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.

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.

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. 

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.

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.

Click here to view the full article.

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. 

Click here to view the full article.

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.