Category: Featured News
List of Biomarkers Could Lead to Improved Diagnosis and Treatment
A biomarker is a biological molecule found in blood, tissues or other bodily fluids that indicates the presence, or in some cases, the absence, of a particular condition or disease. Biomarkers can be useful in diagnosing and treating mesothelioma, and researchers have been investing large amounts of time and money into this research. Now, thanks to a team of scientists who have compiled a “list of relevant cancer blood biomarkers,” diagnosing and treating mesothelioma patients may soon be easier.
According to an Aug. 1 press release from the University of Sheffield, the scientists, led by Dr. Lesley Uttley, from the University of Sheffield’s School of Health and Related Research, created a comprehensive list of 778 biomarkers that are targets of cancer research. The list, gleaned from over 19,000 scientific studies, could be used to “develop an early stage cancer screening test for the general population.”
“Because of the sheer number of publications in this field, previous reviews have only been able to look at one biomarker or a small group of biomarkers,” said Dr. Uttley. “Our data mining approach allowed us to take in all relevant research findings from the five-year period, which meant we could map the full range of potential blood-based biomarkers that are particularly relevant for early detection of cancer.”
The list that the researchers compiled will be grouped by molecular function as well as including information about the tests and technologies that currently exist to detect the biomarkers. Next, the researchers will group the biomarkers by cancer type, and assess each biomarker and ensure that it “could feasibly be used as part of a screening test.”
Finally, the validated biomarkers will be used in clinical trials to determine how effectively they identify the presence of cancer, and to assess whether the screening tests work effectively and are cost-effective. Prior to the start of the clinical trials, the list will be whittled down to close to 50 biomarkers. The expectation is that this process could take between six and eight years.
“Our vision is that the screen will pick up even the small amounts of these biomarkers that might be in the blood at an early stage of the cancer, without necessarily identifying which cancer they relate to,” said Professor Ian Cree, Early Cancer Detection Consortium Director and Molecular Pathologist at University Hospitals Coventry and Warwickshire NHS Trust. “Patients would then be referred for more specific tests, that could narrow down the tumour type.”
Pleural mesothelioma is a serious cancer caused by breathing in asbestos fibers that then become lodged in the thin membrane that lines and encases the lungs. With no known cure for mesothelioma, an emphasis is placed on early detection and personalized treatment to minimize the impact of this deadly disease on those at-risk.
A reliable method of screening people who have been exposed to asbestos and detecting mesothelioma at an early stage would improve treatment options for patients and improve their quality of life while battling the cancer.
Personalized care targeted to a patient’s unique mesothelioma characteristics optimizes the potential for success of the treatment and offers treatment options that may not otherwise have been considered. Mesothelioma treatments can differ dramatically across patients, and patient-centric treatment that targets the individual’s unique disease characteristics offers the right treatment at the right time.
“Biomarkers play a critical role in improving the drug development process as well as in the larger biomedical research enterprise,” according to a 2011 article from the National Institutes of Health. “Understanding the relationship between measurable biological processes and clinical outcomes is vital to expanding our arsenal of treatments for all diseases, and for deepening our understanding of normal, healthy physiology. “
Mesothelioma Community Will Benefit from Precision Medicine Initiative
In October, Mesothelioma Help presented the National Institute of Health’s plan to fund and manage President Obama’s Precision Medicine Initiative. Now, 18 months after the President made bringing personalized health care to all Americans a focus, the White House has announced “new investments, partnerships, and policies that aim to bring us significantly closer to our goal” of fully utilizing technology and people. The mesothelioma community is watching this initiative geared towards ensuring U.S. patients get the treatments that will work best for them.
Mesothelioma is an asbestos-caused cancer that has few treatment options. However, recent research has turned the focus to personalized care and looking at the disease characteristics as opposed to using the most commonly used treatment protocol. Research has shown this is the best way to increase the survival for patients. This program will help bring tools and technology needed to help researchers continue down this path.
In a July 6 press release from the White House, the three key investments in the Precision Medicine Initiative (PMI) are:
- $55 million from the National Institutes of Health (NIH) to recruit the volunteers needed for the PMI Cohort Program;
http://www.nimh.nih.gov/health/topics/depression/index.shtml - A U.S. Food and Drug Administration proposal to streamline its oversight of genomic tests; and,
- Development of appropriate tools for researchers to access data.
PMI Cohort Program Gets Boost from Veterans
The ultimate goal of the PMI project is to create a database, through the PMI Cohort Program, containing genetic information, biological samples, and dietary and lifestyle information of one million Americans who volunteer to share this information and, potentially, their electronic health records. The $55 million is ear-marked to help health care provider organizations, technology developers, and community health centers launch the steps needed to recruit volunteers. This information will be used to “lay scientific foundation for precision medicine for many diseases,” according to the NIH.
Nearly 3,000 Americans are diagnosed with mesothelioma each year, and of those, one-third are military veterans. Although many veterans are unaware of this statistic that is a result of their years of service, many have stepped up to the plate once again to help their fellow Americans by allowing science to explore their medical data. As part of the PMI Cohort Program, the VA is partnering with the NIH to help enroll the nearly 500,000 who donated data to the Million Veteran Program, a VA-backed program similar to PMI’s, directly into the PMI Cohort Program and to share the VA’s successes.
Genetic Testing Offers Mesothelioma Patients A Chance at Increased Survival
Personalized medicine is considered the wave of the future, and one of the best ways to combat mesothelioma. Tailored care ensures a mesothelioma patient’s unique disease characteristics, including the cancer’s genetic makeup, are targeted when being treated, thus optimizing the potential for success of the treatment.
The FDA shoulders the responsibility of approving medical tests that identify specific biomarkers, such as the EGFR biomarker often targeted in mesothelioma, to support personalized care. Under the PMI, the FDA is developing “a flexible yet accountable approach to oversight of genomic technologies.” In addition, it will offer a platform and guidelines for researchers to compare the accuracy of their DNA sequencing tests.
“These new policies will make it easier for developers to market safe and effective genomic tests by relying on community-based standards and well-established sources of scientific evidence that meet appropriate standards,” according to the press release.
To find out more about the Precision Health Initiative visit the National Institutes of Health website.
Photo Credit: NCI
Dr. Anne Tsao Shares Her Knowledge Through Online Curriculum
Anne Tsao, M.D., Director of the Mesothelioma Program and the Thoracic Chemo-Radiation Program at The University of Texas MD Anderson Cancer Center, is one of the leading authorities of mesothelioma in the United States, and she is also one of the strongest advocates for taking a personalized treatment approach to mesothelioma. She has treated hundreds of patients using the latest, targeted treatments available. Now, Dr. Tsao is sharing her knowledge of mesothelioma as a guest faculty member with Clinical Care Options.
Through Clinical Care Options online curriculum, Dr. Tsao discusses “current best practices and provides her perspective on the latest clinical trial data for the treatment of mesothelioma.” The program, targeted to physicians and other healthcare professionals who provide medical care to mesothelioma patients, has a goal “to improve participants’ ability to provide medical care for patients with mesothelioma and understand the significance of ongoing clinical research in this area.”
The online class walks the student through the diagnostic options, compares and contrasts the various chemotherapy options, highlights the latest mesothelioma treatment breakthroughs and provides updates on the latest mesothelioma clinical trials. The student’s knowledge is tested through several multiple choice questions.
“This is a very exciting time with many developments for mesothelioma care,” concludes Dr. Tsao. “We still need to identify prognostic and predictive biomarkers and use these to design our future targeted therapy trials,” and “we need to identify mechanisms for drug resistance by designing our trials to include biopsies at different time points during therapy,” adds Dr. Tsao.
About MD Anderson’s Mesothelioma Program
Mesothelioma is a rare form of cancer caused by past exposure to airborne asbestos fibers. The cancer is highly aggressive and is resistant to many current treatments. Just 3,000 Americans are diagnosed with mesothelioma each year.
Due to mesothelioma’s relative rarity among the general population, it is recommended that mesothelioma be treated by a team of doctors and surgeons led by a mesothelioma specialist rather than by one primary physician. Mesothelioma specialists are aware of the latest research, and they are able to develop a more informed treatment plan than would a physician who does not specialize in the disease.
“Because MD Anderson’s Thoracic Center cares for more patients with mesothelioma than almost any other center in the United States, you can be sure you are being cared for by renowned physicians with the highest levels of experience and skill,” as noted on MD Anderson’s website.
The Center’s Mesothelioma Program is comprised of a team of more than 30 experts representing medical oncologists, surgeons, radiation oncologists, pulmonologists and pathologists who work closely together to customize the best treatment for each patient. Everyone on the team is considered an expert in their field and in mesothelioma.
“This program not only has the clinical arm where we treat the patients, but it also has the clinical research program that offers clinical trials for every single setting for our patients,” said Dr. Tsao in a 2009 podcast for MD Anderson about new advances in mesothelioma. It also has a translational research program making it “one of the very few centers in the world that has such a comprehensive program.”
To find out more about Dr. Tsao and her research on mesothelioma see MD Anderson’s website.
IMPRINT May Lead to A “New Lung-Sparing Treatment Paradigm”
MesotheliomaHelp has recently reported on two studies showing the benefits of pleurectomy/decortication (P/D) over extrapleural pneumonectomy (EPP) for mesothelioma patients. Now, researchers report that following the surgery with chemotherapy and a novel radiation therapy is safe and resulted in a reduced rate of radiation pneumonitis.
Researchers from Memorial Sloan Kettering Cancer Center and MD Anderson tested a newly developed hemithoracic intensity-modulated pleural radiation therapy (IMPRINT) in a clinical trial of 27 mesothelioma patients who had undergone P/D and chemotherapy. The radiation therapy specifically targets the lining of the lung, where the mesothelioma cells are, and reduces the risk of damaging the lung itself.
The median progression-free survival and overall survival were 12.4 and 23.7 months, respectively. In addition, the two-year overall survival was 59% in patients with resectable tumors and was 25% in patients with unresectable tumors. Only eight patients developed radiation pneumonitis (grade 2 or 3) and all of them recovered after a dose of steroids.
“These results justify our next multicenter trial to explore the safety and feasibility of hemithoracic pleural intensity-modulated radiation therapy” in more medical centers with experience with this malignancy, the authors wrote, according to a June 21 article in Cancer Network.
Radiation therapy is one of the primary treatments for pleural mesothelioma, an asbestos-caused cancer of the lining of the lungs. However, due to the complex growth pattern of the mesothelioma cancer cells targeting just the diseased cells is difficult. Some oncologists shy away from it since radiation can sometimes be too damaging to surrounding organs, as well as causing damage to the lung (pneumonitis).
The researchers noted that the new technique using IMPRINT “has a significant learning curve, and thus should be exported to other centers slowly and carefully.”
P/D strips away the diseased membrane lining the lung and visible mesothelioma tumors, but spares the lung. The other surgical option for pleural mesothelioma patients is the EPP, a more radical procedure that involves removal of a lung, the diseased lining of the chest cavity and heart, and a portion of the diaphragm.
The researchers concluded that incorporating IMPRINT “with chemotherapy and P/D forms a new lung-sparing treatment paradigm for patients with locally advanced MPM [malignant pleural mesothelioma].”
Over 3,000 Americans are diagnosed with mesothelioma each year.
The study can be found in the Journal of Clinical Oncology.
To find out more about the clinical trial see ClinicalTrials.gov.
Researchers Report Activin A May Be A Significant Biomarker
Mesothelioma researchers have focused much of their efforts on developing targeted cancer treatments that center on getting to the specific gene or biomarker responsible for the disease. An alphabet soup of biomarkers, including Abcc10, VEGF, and PD-L1, that indicate mesothelioma, have been used to develop cancer treatments to fight the deadly disease. Now, researchers report that activin A is another biomarker that should be targeted when treating mesothelioma patients.
An international team of researchers, led by a group from the Comprehensive Cancer Center of Vienna, Austria, believe activin A, a biomarker that regulates cell growth and activates cell differentiation, could be a prognostic marker of mesothelioma, according to a June 8 article in the European Journal of Cancer. The researchers found that activin A was “significantly elevated in MPM [malignant pleural mesothelioma] patients.”
Pleural mesothelioma is an incurable, asbestos-caused cancer that attacks the pleural tissue surrounding the lung. The cancer is highly aggressive and is resistant to many cancer treatments making it a difficult disease to treat effectively. Biomarkers, or genetic indicators of the presence of disease, such as mesothelioma, can also be used to determine the severity of the disease, such as in a prognostic biomarker, and to assess the efficacy of a treatment. The findings by these researchers of the significance of activin A can guide medical professionals in the care of mesothelioma patients.
The highlights of the study, as noted by the authors who looked at data of 129 mesothelioma patients, include:
- Plasma activin A levels are increased in malignant pleural mesothelioma (MPM) patients.
- Increased levels associated with non-epithelioid morphology and high tumour volume.
- Plasma activin A level was an independent prognostic factor in MPM patients below 66 years of age with an epithelioid histology.
Research has shown that epithelioid mesothelioma is the most common type of mesothelioma, accounting for nearly 75 percent of all new cases. A study published in the September 2000 respiratory medicine journal Thorax determined that epithelioid mesothelioma patients had a better prognosis than those diagnosed with sarcomatoid or biphasic mesothelioma.
“Our findings suggest that the measurement of circulating activin A may support the histological classification of MPM and at the same time help to identify epithelioid MPM patients with poor prognosis,” concluded the researchers.
Results of the study can be found in the June 8 issue of the European Journal of Cancer.
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