Mesothelioma | Treatment Options and Support for Patients and Families
Mesothelioma treatment options and support for patients and families. Legal options for those diagnosed with malignant mesothelioma. The blog contains information for Mesothelioma Patients,Mesothelioma caregivers, Mesothelioma diagnosis, Mesothelioma exercise tips and much more.
A research team that included scientists from the University of California San Francisco (UCSF) recently announced a major breakthrough in immunotherapy gene editing. UCSF is one of the top medical schools in the country and is an important resource for mesothelioma patients because the UCSF Medical Center’s Thoracic Oncology Program includes specialists in malignant mesothelioma.
Scientists are working on cancer treatments that leverage the human immune system in a number of ways. Treatments that involve immunotherapy gene editing have moved forward slowly, because this type of therapy was time consuming and expensive. The recently announced immunotherapy gene editing research could change all that. What follows might be a big leap forward in the treatment of numerous diseases, including mesothelioma.
What Is Mesothelioma Immunotherapy?
Before describing the new immunotherapy gene editing study, it’s helpful to consider what the term “immunotherapy” means and how mesothelioma immunotherapy helps attack this rare form of cancer.
The human immune system is more powerful than any chemotherapy drug at killing foreign invaders, viruses, and rogue cancer cells. To survive, cancerous tumors hijack your natural immune defenses and use them to flip the “off” switch on your body’s immune response.
Mesothelioma immunotherapy drugs, such as Keytruda, Opdivo, and Yervoy, down-regulate or suppress proteins that cancer cells use to hide from your immune response. These so-called checkpoint inhibitors unmask the cancer and stimulate your immune system to go on the attack.
Checkpoint inhibitors have been very successful for a minority of cancer patients, including some mesothelioma patients, but most people get little or no benefit from these drugs. Mesothelioma immunotherapy researchers are trying different approaches in hopes of discovering ways to make immunotherapy drugs effective for many more cancer patients.
At the same time, researchers are pursuing other ways to help enlist the human immune system into the fight against cancer. Because immune system cells, especially T cells, can target just the cancerous cells, immunotherapy treatments may have fewer side effects and be more effective at removing all cancerous cells, even after they have spread or metastasized to other parts of the body.
The latest immunotherapy gene editing study looked at one of these alternate approaches. Gene editing allows doctors to create a therapy that hones in on the specific mutations of an individual patient’s cancer cells. The benefit of this type of personalized medicine is that it is quite targeted and (researchers hope) more likely to be effective. The down side is that personalized therapies are very expensive and can be time-consuming to create. This immunotherapy gene editing study could revolutionize personalized immunotherapy because, if it proves successful in human trials, it will reduce the time it takes to create treatments and, ultimately, lower the cost.
Immunotherapy Gene Editing Study is Shocking – Literally
Immunotherapy gene editing is not new. As Mesothelioma Circle recently reported, one patient with inoperable Stage 4 breast cancer that had metastasized throughout her body experienced an amazing recovery. After she enrolled in an immunotherapy gene editing clinical trial, researchers removed some of her immune system’s T cells, modified them to recognize and attack her cancer, grew billions of these modified T cells, and then reinjected them into her body. Her tumors shrank then disappeared; this patient with advanced, terminal cancer is now in remission.
That patient’s success story was due to a monumental effort in the lab. Researchers used viruses to inject modified DNA into her T cells. Viruses are effective DNA delivery systems, but they have significant drawbacks. It can take months to create the virus needed to serve as a vector for a specific patient’s cancer fighting cells. In addition, viruses insert the DNA haphazardly; scientists can’t control where in the T cell the replacement DNA is injected.
In this recent immunotherapy gene editing study, scientists tried something new. They used a burst of electrical current to relax the membrane that protects the cell from foreign invaders. While the shock loosened the cell wall, researchers used CRISPR-Cas9 technology to cut the T cell’s DNA and splice in a new sequence that would activate its ability to seek and identify cancer cells.
CRISPR-Cas9 is the molecular equivalent of a pair of scissors: it cuts apart a DNA strand then removes or inserts DNA code. CRISPR-Cas9 is limited to inserting small segments of new DNA. With the electric shock technique developed in this immunotherapy gene editing study, researchers were able to use CRISPR-Cas9 to insert much larger segments of DNA.
This new immunotherapy gene editing technique is much more accurate than using a virus to deliver the DNA edits because scientists can place the replacement DNA at a precise point in the DNA of the T cell. It’s also much quicker, because it doesn’t require the development of a new virus. It could reduce the time needed to create personalized T cells to attack a specific cancer from months down to a couple of weeks.
The scientific community has hailed this research as a major breakthrough. For patients with rare forms of cancer such as mesothelioma, this potential advance in cancer treatment is exciting news.
Many Diseases Can Benefit from Immunotherapy Gene Editing
The scientists who conducted this immunotherapy gene editing research studied the response of their edited T cells in the petri dish and got positive results. They also put human melanoma cells in mice and created modified T cells to hone in on the melanoma. The T cells did what they were programmed to do and eradicated the melanoma in the mice.
This technique has not yet been tried on human subjects, but it could have far-reaching implications for human health. Already, the researchers have created modified T cells to replace the mutated T cells that have caused an autoimmune disorder in three siblings. The scientists are waiting on approval from the FDA to administer the gene edited immune cells to these young people. If it works, it could be a far better treatment for their disorder than the current treatment, a bone marrow replacement.
Researchers suggest that clinical trials on humans will be coming, perhaps as soon as a year from now. In addition to the treatment of rare cancers such as mesothelioma, immunotherapy gene editing has the potential to cure HIV (which damages T cells). Other autoimmune diseases such as rheumatoid arthritis and lupus could also benefit from this breakthrough in medical technology.
What Could Immunotherapy Gene Editing Mean for Mesothelioma Patients?
If you have mesothelioma, every potential new tool to combat this serious form of cancer is a cause for hope. Immunotherapy gene editing has already helped one patient with very advanced cancer. While an immunotherapy gene editing mesothelioma treatment has not yet been developed, the increasing speed of advances in cancer treatment means that mesothelioma patients could have new options in years rather than decades. If you are able to enroll in a clinical trial, you could have access to new immunotherapy gene editing treatments even sooner.
When you think about your mesothelioma care team, you probably think about mesothelioma specialists, radiologists, pathologists, and other medical specialists with a background in mesothelioma care and oncology. Even though nurses are an integral member of your mesothelioma care team, they might not even make the list. Nurses are expected to step in and quietly be the glue that keeps a patient’s care together, without getting the credit they are due. A new study from the UK demonstrates the importance of lung cancer specialist nurses to improved patient outcomes. If the medical establishment is listening, it could change the way we think about nursing education and nurse specialists.
Study Shows Importance of Lung Cancer Specialist Nurses
The UK study was conducted the University of Nottingham and London South Bank University. The research looked at the medical records of 100, 000 lung cancer patients in Great Britain and 200 lung cancer specialist nurses involved in caring for some of these patients.
In the UK, the National Health Service (NHS) provides healthcare for all residents. This research aims to help the NHS develop evidence-based procedures to improve patient outcomes.
One of the principal scientists who worked on the study, Professor Alison Leary of London South Bank University, is a nurse researcher and champion of the nursing profession. She has previously conducted research which found that unqualified staff at the NHS had been placed in roles meant for nurse specialists. The new study shows how dangerous that practice is.
When patients received care from lung cancer specialist nurses, especially when the lung cancer specialist nurse was part of the medical team from the beginning, they were less likely to be admitted to the hospital.
The study found that patients who were cared for by lung cancer specialist nurses during chemotherapy or radiotherapy had a 17 percent lower death rate during their first year of treatment.
Researchers criticized the NHS for putting lung cancer specialist nurses and other nurses with advanced care specializations into more general roles, to help with nursing staff shortages at understaffed health centers. This new study shows, more clearly than ever, the value of lung cancer specialist nurses in delivering better outcomes for seriously ill patients.
These findings dovetail with research presented at the recent International Mesothelioma Interest Group conference in Ottawa. The study received a Young Investigator Award sponsored by Kazan Law, which also sponsors Mesothelioma Circle. Researchers on that study, which was also conducted in the UK, found that the shock of a mesothelioma diagnosis was moderated when patients at the NHS were quickly referred to a mesothelioma nurse specialist. Support from expert nurses helped families understand what to expect as they entered mesothelioma treatment.
Lung Cancer Specialist Nurses Can Help Mesothelioma Patients
In the US, unlike the UK, our healthcare system varies from state to state and from hospital to hospital. While many US cancer centers employ clinical nursing specialists or advance practice nurses with a specialty in oncology, not every hospital will have a full staff of oncology nurses.
There are thousands of clinical nurse specialists in the US. Many of these are oncology nurses, including expert lung cancer specialist nurses. But a shortage of oncology nurses means that there are not enough to provide every cancer patient with the skilled nursing care that is so important to survival.
There are many factors that contribute to the shortage of oncology nurses. The cancer rate in the US has climbed steeply. New cancer treatments often require more complex skills from the oncology nurses who deliver them. Combine this with better treatments that lead to longer survival times, and there are many more cancer patients who need treatment each year. There aren’t enough new oncology nurses who complete training to fill the increasing demand.
Treatments such as mesothelioma immunotherapy can last for a year or more and may require skilled nurses to administer the medication. Add the fact that doctors are increasingly delegating patient care to their skilled nursing staff, and you have the recipe for too few clinical nurse specialists to meet the demand.
A nurse like the lung cancer specialist nurses in the UK study can be an important resource for you if you are a mesothelioma patient. A mesothelioma nurse specialist or an oncology nurse who understands the ins and outs of chemotherapy and radiation therapy, the possible side effects and infections that can occur during treatment, will improve the care you receive. An oncology nurse who knows to look for signs of complications after mesothelioma surgery could save your life.
You Deserve Specialized Mesothelioma Care
If there aren’t enough oncology nurses in the US, there are even fewer nurses who specialize in the care of mesothelioma patients. Hospitals that have special mesothelioma care units are the most likely places to find lung cancer specialist nurses with experience in mesothelioma care.
If there isn’t a mesothelioma care center in one of the hospitals near you, you may be able to travel to another city to receive special care. Check with your insurance provider to find out about coverage for treatment by mesothelioma specialists, including a trained mesothelioma nurse, in a different city.
If you aren’t able to travel to a mesothelioma center, you may still be able to receive specialized care through telemedicine. Ask your oncologist about consultation with a mesothelioma specialist.
If you’re a veteran and your exposure to the asbestos that caused your mesothelioma occurred during your military service, you may be entitled to special care through the VA. There are large numbers of veterans who were exposed to asbestos during Vietnam and other conflicts ad who have since developed mesothelioma. Because of this, the VA has created special mesothelioma care units at several VA hospitals.
The West Roxbury Campus of the VA Boston Healthcare System and VA West Los Angeles Medical Center, which is part of the VA Greater Los Angeles Healthcare System, are two VA healthcare centers that employ specialists in mesothelioma care. The San Francisco VA Healthcare System also provides mesothelioma care, thanks to its affiliation with the UCSF, Medical Center, and the VA Palo Alto Health Care System, with its affiliation with Stanford University Medical Center, are other centers for cutting edge mesothelioma care and research. It’s no accident that these cities also have private hospitals that are known for ground-breaking mesothelioma research and care; some of the same mesothelioma specialists treat patients in both private and VA medical centers.
If you receive mesothelioma care through the VA, you have the right to care at a VA center specifically equipped to treat mesothelioma patients, even if that is not the closest VA hospital to your home. The VA has a Beneficiary Travel program that could even pay your expenses for travel to one of these VA centers.
No matter where you receive your medical care, skilled nurses like the lung cancer specialist nurses in the UK study can extend your survival time. Make sure that your mesothelioma medical team includes a nurse with advanced practice certification in oncology.
Mesothelioma metastasis occurs when the cancer forms new tumors in other parts of your body. It often means there has been a serious progression of the disease. A new clinical trial, A Safety and Tolerability Study of INCAGN02385 in Select Advanced Malignancies, will study whether a new immunotherapy drug can slow or reverse mesothelioma metastasis.
The study is open to patients with more than a dozen forms of cancer, showing the promise of immunotherapy to reorganize the way cancer is treated. The effectiveness of many immunotherapy treatments may depend more on the way your cancer hides from your immune system than what type of cancer you have.
This is a positive development for patients with mesothelioma metastasis, as well as patients with other rare forms of cancer. If a treatment has the potential to work against multiple cancer types, funding for research and development of new treatments is easier to find.
LAG-3 Blocker Could Attack Mesothelioma Metastasis
The clinical trial for mesothelioma metastasis involves a drug so new that it is identified only as INCAGN02385; it doesn’t yet have a brand name. This Phase 1 trial will recruit 55 patients, all of whom will receive the drug. In the first part of the study, researchers will slowly increase the dose to determine how much patients can tolerate and also to find the most effective dose. In the second half of this clinical trial, participants will receive the optimal dose, as determined by Part 1 of the study.
INCAGN02385 is an antagonist antibody of Lymphocyte-activation gene 3 or LAG-3. Like other targets of immunotherapy such as CD4 and PD-1, LAG-3 plays a role in the regulation of the immune system. LAG-3 works with regulatory T cells, or Treg, to prevent autoimmune responses and keep your immune system from attacking your body. Cancerous tumors sometimes hijack this immune regulation mechanism and use it to stop your immune system from detecting and killing mutant cancer cells.
An antagonist antibody to LAG-3 like INCAGN02385 has the potential to unleash the immune system’s cancer-fighting power. Some scientists think this may be a better mesothelioma immunotherapy checkpoint blocker than the immunotherapy drugs already on the market that target other immune system pathways. Not only does INCAGN02385 have the potential to stimulate effector T cells (as the other checkpoint inhibitor drugs do) but it can also prevent the Treg cells from suppressing the immune response. Effector T cells are immune system cells that spring into action quickly once they are activated.
What is Mesothelioma Metastasis?
Metastatic cancer, in all forms, is more difficult to treat than cancer that is limited to its original site. This is why many mesothelioma treatments aim to prevent mesothelioma metastasis.
Mesothelioma cells can spread through your lymphatic system. This is why the lymph nodes are often one of the first places that mesothelioma metastasizes. When you develop mesothelioma metastasis, the new tumor will be made of cancerous mesothelial cells, no matter where it forms in your body.
Until recently, patients with mesothelioma metastasis or any other form of metastatic cancer generally had a poor prognosis. Advances in cancer treatments have extended the life expectancy of patients with these late-stage cancers. Immunotherapy drugs such as INCAGN02385 have the potential to go further and reverse the course of the disease. A few patients have experienced amazing recoveries from cancer that had metastasized throughout their bodies thanks to cutting-edge immunotherapy and personalized cancer treatments. This upcoming clinical trial could be the first step to a treatment that can offer improved survival to even more cancer patients.
Patients with Mesothelioma Metastasis Eligible for Clinical Trial
If you have mesothelioma metastasis, you could be eligible for the INCAGN02385 clinical trial, which will only accept patients whose cancer has advanced beyond the original tumor. The trial will be conducted by the drug’s maker, Incyte Biosciences International. Participants can enroll at multiple locations around the US.
The study is only accepting relatively healthy participants. You must have an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1. ECOG is a system that researchers use to rate the health of participants in clinical trials. A grade 0 status means you can function normally and do anything you could do before your mesothelioma diagnosis. At grade 1, you can’t do anything strenuous, but you can still walk on your own and do some light work.
To qualify, your mesothelioma tumor has to be measurable on the RECIST scale for solid tumors. You may have received mesothelioma treatments of any kind, including surgery, chemotherapy, and radiotherapy, and still participate in this clinical trial, but you are limited from receiving certain mesothelioma treatments during the study period.
Participants in this clinical trial will receive a tumor biopsy before receiving the drug and periodically during the research. The success of the study will be determined by how long participants are free from progression or experience a reduction in their metastatic cancers. The hope is that INCAGN02385 will prevent further mesothelioma metastasis and may even shrink the tumors.
Your immune system is smarter than a chemotherapy drug. Once your T cells are activated by an immunotherapy drug, they can seek out and destroy cancer cells anywhere in your body. Your T cells can attack mesothelioma metastasis in a way that traditional treatments can’t. And your immune system can do all of this without harming your healthy tissue.
At this point, immunotherapy is still just a promise for most mesothelioma patients. Our immune system is a complex machine and scientists are unlocking its secrets one cell at a time to find treatments that work for a wider group of patients with advanced cancer. Perhaps several keys at once will be needed to unlock this door. The few cases of mesothelioma patients who have had remarkably positive results from mesothelioma immunotherapy show what could be on the other side of that door. Researchers are hard at work trying to find the keys.
Even if you don’t have mesothelioma metastasis, you can help find the key to better mesothelioma treatments when you enroll in a mesothelioma clinical trial. There are many trials recruiting patients. You can use Mesothelioma Circle’s free clinical trial matching tool to find a mesothelioma clinical trial that’s right for you.
It’s important to pay attention to your mesothelioma pain. Acute mesothelioma pain can be debilitating. Chronic pain, even if it is not severe, is exhausting. Mesothelioma pain can keep you from activities, such as exercise, which help your body heal from surgery or chemotherapy. Depression can go hand in hand with mesothelioma pain, and that can reduce your resilience, as you fight mesothelioma.
Not all mesothelioma patients experience pain, but statistics show that about a third of cancer patients experience pain due to their cancer or cancer treatment. When you understand your mesothelioma pain and take it seriously, you not only improve your quality of life; you could improve your survival time as well.
4 Myths about Pain Management
If you or someone you care about is experiencing mesothelioma pain, it’s important to talk about it with your doctors and come up with a pain management plan. You might believe that treatment for your pain isn’t important. That is not true.
Here are four myths about pain; don’t let them stop you from getting the mesothelioma pain management you need.
1. My mesothelioma pain is mild – I’ll wait till it’s worse before I treat it. Maybe it will just go away.
Here’s the truth about mesothelioma pain: it’s much easier to manage if you start early. If you wait until your pain is severe, it’s likely that you will have to take higher doses of pain medication in order to control it.
If your cancer pain does go away, you can stop your pain medications. But don’t wait to get started.
2. I’m tough; I can handle the pain.
Sometimes, pride can make it hard to speak up about your pain. Maybe you see yourself as strong and admitting that you are in pain seems weak. Perhaps you want to protect your family from knowing how much pain you’re feeling, or you don’t want to be a complainer.
The truth is, you can handle the pain until you can’t handle it. The sooner you speak up, the easier it will be to treat your pain. Your loved ones will not think less of you.
3. My doctor didn’t bring it up, so mesothelioma pain must not be important.
Studies have shown that pain management, sometimes called palliative care, is an essential part of cancer treatment that should begin right after diagnosis. Managing your mesothelioma pain can improve the effectiveness of other therapies. Unfortunately, not all doctors are aware of the importance of pain management. Plus, your doctor has no way to gauge your pain level unless you say something.
If you experience mesothelioma pain, speak up. If you don’t feel you can bring up the subject with your doctor, tell a family member or caretaker and ask them to advocate for you. You deserve a pain management plan.
4. If my doctor prescribes opioid pain medication, I will become a drug addict.
While the opioid addiction epidemic in the US is a very real problem, many people take opioids and other pain medications without becoming addicted.
If you have a history of addiction or substance dependence, tell your doctor. But don’t let the fear of addiction keep you from seeking treatment for your mesothelioma pain.
Causes of Mesothelioma Pain
Mesothelioma pain can be caused by the cancer itself or by mesothelioma treatment. The reason for your pain will determine your options in getting pain relief.
· Nerve Pressure
When a tumor presses on a nerve, this can cause acute or chronic mesothelioma pain.
· Pleural Effusion
Pleural mesothelioma pain can be caused by the fluid buildup in the lining around your lung. This fluid accumulation is called a pleural effusion. Pleural effusion can also press on your lung and make it hard to breathe, adding to your discomfort.
Ascites is the medical term for an excess of fluid in your abdomen. Peritoneal mesothelioma sometimes causes ascites, which can press on abdominal organs and interfere with digestion.
· Chemotherapy or Radiation Side Effects
After radiation, you may experience pain at the spot where the X-rays entered your body. The catheter from intravenous chemotherapy can lead to a local rash or pain. The side effects of chemotherapy or radiation, such as nausea and headaches, can also be painful.
· Recovery from Surgery
Surgery is a trauma to your body and it’s expected that you will feel some pain during your recovery. Management of post-surgical pain should be part of your recovery plan.
· Metastatic Mesothelioma Tumors
When mesothelioma cancer cells migrate to other parts of your body, they can form tumors. These tumors can cause pain if they press on an organ or nerve.
Managing Mesothelioma Pain
If your mesothelioma pain is mild, your doctor may suggest over-the-counter medications such as acetaminophen, aspirin, or ibuprofen. For more severe or chronic pain you may need a prescription painkiller such as codeine, morphine, oxycodone, or fentanyl.
If you experience chronic mesothelioma pain, your doctor will probably suggest a pain medication that you can take every day. It’s important to get ahead of the pain and take prescribed pain management drugs on schedule, even if you’re not feeling pain in that moment. If you wait for the pain to strike, your medication may not be able to control it. If your pain management plan is working, you should feel little or no pain.
Your doctor may prescribe two different pain medications, one for chronic pain and one for breakthrough pain. Breakthrough pain is sudden, severe pain that breaks through the pain barrier of your daily mesothelioma pain medication. Medication for breakthrough pain can be taken as needed to control acute pain spikes.
In addition to mesothelioma pain medication, you may need one or more medications to manage the side effects of pain medicine. Many painkillers cause constipation, so a stool softener is often given with those medications.
If your mesothelioma pain is caused by a buildup of fluid, your doctor may be able to relieve the pressure by draining the fluid. When a tumor presses on a nerve or an organ, surgery might be able to remove the mass that’s hurting you. If surgery isn’t possible, chemotherapy or radiation may be able to reduce the size of the tumor and relieve your pain.
Alternative Treatments for Mesothelioma Pain
Alternative treatments can sometimes help relieve mesothelioma pain. Massage can relax and soothe stiffness, as can gentle yoga and stretching.
If you want to try acupuncture, seek out a practitioner with experience using this ancient Chinese medicine to treat pain. Some people have found relief from pain through biofeedback or physical therapy.
You can combine natural treatments with prescription pain medications. Just be sure to check with your mesothelioma doctor before you take any herbal remedies or vitamins, as these may react with your other medications.
Mesothelioma is a serious form of cancer. Reducing your pain will free up your body’s resources to fight mesothelioma. An effective mesothelioma pain management plan is an important part of your mesothelioma treatment.
The National Cancer Institute (NCI) will soon begin to recruit patients for a study of treatment with olaparib for mesothelioma. The two-year Phase II clinical trial (identifier NCT03531840) will examine whether a drug that is approved for treatment of advanced ovarian cancer and breast cancer can also prevent tumor progression in mesothelioma patients. Olaparib is produced by AstraZeneca and is also known by its trade name, LYNPARZA.
The potential usefulness of olaparib for mesothelioma comes down to genetic factors that may predispose some patients to certain cancers. Olaparib is particularly useful in breast cancers with a mutation in the BRCA protein. A mutation in the BAP1 (BRCA1 associated protein-1) gene is thought by some to correlate with a higher risk of developing mesothelioma among people who were exposed to asbestos. If it works for breast cancer patients, olaparib for mesothelioma could offer another avenue of treatment.
How Does Olaparib Help Cancer Patients?
To understand treatment with olaparib for mesothelioma patients, it’s helpful to have a refresher on the basics of cellular reproduction. Before a cell replicates itself, its DNA splits in two and creates a copy. The new cell will have the same DNA as the old one. If a mistake occurs in the copying process, there’s a variation in the DNA code, creating a mutation.
DNA is arranged in a double helix: a twisting ladder of paired genes. DNA strands often break or get damaged and need repairs. The proteins that perform these repairs are implicated in some types of cancers – and now in a potential cancer treatment.
Cancer cells replicate more often than normal cells, so they have a particular need to keep their DNA in good repair. Poly ADP ribose polymerase (PARP) is group of proteins whose specialty is the repair of breaks in a single strand of DNA. If there’s a break in one strand of DNA, it can turn into a complete break in the double helix when the cell tries to reproduce.
BRCA1 and BRCA2 are proteins that repair breaks in double DNA strands. When there is a mutation in the genetic code for the BRCA protein, the DNA double helix isn’t properly repaired during replication. This BRCA mutation is a factor in some cancers, particularly breast cancer.
Olaparib works by blocking PARP. Because PARP can’t repair the little dings on the DNA strands, these develop into more big breaks as cells divide. When BRCA is mutated, it’s not able to repair these broken double DNA strands and cells. This breakdown in DNA replication can keep cancer cells from reproducing themselves.
Olaparib is approved by the FDA as a single treatment for certain patients with ovarian or breast cancer. By blocking PARP, olaparib may also prevent mesothelioma tumors from growing and metastasizing.
As with so much of what happens in our cells, scientists don’t fully understand how olaparib prevents the progression of certain tumors. In clinical trials on patients with advanced ovarian cancer, more than a third of patients with BRCA mutations benefited from the drug. Almost a quarter of patients without BRCA mutations were also helped by olaparib; researchers don’t fully understand why.
With more research, including this clinical trial of olaparib for mesothelioma, scientists will continue to expand their understanding of how cancer grows – and expand treatment options for patients with mesothelioma and other cancers.
BAP1 and Olaparib for Mesothelioma
The NCI research team sees potential of olaparib for mesothelioma because a mutation in the BAP1 gene is found in some mesothelioma cancers and BAP1 is related to BRCA1. The functions of the BAP1 enzyme include suppressing the growth of tumors and suppressing metastasis. When BAP1 is damaged, it may not perform these critical functions, allowing mesothelioma tumors to form.
The upcoming Phase II mesothelioma clinical trial will look at the effectiveness of olaparib for mesothelioma patients with a BAP1 mutation. Researchers will also study the drug in mesothelioma patients who don’t have this mutation. The FDA has not yet approved olaparib for mesothelioma treatment. In this Phase II trial, there will be no control; all participants will receive the olaparib treatment.
The researchers hope to recruit 40 mesothelioma patients who have already received mesothelioma treatment. The study is open to all mesothelioma types.
Participants in the clinical trial will get 21-day cycles of treatment with olaparib. The drug is taken orally twice a day. If you are accepted into this clinical trial, you’ll need to keep a diary recording the dose of olaparib you are taking and any symptoms or side effects you experience. You’ll give blood and urine samples periodically, for lab analysis.
Part of the preparation and screening for this clinical trial is genetic testing. The researchers will share with you any genetic information they learn about you. This could be valuable information as you explore additional mesothelioma treatments or clinical trials.
The study of olaparib for mesothelioma is expected to be ongoing for two years. You can stay in the study as long as you like. Researchers expect participants to continue while the olaparib is an effective treatment for their mesothelioma. As with every clinical trial, you are free to leave at any time. If the side effects are too hard on you or if your mesothelioma progresses, you may choose to seek different treatments. Participants in this clinical trial will work with their mesothelioma doctors to determine the best course of treatment throughout the study period.
The researchers ask that all participants return for a follow-up exam about a month after stopping olaparib for mesothelioma. In addition, they may ask some study participants to have regular scans to track tumor progression.
Possible Side Effects of Olaparib for Mesothelioma
Like most cancer drugs, olaparib can have side effects. Normal side effects include digestive problems such as nausea and vomiting; excessive tiredness; achy joints; and anemia. In some patients, olaparib can cause bone marrow diseases. These diseases, Myelodysplastic Syndrome (MDS) or Acute Myeloid Leukemia (AML), can be life-threatening. Part of the intake process for the NCI clinical trial of olaparib for mesothelioma will be screening for conditions that would make you more susceptible to MDS or AML.
The researchers will inform patients of dietary recommendations while taking olaparib. Some vitamins and medicinal herbs, as well as over-the-counter medications, can interfere with the effectiveness of this cancer treatment.
If you are not a good candidate for the NCI olaparib study, there could be another mesothelioma clinical trial looking for mesothelioma patients just like you. Take a look at the clinical trial matching tool here on our website. Participating in a mesothelioma clinical trial can give you access to new treatments that aren’t yet approved, like olaparib for mesothelioma.
When you get a cold or the flu, you probably want to get in bed and stay there until you feel better. Rest and sleep are important when we are battling illnesses, including mesothelioma. But movement is also important. There are many benefits of exercise for mesothelioma patients.
You don’t have to run a marathon (but you can if you feel like it). Gentle exercise for mesothelioma patients is a vital part of your treatment plan. Best of all, your workout can be one of your most positive experiences during mesothelioma treatment.
The Upsides of Exercise for Mesothelioma Patients
It’s hard to overstate the benefits of exercise for mesothelioma patients. Getting your body moving will improve your health and well-being in a variety of ways. Here are just a few:
Reduced fatigue. It may seem counter-intuitive that exercising will make you less tired. If you’re already feeling exhausted, it’s hard to imagine that more activity will do anything but drain your already depleted reserves of energy. But it’s true: regular exercise will give you back all the energy you spend and then some. You may be more tired the first few times you exercise, but you will soon find that the heaviness of fatigue lifts. It can be hard to overcome inertia if mesothelioma has knocked you off your feet, but it gets easier each time you get up and move.
Improved mood. Depression and anxiety are common among mesothelioma patients. While counseling can be extremely helpful for these symptoms, one of the best ways to relieve depression is through exercise. The more you are able to move, the less you will feel helpless and hopeless. Exercise for mesothelioma patients can bring a sense of well-being and renewed self-esteem. Depression can feel like extreme fatigue; you may not want to get out of bed or up off the couch. But once you do, you’ll find your mood improves.
Protection against muscle wasting. During chemotherapy, many mesothelioma patients find it hard to keep down food. Weight loss is common; for some people, this includes wasting away of muscle tissue. Muscle wasting complicates recovery and can worsen your prognosis. If you can keep moving during and after chemotherapy, you get the blood flowing to your muscles and help keep them – and you – healthy.
More appetite, less nausea. Chemotherapy can take a toll on your digestive tract. Exercise may help reduce the nausea that sometimes accompanies mesothelioma chemotherapy and increase your appetite, so you are able to maintain a healthy weight and keep yourself strong.
Reduced risk of other illnesses, such as heart disease and diabetes. Exercise is at the top of the list of ways to prevent common, chronic diseases like diabetes and heart disease. These and other illnesses can complicate your mesothelioma treatment.
Additional health benefits of exercise for mesothelioma patients. When you are inactive, you can become wobbly and more prone to falling. A fall can lead to a broken bone and more time in the hospital. Exercise will improve your balance and help you build muscles that are strong enough to keep you upright. Your lymphatic system, which carries wastes away from your cells, is an important part of your immune system. Your body doesn’t have a pump to move lymph the way your heart pumps blood; lymph relies on your movement. Every time you swing your arms or move your legs, you help your lymphatic system do its job. Each movement improves your overall health and helps you fight mesothelioma.
These are just a few of the ways that exercise for mesothelioma patients can lead to better health, which is even more important during cancer treatment than before.
Best Forms of Exercise for Mesothelioma Patients
People who are in good physical shape tend to be more resilient when faced with a serious illness like mesothelioma. But you can benefit from exercise even if you were a couch potato before you became ill.
Here are four tips for exercise for mesothelioma patients, to help you build your strength and feel better.
Pick your favorite exercise.
If you enjoyed swimming before your mesothelioma diagnosis, find a pool with a walking lane where you can get back in the water. If you were a runner, put on your running shoes and get outside. If you love to dance, play some of your favorite music and shimmy! Any exercise that you enjoy will be beneficial, as long as you respect your physical limitations and take it easy at first.
If you didn’t exercise much or at all before mesothelioma, try a few different things to see what you like. Many cancer patients benefit from a gentle yoga class or tai chi. Simply getting up and walking can be great exercise for mesothelioma patients.
If you’re in the thick of mesothelioma treatment, you may feel like you can’t move at all, but there’s almost always something you can do. Flex your feet and hands while you’re lying down. Get a squishy ball and squeeze it. Practice standing up and sitting back down a few times.
Do one movement the first day and two movements the next. Build slowly. It may seem like so little that it’s not really exercise, but you will surprise yourself with how much stronger you feel, one baby step at a time.
Stick to it.
The results from exercise for mesothelioma patients don’t happen overnight. You might feel no different at first and wonder why you are putting in the effort. If you stick with it and increase slowly, however, you will wake up one day and realize that you have more energy and vitality.
Celebrate tiny victories.
Every day that you are able to exercise is a victory. If you could only walk across your living room at first, celebrate the day you feel strong enough to go outside. Celebrate the day you make it around the block, the day you don’t need a cane, the day you can make it to a nearby park. You’re not in training for a marathon but for something much more important: you’re fortifying your body to stand up to mesothelioma.
Cautions about Exercise for Mesothelioma Patients
Exercise provides many benefits for mesothelioma patients, but there are risks if you overdo it. When you are in recovery from surgery, follow your doctor’s orders on what kinds of movement you can and can’t do. Don’t do anything that overtaxes your energy or puts you in danger of getting injured.
The key to exercise for mesothelioma patients is to listen to your doctors and to your body. Do what you can and don’t judge yourself. Every time you move your body, you’re improving your survival time.
Elisabetta Casalone from the University of Turin in Italy presents the abstract developed by her team at iMig 2018 in Ottawa, Canada.
One of the complicating factors for many mesothelioma patients is that this rare and life-threatening form of cancer is difficult to diagnose. This can leave mesothelioma undetected until it has progressed to a later stage, when it is harder to treat. The symptoms of pleural mesothelioma overlap with other, more common illnesses, including lung cancer and pneumonia. To combat this problem, researchers in Italy are studying samples from pleural mesothelioma patients to develop a set of mesothelioma biomarkers that can be used for early diagnosis.
The study on mesothelioma biomarkers is only one of dozens of pieces of mesothelioma research presented at the biennial conference of the International Mesothelioma Interest Group (iMig) this year in Ottawa, Canada. Mesothelioma Circle is highlighting studies that received the Young Investigators Awards at this year’s conference, including this attempt to identify mesothelioma biomarkers.
New Research on Mesothelioma Biomarkers
A large team of Italian researchers, led by Elisabetta Casalone of the University of Turin, has given themselves a challenge: review serum samples from people who have been exposed to asbestos and see if there’s a difference between those who have developed pleural mesothelioma and those who are cancer-free. If they can find and verify a set of mesothelioma biomarkers that are different from biomarkers found in people without cancer, the scientists will use this as a basis for an early test for pleural mesothelioma.
Italy has an unfortunate relationship with mesothelioma. The country was home to the largest asbestos mine in Europe, the Balangero mine near Turin. Italy records over one thousand mesothelioma diagnoses every year, even though the country’s population is less than 60 million. The US sees about three times as many new mesothelioma cases per year, but our population is more than five times as large.
The chrysotile form of this deadly mineral that was produced at the Balangero site has proven particularly toxic to humans. Researchers have found that miners at the site experienced a significant rate of mesothelioma and other asbestos-caused cancers. Italy banned asbestos in the early 1990s, but, for the people who live near and worked in the asbestos mines, the danger is not over.
The Italian research team used massive parallel sequencing (MPS), a technique to efficiently sequence the microRNA(miRNA) from 30 pleural mesothelioma patients and 30 healthy participants. MiRNA is a type of RNA that doesn’t create proteins (as many RNA molecules do) but is used to regulate the expression of certain genes. This can include silencing (shutting genes down) or activation. These tiny bits of RNA could hold a key to turning on or off genes that clear the way for cancer cells to grow unchecked. The search for mesothelioma biomarkers is part of a larger trend in cancer research to find the molecular and cellular characteristics that cause one person to develop cancer while another, with the same environmental exposure, does not.
The team discovered a difference in two places: miRNA -126 was downregulated (the serum contained less of this RNA than normal) and miRNA-197 was upregulated (found in larger than expected amounts) in patients with pleural mesothelioma.
This promising research is just beginning. The team from Italy plans to study samples from the European Prospective Investigation into Cancer and Nutrition (EPIC). EPIC is a long-term study that started in 1992 and includes more than half a million participants. The study has collected serum samples, which the Italian researchers will sequence to determine if their initial assumptions about mesothelioma biomarkers hold true in a larger sample.
Diagnostic Tools for Pleural Mesothelioma
As any mesothelioma patient knows, pleural mesothelioma is not an easy disease to diagnose. Your doctor must first rule out more common and likely causes for symptoms such as a persistent cough, pleural effusion (fluid buildup), shortness of breath, unusual tiredness, or a low fever. Mesothelioma may be misdiagnosed at first. Sometimes it’s only after treatment for another illness fails that doctors investigate further and discover mesothelioma.
If you know you worked or lived around asbestos dust, you and your doctor can both be vigilant for signs of mesothelioma. But many people who were exposed to toxic asbestos aren’t aware of it since employers didn’t warn their employees or provide proper protection. Your exposure might have happened decades ago, and it may be hard to even remember the kinds of products you handled at a work site in your distant past.
An early step in diagnosis is to draw a serum sample from the fluid buildup caused by mesothelioma. This can also relieve the pressure of the excess fluid in the lining around your lungs. There are rarely enough cancer cells in this fluid to determine if you have pleural mesothelioma. In most cases, your doctor will have to perform a more invasive excisional biopsy. This takes a tissue sample from your tumor, which is then examined by a pathologist, to get a definitive mesothelioma diagnosis.
If the Italian research team is able to find a set of mesothelioma biomarkers, your doctor could run a test on a simple serum sample. This test will be less expensive and less invasive than a biopsy. If the test has a high rate of accuracy, it might eliminate the need to perform an invasive biopsy to get a mesothelioma diagnosis.
The Importance of Early Mesothelioma Diagnosis
The more scientists learn about mesothelioma biomarkers, the closer we get to a system of early detection. This would be particularly useful in Italy, with its high rate of asbestos exposure and resulting mesothelioma cases.
Imagine a world where every person with a history of asbestos exposure could take a simple annual test to check for mesothelioma. The test might uncover the disease at the very earliest stages, even before symptoms have developed.
As with all forms of cancer, early detection allows for a broader range of mesothelioma treatment options and better outcomes from treatment. Even if mesothelioma biomarkers and early detection don’t lead to a mesothelioma cure, they could significantly increase the survival time for mesothelioma patients. A biomarker generally refers to a measurable indicator of some biological state or condition.
Mesothelioma Biomarkers Study Wins Young Investigator Award
The search for mesothelioma biomarkers was one of several promising studies singled out for a Young Investigator Award at the 14th International Conference of iMig 2018. Kazan Law, which sponsors the Mesothelioma Circle website, also provides sponsorship for these awards.
Mesothelioma usually shows up in the later years of life because this cancer takes so long to develop. But young researchers who are just beginning their scientific careers can make significant contributions to our understanding of this life-threatening cancer. The Young Investigator Awards recognize this new generation of creative scientists who are working toward better outcomes for mesothelioma patients.
Scientists are known for being cautious. They validate their results before going public with their research. They are wary of making promises they can’t keep. So you know that, when Laszlo G. Radvanyi of the Ontario Institute for Cancer Research calls immunotherapy clinical trial results “unprecedented” and states that this may lead to a “revolution” in cancer treatment, the research has found something big.
The immunotherapy clinical trial results that got Dr. Radvanyi excited were for just one patient. Her recovery from late-stage metastatic breast cancer was so dramatic that researchers from the National Cancer Institute published an account of her recovery in Nature Medicine.
Their article, “Immune recognition of somatic mutations leading to complete durable regression in metastatic breast cancer,” told the amazing story of Judy Perkins, a patient whose breast cancer returned 10 years after her first diagnosis, and with a vengeance.
After chemo failed her, Perkins knew that an immunotherapy clinical trial was her only hope – and a slim one. She realized that, even if she was able to enroll in a study, her chances of survival were low.
Judy Perkins has been declared cancer-free. She felt so good recently that she went on a 1,200-mile kayak race. Her story has electrified the cancer community.
Immunotherapy Clinical Trial Gives a Lifeline Terminal Cancer Patient
Judy Perkins was just 38 years old when she received her first cancer diagnosis. Her breast cancer was at Stage 0 or precancerous. She had surgery and then went on with her life, happy that early detection had kept the tumor from developing into cancer.
When she later discovered a lump near where her left breast had been before her mastectomy, the news was bad: far from being cured, her breast cancer had metastasized, quietly advancing to Stage IV by the time she found the lump, at age 47.
Perkins was told she had three years to live. She started chemotherapy and hormone therapy, hoping for some relief, and took bucket-list trips with her family. Meanwhile, tumors grew on her liver and under her ribcage. Eventually, one tumor pressed on a nerve in her chest with such force that she was in nearly constant pain.
Two years after her terminal diagnosis, Judy Perkins crept through each day, barely able to function, preparing for the end she thought was inevitable and imminent. She had only one hope left: an immunotherapy clinical trial that she had found and enrolled in, conducted by the National Cancer Institute (NCI).
Adoptive Cell Transfer Provides Astounding Results
The immunotherapy clinical trial extracted tumor-infiltrating lymphocytes (TILs), a type of white blood cell that fights tumors, from Perkins. The NCI researchers grew more TILs in the lab – as many as 90 billion of them.
The scientists didn’t grow just any TILs. They chose the cells that were most finely-tuned to fight her tumors. Then they reinjected this immune fighting force back into her body and waited to see the result.
At first, the immunotherapy clinical trial wore Perkins out. She had to deal with pain, exhaustion, and other unpleasant side effects. But something else was happening with her body, too. The nerve pain started to ease; the tumor that pressed on it was shrinking. Within a few weeks, the pain disappeared.
A tumor that had become visible, sticking out of her chest, also receded. She went off pain medication. Within a short time, the tumors disappeared completely. The TILs in her system had not only attacked her cancer; they had multiplied, providing her with a targeted immune response that eradicated her tumors in a way conventional treatment could not.
Between the start of the immunotherapy clinical trial until after treatment, Judy Perkins went from the struggle of end-stage cancer to a new lease on life. It took her some time to regain the strength she had before cancer knocked her off her feet, but she’s now back out hiking and doing the activities she has always loved, thanks to an immunotherapy clinical trial with results that are nothing short of a miracle.
What Does this Immunotherapy Clinical Trial Mean for Mesothelioma Patients?
The TIL immunotherapy that cured Perkins’ metastatic breast cancer has also been used successfully on patients with metastatic cancer that originated in the colon, cervix, and bile ducts. But Steven A. Rosenberg, a lead NCI researcher on this immunotherapy clinical trial, told Forbes that he thinks this technique has the potential to help any kind of advanced cancer. That is promising news for mesothelioma patients.
This study shows that cancers with multiple mutations may be good candidates for certain types of immunotherapy. Since mesothelioma typically stems from several genetic mutations, this could be a positive sign for future mesothelioma treatment.
When cancer metastasizes, the mutated cells migrate from the site of the original tumor and form new tumors in other parts of the body. Metastatic cancer is much harder to treat than cancer confined to the site of the original tumor. Many mesothelioma treatments focus on containment to prevent metastases and increase the survival time of patients.
This new immunotherapy clinical trial provides hope for patients with late stage and metastatic cancers. This is particularly important for mesothelioma patients. Because mesothelioma takes so long to develop and because the symptoms overlap with those of many other diseases, it can be hard to diagnose. This means that the mesothelioma cancer has often progressed to a later stage by the time of diagnosis. More treatment options for late stage cancer means more hope for mesothelioma patients.
This study does come with some caveats. While Perkins’ recovery was dramatic, two other patients whom she referred to the immunotherapy clinical trial did not survive. Checkpoint inhibitor immunotherapy drugs like Keytruda and Opdivo provide dramatic results for some cancer patients, including some mesothelioma patients, but many patients do not yet get relief from these treatments.
In addition, TIL treatment is complicated and expensive. Not all treatment facilities currently have the ability to provide the kind of genetic sequencing required and the cost of the treatment is high.
Scientists have expressed optimism that this type of immunotherapy treatment will soon become more available, as technology and science advance. Just a few years ago, we didn’t have the tools to easily sequence DNA and RNA. As genetic sequencing speeds up, treatment of cancer mutations at the cellular level through immunotherapy becomes ever more possible. Targeted, individual treatments like the TIL therapy given to Judy Perkins may soon become attainable for a wider range of cancer patients, including mesothelioma patients.
Joining a Mesothelioma Immunotherapy Clinical Trial
There are numerous mesothelioma immunotherapy clinical trials underway. You can help advance scientific knowledge by joining one. You also have the chance to become the next mesothelioma success story.
To find out if there’s a mesothelioma clinical trial that’s right for you, use our clinical trial matching tool. The consultation is confidential, and the matching service offered by our partner, CANTRIA, is completely free.
If you are coping with mesothelioma, either as a patient or a caregiver, you know the daily challenges of dealing with the physical symptoms of this serious cancer and the side effects of mesothelioma treatment. Coping with mesothelioma takes an emotional toll as well; many patients grapple with anxiety and depression.
Numerous studies have shown that one thing that often helps relieve both the physical and emotional pain of a mesothelioma diagnosis: spirituality. You don’t have to be religious to find relief in spiritual practices when you are coping with mesothelioma.
What Are Spiritual Practices?
Spirituality can overlap with religion, but it’s not the same. Spiritual practices are anything that brings serenity and peace into your life.
For many people, their religious practice is deeply spiritual. For others, being in nature, meditating, creating art, singing, or doing yoga may give a feeling of connection to forces larger than themselves.
Spirituality is a sense of belonging in the world, of being connected to others, cared for by a greater wisdom. You may find this place of comfort in church or in a forest – or both.
Challenges in Coping with Mesothelioma
Coping with mesothelioma can be a challenge to your spirituality. You may be angry at God. You might feel abandoned and unprotected. This is an understandable reaction to the shock of a mesothelioma diagnosis. For many, however, the illness ultimately drives them to seek out a new spirituality or connect more strongly with their current spiritual practices.
Fear, anxiety, and depression are common among mesothelioma patients and their caregivers. It’s understandable, even natural, to experience some emotional distress when you are dealing with a health crisis.
How you cope with these challenges could affect your mesothelioma prognosis. Emotional stress gets in the way of your body’s natural healing powers, so it’s important to find ways to support your emotional health. Spiritual practices can provide this support.
Studies have shown that cancer patients with a strong sense of spirituality often have better outcomes than those who do not feel that connection. Spiritual practices have been shown to lead to better emotional and physical health in those coping with a cancer diagnosis and treatment.
Research has also shown that, while many cancer patients would like spiritual care to be integrated with their medical care, most medical professionals don’t provide enough support in this area. Don’t be afraid to bring up the topic. Ask your doctor or nurse for the resources you need to support your spiritual practices when you are in the hospital or in a rehab facility.
Find a way to continue spiritual practices that are meaningful to you no matter where your mesothelioma treatment takes you. Spirituality can go with you everywhere, even into the sterile setting of a medical building.
Spiritual Suggestions for Coping with Mesothelioma
You may not think of yourself as a spiritual person. That doesn’t mean you can’t adopt soothing spiritual practices to help while you are coping with mesothelioma. Whether you go to church every Sunday or are a confirmed atheist, consider trying one or more of these spiritual practices (or others that you think of). It could improve your outlook and your outcomes.
Talk to a spiritual counselor.
Talk with a chaplain or other spiritual counselor. If you aren’t able to speak with someone from your own religious tradition, have a conversation with someone from a different faith. Chances are that the counselor will be able to provide you with compassion and support on your journey to spiritual healing. You may be surprised by what you learn from a spiritual or religious counselor, even one who does not share your faith.
Go on a nature pilgrimage.
Do you remember the joyful feeling of a sunrise over the lake where you spent childhood summers? Does your heart sing when your feet crunch across the twigs in your favorite forest? These are spiritual experiences and that can provide a space of peace for you while you are coping with mesothelioma.
You could travel to a special place where you have had spiritual experiences in the past. Or you might find spirituality in a city park or your own back yard, or all of the above. Natural beauty has a great power to soothe and heal.
Go to church.
Perhaps you have fallen away from your religious practice. You might find spiritual relief in rediscovering your religion. Or you might appreciate the spiritual practices and wisdom found in a new congregation – or several.
If you’re having a hard time finding the spirituality in religion to help you cope with mesothelioma, become exploratory. Try out different religious practices until you find one that speaks to you. The spiritual relief found in places of worship can make coping with mesothelioma much easier to bear.
Try meditation or prayer.
Studies show that meditation can calm your brain and boost your immune response. It helps improve your mood, relieving depression and worry. Meditating can help you feel physical pain less sharply.
If you have a hard time getting yourself to meditate, try taking a class. Some people find it easier to meditate in a room with others; you might be able attend group meditations at a meditation center.
If meditation is not for you, try prayer. Prayer may provide many of the same health benefits as meditation.
And, of course, feel free to take up both of these healing spiritual practices.
Make music. Listen to music.
Many people find spiritual support in singing or playing an instrument. If you have a tin ear but you love music, go to a concert or simply put on the headphones and you’re your favorite music sweep over you. Music can provide wonderful spiritual healing.
Make art. Surround yourself with art.
As with music, many people find healing in visual art. Playing with paints or clay, woodworking or collage can all be spiritual practices. Treat yourself to an art class or simply paint for the fun of it at home.
Being around art created by others can also be healing. Allow yourself time to sit in a museum gallery and gaze at a painting that lifts your heart.
7. Try a yoga class.
Many people find spirituality in movement. Walking, swimming, dance, or other movement can be spiritual practices.
If coping with mesothelioma has impaired your ability to move, find a gentle yoga class and a teacher who will tailor the poses to your physical ability. Many yoga classes include a spiritual component. There are also other types of gentle movement that include spiritual practices, such as tai chi and qigong.
Choose one of these spiritual practices that speaks to you or try all of them. Whether you are the patient or the caregiver, coping with mesothelioma will be one of the hardest things you do in your life. Spirituality can help ease that burden and keep joy and hope alive in your heart during this difficult time.
Rachael Zemek from the University of Western Australia in Australia presents her team’s abstract to a group at iMig 2018 in Ottawa, Canada.
Much recent research on how to stop a mesothelioma tumor, as well as other types of cancer with poor prognoses, has focused on immunotherapy. At present, mesothelioma immunotherapy treatments only help a small number of patients. But the result for those patients is so remarkable that scientists are scrambling to understand how to harness the power of immunotherapy to help more mesothelioma patients.
A study that generated excitement at the 14th International Conference of the International Mesothelioma Group (iMig) looked at why one mesothelioma tumor will respond to immunotherapy treatment and another won’t. The answer to this question could provide a blueprint for pre-treatment to improve the effectiveness of mesothelioma immunotherapy.
Research on Mesothelioma Tumor Microenvironment
A group of researchers led by Rachael Zemek from the University of Western Australia in Australia gave themselves an ambitious goal: create a controlled environment to grow cancerous tumors in a line of mice that are genetically identical. They needed this control because they wanted to explore whether differences in the microenvironment around a mesothelioma tumor affected its response to a checkpoint blocking immunotherapy drug. They had to rule out other differences in the mice and the tumors to isolate the key biomarkers.
The study is very technical; here are some definitions to help you understand it.
Checkpoint blocker: Your immune system is capable of killing off damaged and diseased cells, including cancer cells. A complex environment of proteins regulates your immune system. Cancerous tumors manipulate these proteins to avoid a lethal response from your immune system. Mutations can alter immune pathways and allow a mesothelioma tumor to grow freely because it is invisible to the immune system. Immunotherapy drugs that overcome this cancer mechanism are called checkpoint blockers. The general term for this immunotherapy technique is immune checkpoint blockade (ICPB).
PD-L1: PD-L1 stands for programmed death ligand 1. PD-L1 is a protein that, when it is doing its job correctly, turns down your immune system at times when your normal immune response would cause harm. PD-L1 is the reason that a pregnant mother’s immune system doesn’t attack her fetus as a foreign body. Some cancer cells have evolved a mechanism to increase the amount of PD-L1, thus turning away the killer T cells that would normally find and kill them.
PD-1: Programmed cell death protein or PD-1 tones down immune response to keep inflammation in check and prevent autoimmune responses (where your immune system believes your healthy cells are diseased and attacks them). As the name suggests, PD-1 also promotes the cycle of cell death that is necessary to our health. PD-1 is overexpressed in some cancerous tumors, causing the immune system to stand down when it should be on guard against dangerous cancer cells.
CTLA4: Shorthand for cluster of differentiation 152, CTLA4 is a segment of a T cell that bonds with proteins that suppress immune response. Cancerous cells sometimes cause an overabundance of CTLA4, thus reducing your immune response to the cancer.
The researchers used ICPB treatments that target the PD-L1, PD-1, and CTLA4 pathways. They looked deep into the microenvironment around the mesothelioma tumor to find biomarkers associated with how each tumor responded to mesothelioma treatment.
If this research opens the door to more effective immunotherapy, it’s hard to overstate its importance. Like all avenues of scientific inquiry, however, the outcome is uncertain. Even if this study doesn’t lead to mesothelioma immunotherapy pre-treatment, it’s certain that other researchers are asking similar questions, and someone will find an answer – though perhaps not as quickly as mesothelioma families would like.
Mesothelioma Tumor Response to Immunotherapy
You may have heard stories about a few mesothelioma patients who have had amazing success with checkpoint blocking immunotherapy drugs like Keytruda. There are cases where a patient’s mesothelioma tumor has shrunk to the point where the cancer has gone into remission. This is unprecedented for mesothelioma and it has, rightly, generated a lot of excitement in the mesothelioma community.
The problem is that, for many mesothelioma patients, immunotherapy drugs are either not very effective or not at all effective. While the treatment uses the power of your own immune system and can be less harsh than chemotherapy drugs, some people experience very unpleasant side effects when the drugs send their immune systems into overdrive.
The question that no one yet knows the answer to is why a few patients respond so well to immunotherapy drugs while others aren’t helped at all. The answer isn’t necessarily to match immunotherapy treatments to the precise gene mutations that they target; there have been surprising recoveries in some patients without those mutations.
The research presented by the Australian team at iMig represents an innovative approach to this problem. If they successfully identify biomarkers in the microenvironment around the mesothelioma tumor that predict whether a tumor will respond to checkpoint blocking immunotherapy drugs, their study will pave the way for more effective immunotherapy.
Is this the Next Mesothelioma Breakthrough?
This study of the mesothelioma tumor microenvironment could have a big impact on mesothelioma treatment. The Australian researchers were able to identify differences in the mouse tumors, even though the tumors had all been generated from the same cell line.
The scientists were able to divide the tumor microenvironment into two distinct categories. The tumors that responded to checkpoint blockers all fell into one category; the tumors that didn’t respond all fell into the other. They reported that their result matches data from human patients who have been treated with antibodies to PD-1.
After identifying the biomarkers for responsiveness, the researchers were able to use drugs to turn on the helpful genes. This led to a better response to immunotherapy in the mouse tumors.
The Australian study found a gene signature that led to positive response to immunotherapy treatment. This can potentially be used to understand which mesothelioma patients are most likely to benefit from these treatments. It could also lead to the development of a two-part treatment: first, alter the microenvironment to be more receptive, then administer immunotherapy.
Important Research by Young Investigators
The iMig conference is held every two years. Each time, several studies are singled out for the Young Investigator Award. The Australian research team received one of these awards at the 2018 conference for their exciting study in mice.
The Young Investigator Awards help promising young scientists advance their careers and their research. The awards recognize the contributions made by new scientists who may be just entering the field of mesothelioma research.
Kazan Law, the law firm that sponsors the Mesothelioma Circle blog, also sponsors the iMig Young Investigator Awards. Support of scientists and of the iMig conference is a key part of the firm’s continuing commitment to serve mesothelioma patients and their families. Until there is a cure, the fight for better mesothelioma outcomes continues.