incentive to push one flavor over another?

Has your doctor tried to maintain “neutrality?” Radical surgery will transform the patient’s life irreparably. Has your doctor tried to suppress his own bias, anger or elation in recommending a treatment? Has your doctor truly explained whether an option first, does no, or at least very little, harm, balanced against the prospect of measurable benefit?

It’s not easy for a surgeon, or anyone, to “go Swedish” and consciously set aside biases. One thing is for certain, you’re not getting a fair shake if your doctor tells you he’s going to cure your mesothelioma. There is no proven cure for mesothelioma, period. At best, with an enlightened strategy, orchestrated by the an honest and caring medical team, meso patients can buy valuable time.

As WC Fields used to say: Trust your fellow man, but always cut the cards.

Roger G. Worthington, Esq.
December 15, 2010

Is EPP The Answer?

For years in the US the conventional wisdom taught that if you have pleural mesothelioma and you want to survive, you better have your lung taken out.

A new study from the UK has debunked that theory.

Doctors in the UK recently published the preliminary findings from the Mesothelioma and Radical Surgery (MARS) study, a randomized trial in which one group of participants would receive chemotherapy, then extrapleural pneumonectomy (EPP), then radiotherapy. The second group of patients would receive other types of aggressive therapy, but would not receive EPP.

Significantly, the study did not contain an arm for patients to choose or undergo the surgical alternative to the EPP, known as the Pleurectomy/Decortication, which removes the tumor only and spares the lung.

The goal of the trial was to determine whether EPP in conjunction with adjuvant chemotherapy and radiotherapy offered benefits to the patient in terms of life expectancy and quality of life, as compared to other standard therapies. The study also assessed the benefits compared to the surgical risks of morbidity or mortality.

In a nutshell, the MARS trial unambiguously debunked the popular theory that the EPP is the best surgical treatment for pleural mesothelioma patients.

Please read the abstract, as well as the comments by PD pioneer Dr. Robert Cameron of UCLA and the Pacific Meso Center.

Dr. Cameron has been treating mesothelioma patients for over 20 years. He is one of the innovators of the lung-sparing Pleurectomy/Decortication. He has has performed the procedure on over 300 patients in his career. It takes about twice as long as the EPP, is highly tedious, but the results have been worth it in terms of lower patient mortality, above average median survival, and improved quality of life. For more about Dr. Cameron's expertise, click here.

The MARS trial offered up sweet validation of Dr. Cameron's approach -- an approach that has not always endeared him to his pro-EPP surgical colleagues. He writes: "This most recent trial is even more proof that no one suffering from the ravages of mesothelioma should be subjected to the further indignation of a radical, debilitating and useless operation based on "selected" data.”

The take home message: there's no substitute for due diligence. Before consenting to a radical, lung amputating surgery, do your homework. Ask tough questions. And call Dr. Cameron.

December 8, 2010