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Monday, June 25, 2018

Measuring Progress in Mesothelioma Treatment

​These are undeniably exciting and complex times in oncology care and cancer research. Breakthroughs are happening thanks to technology, increased data sharing, and scientific insight. Unfortunately, those diagnosed with rarer cancers see fewer innovations and upgrades to their standard of care. Arguably, common cancers receive greater awareness and funding to make both small improvements and greater advancements regularly in care, compared to those affected by and researching rarer cancers. This is mainly due to lower rates of incidence, fewer patients to involve and, in some cases, limited opportunities for care due to aggressive onset and late stage diagnoses. Malignant mesothelioma is just one example of a cancer where innovation has fallen far behind need, resulting in a standard of care that, by comparison to more common cancers, has not seen significant improvements over the last decade.

With an average of 3,000 diagnoses annually in the U.S., mesothelioma typically presents with an aggressive onset as it is often detected in an advanced stage. This cancer also has an extremely long latency period because it is caused by exposure to asbestos that could have occurred between 10 years and 50 years prior, leaving individuals unaware they are at risk of developing it. Research has evolved and accelerated in almost every facet of oncology care, but seeing the full scope of how translational medicine is impacting researchers, clinicians and patients can be difficult. Looking into the recently available treatment options and innovations into this rare cancer is a specific illustrator of the relationship between emerging options and the ways in which patients and standards of care are seeing improvements at an unprecedented rate.

Previous research breakthroughs have helped advance treatment, but potential options for those with mesothelioma have largely come from insights into other cancers, namely melanoma and lung cancer. Rather than waiting for results to come in from more well-funded areas, personalized cancer vaccines have the promise of research working directly into the treatment of this rare cancer. This offers patients and oncologists new options that are being developed at a speed not experienced before. Given the cancer's extremely low survival rate, coupled with its short life expectancy, the availability of research and clinical trials into drug therapies specifically targeting mesothelioma could be revolutionary.

Looking into the connection between melanoma and mesothelioma through the BAP1 gene has unlocked many discoveries into the progression and makeup of the group of malignancies that share it. This has led to a greater understanding of this group and the way cancers behave, yet has not produced any comprehensive advances related to standard of care or clinical options for those with mesothelioma. One step further, research into lung cancer and the PD-L1 protein have advanced beyond merely making a connection with mesothelioma and into the clinical setting for mesothelioma patients. Although for those who are healthy enough or in the proper stage, these trials have seen mixed results in availability and efficacy for those who qualify for the drug therapy.

Personalized cancer vaccines work to mitigate the inconsistency those looking to participate in trials often encounter, both in qualifying for and in response to treatment. By sequencing the DNA and studying mutations unique to each patient, antigens are targeted to the tumor, meaning patients can immediately begin treatment customized to their needs. This bypasses the current life cycle of research that leaves patients and specialists waiting for therapies to become available. It can also address the issue that many encounter even after trials do recruit that there's no guarantee they'll be able to qualify for. While personalized cancer vaccines are still in the early stages of use, the promise they hold is uniquely significant for those with rare cancers.

Diagnostic tools are also becoming more advanced and can now hone in on and detect biomarkers specific to mesothelioma with greater accuracy. From breath tests to liquid biopsies, proteomics are joining genomics in having a greater role in cancer therapy. Currently, to arrive at a conclusive diagnosis, a full needle biopsy, along with imaging and results from testing fluid samples from ascites and pulmonary edemas that often accompany symptom onset, are all needed. The tests, scans, analysis, and lab work take up precious time and resources for mesothelioma patients, who face an average prognosis of 15 months. Efficient testing and early detection can be the difference between having available treatment options to explore or left with palliative measures only for some patients.

A recent study focused on surface level proteomics, in particular through human serums derived from patients, looked for a set of biomarkers specific to mesothelioma. From highly targeted ones like mesothelin to more general cancer markers, the tests have shown promise for less-invasive and more-efficient detection without the standard course of tests. European researchers are working on yet another promising area of proteomic research focusing on breath tests to detect protein markers specific to pleural mesothelioma. Ongoing study results have provided consistent and effective data showing promise in not only detecting markers for mesothelioma and benign chronic asbestos-related diseases and controls, but also those distinct to malignancy.

Immunotherapy and biologics are undoubtedly the next frontier of cancer treatment, but surgical innovations are paving the way for less-invasive, more-accurate and effective options today. For complex cancers like mesothelioma that are often not discovered until later stages, a multimodal approach is often necessary. Small surgical advancements are one more step toward fostering successful patient outcomes.

One such innovation related to treating peritoneal mesothelioma is revisiting the element of chemotherapy immediately after removing malignant tissue and organs through Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) and Pressurized Intrathoracic Aerosol Chemotherapy (PITAC). The pressurized aerosol version of this treatment is helpful in a number of ways. A recent study found that the surgical administration of this chemotherapy was found to be successful and less-invasive compared to a traditional wash through Hyperthermic Intraperitoneal Chemotherapy (HIPEC) after tumor resection. Being a spray, rather than a liquid wash, allows the drug to reach farther into areas of the body through a controlled, consistent application. This also provides a less-invasive surgical method of chemotherapy delivery, with the aerosol able to be administered through a laparoscopic procedure rather than full incision into the peritoneal cavity, helping patients recover faster with less healing time needed.

With so much research happening in so many areas of focus, measuring progress and promise through a narrowed lens can be helpful to assess where we are in moving oncology care forward.

This article was authored by staff from the Mesothelioma Cancer Alliance. This organization serves as a source of information, support, and community for those affected by mesothelioma cancer and asbestos-related diseases.