Category: Featured News

“Lung Decision Precision” Screening Tool May Lead to Early Detection of Mesothelioma

• Lisa Hyde-Barrett
• Asbestos Exposure, Featured News, Mesothelioma Diagnosis

The key to increased life expectancy when battling lung cancer, and other extremely aggressive cancers such as mesothelioma, is early detection. Unfortunately, while there are standard screening tests and guidelines for breast cancer, colon, and prostate cancer, lung cancer screening tests are limited to high risk patients, defined as life-long heavy smokers. Now, researchers have developed a personalized lung cancer screening decision tool which incorporates past asbestos exposure as a criteria to guide individuals and physicians in determining their lung cancer screening options.

Researchers from the University of Michigan have unveiled a lung cancer screening Q&A tool that can be used by medical professionals to identify people who may benefit from a low-dose computed tomography (LDCT) screening. For people who do not have any symptoms often associated with lung cancer or pleural mesothelioma, such as difficulty breathing, coughing or fatigue, there is seemingly no reason to screen for lung cancer.

That is why the personalized Lung Decision Precision tool for physicians, which presents a series of questions targeting the person’s smoking history and asbestos exposure, is important. The tool is designed to open discussion between the physician and patient to determine whether a lung screening is appropriate.

“This allows us to identify which patients are in the preference-sensitive zone for the decision about screening, and which ones have a very clear potential benefit to them,” said Tanner Caverly, M.D., M.P.H., an assistant professor in the Division of General Medicine and Department of Learning Health Sciences at the U-M Medical School.

The Lung Decision Precision Tool asks the critical question: “Has the patient been exposed to asbestos at work?” Based on a “yes” answer, the patient is asked to confirm the following:

• You worked in one or more of the following occupations: asbestos worker, insulator, lagger, plasterboard worker, dry waller, plasterer, ship scaler, ship fitter, rigger, shipyard boilermaker, shipyard welder, shipyard machinist, shipyard coppersmith, shipyard electrician, plumber/pipefitter, steamfitter, or sheet metal worker.
• You worked in this job for at least 5 years.
• You began working in this job at least 15 years ago.

Asbestos is a human carcinogen, known to cause lung cancer and pleural mesothelioma, a cancer of the lining of the lungs diagnosed in nearly 3,000 Americans each year. The U.S. Environmental Protection Agency warns that there is no safe level of exposure. In addition, the Occupational Safety and Health Administration reports, “every occupational exposure to asbestos contributes to the risk of getting an asbestos related disease.”

While no longer used in new buildings in the U.S., asbestos was added to a variety of products including insulation, steam pipes, furnace ducts, floor tiles and roofing shingles, in buildings and homes built prior to EPA regulations were put in place in the 1970’s. People who worked in construction, ship-building, plumbing and in the military are at a higher risk than others of developing mesothelioma.

The only recommended screening test for lung cancer is LDCT, according to the Centers for Disease Control and Prevention. During an LDCT an X-ray machine scans the body and uses low doses of radiation to make detailed pictures of the lungs to help find abnormal areas that may be cancer. The American Cancer Society reports that in a study of 50,000 smokers or former smokers aged 55 to 74 researchers found that people who got LDCT had a 20% lower chance of dying from lung cancer than those who got chest x-rays.

Mesothelioma is often not diagnosed until symptoms are present, and the cancer is in its late stages. At this point, prognosis is  often less than one-year. Stopping tumor growth and preventing metastasis is especially critical for mesothelioma and lung cancer where the diseases are highly aggressive. This can only be achieved if the mesothelioma cancer is detected early.

“As a clinician I’d like to have this [tool] for many of the things I do, where it would be meaningful to know how beneficial something could be for the individual patient, and we could talk about whether it’s indicated for them,” said Caverly.

The research team also launched a companion website, “Should I get screened”, for patients that includes easy-to-understand information about the pros and cons of lung cancer screening, and includes a “lung cancer risk calculator.”

If you have been exposed to asbestos in the past, talk to your doctor about the Lung Decision Precision tool.

Find out more about the tool in the May 29 issue of Annals of Internal Medicine.

Sources:

• University of Michigan
  http://ihpi.umich.edu/news/scan-or-not-scan-research-shows-how-personalize-lung-cancer-screening-decisions
• Annals of Internal Medicine
  http://annals.org/aim/article-abstract/2682684/identifying-patients-whom-lung-cancer-screening-preference-sensitive-microsimulation-study
• Lung Decision Precision tool
  https://share.lungdecisionprecision.com/
• Should I get screened
  http://www.shouldiscreen.com/
• The American Cancer Society
  https://www.cancer.org/cancer/lung-cancer/prevention-and-early-detection/early-detection.html
• Occupational Safety and Health Administration
  https://www.osha.gov/SLTC/asbestos/

Combination of Electric Fields and Chemotherapy May Be A New Treatment Option for Pleural Mesothelioma Patients

• Lisa Hyde-Barrett
• Featured News, Research, Treatments

The key to increasing  survival for mesothelioma patients is to kill the cancer cells before they can spread to other organs. Treatment options, including surgery, chemotherapy and radiation, all contribute to a patient’s survival, but many times the prognosis remains unchanged. Now, one company has turned to experimenting with delivering electromagnetic waves to the chest of pleural mesothelioma patients and reports improvements in overall survival when combined with chemotherapy.

Novocure, a UK-based medical device company that develops and markets Tumor Treating Fields delivery systems,  developed the novel devices as an alternative way to destroy tumor cells while sparing healthy tissue. Already approved by the U.S. Food and Drug Administration for the treatment of brain cancer, the  device is now in a Phase II clinical trial for pleural mesothelioma patients.

In April, researchers gave an interim review of the STELLAR clinical trial reporting that the first 42 pleural mesothelioma patients treated with the combination of Tumor Treating Fields (TTF) and pemetrexed and cisplatin or carboplatin had a one-year survival rate of 80 percent, compared to 50 percent in the chemotherapy only patients. Median progression free survival was 7.3 months versus just 5.7 months in the chemotherapy controlled group.

“We are extremely pleased with these top-line results, which bring us one step closer to realizing the potential for a new treatment for mesothelioma patients in desperate need,” said Dr. Eilon Kirson, Novocure’s Chief Science Officer and Head of Research and Development, in an April 17 press release.

The NovoTTF-100L device used in the clinical trial provides mesothelioma patients with a round-the-clock treatment option that allows them to maintain an active lifestyle without interference to activities such as walking outdoors, shopping, and cleaning. Connected to the patient via insulated electrode arrays placed on the upper torso, the device delivers low-intensity alternating electric fields to the region near the mesothelioma tumors. The TTF is inconspicuous and  light enough to carry to most functions and activities. The device needs to be active approximately 18 hours a day. According to the company’s website there are no limiting side effects.

“Mesothelioma is the first torso indication for which Novocure will pursue FDA approval,” said Dr. Kirson.

Novocure previously received a Humanitarian Use Device (HUD) designation for the use of TTF  for pleural mesothelioma. The next step is to submit a Humanitarian Device Exemption (HDE) application to the FDA. For medical devices, an HDE exempts the businesses from proving effectiveness of the device. However, the company must show that the HUD “will not expose patients to an unreasonable or significant risk of illness or injury and the probable benefit to health from use of the device outweighs the risk of injury or illness from its use, ” according to the HDE application requirements.

Pleural mesothelioma, a rare form of cancer affecting the lining of the lungs, is highly aggressive and is resistant to many cancer treatments. Most often diagnoses are not made until symptoms appear and the disease has progressed to an advanced stage leaving the patient with life-threatening complications. 3,000 Americans are diagnosed with mesothelioma each year.

Sources :

• STELLAR clinical trial
  https://clinicaltrials.gov/ct2/show/NCT02397928
• Novocure’s Chief Science Officer and Head of Research and Development
  https://www.novocure.com/novocure-reports-positive-top-line-results-from-stellar-phase-2-pilot-trial-in-mesothelioma/
• NovoTTF-100L
  https://www.novocuretrial.com/stellar-mesothelioma/living-with-ttfields/
• Humanitarian Device Exemption
  https://www.fda.gov/medicaldevices/deviceregulationandguidance/howtomarketyourdevice/premarketsubmissions/humanitariandeviceexemption/default.htm
• HDE application requirements
  https://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/HowtoMarketYourDevice/PremarketSubmissions/HumanitarianDeviceExemption/ucm563286.htm

Honor our Fallen Veterans This Memorial Day

• Lisa Hyde-Barrett
• Featured News

Pools open across the U.S., families flock to the beach, and school-aged kids look forward to summer vacation on Memorial Day. Although the day is seen as the unofficial start of summer, it is meant to honor all those who died while serving in the U.S. military.

According to USMemorialDay.org, over 1.8 million soldiers have given their lives for America since 1775. Among foreign wars, World War II was the deadliest for the U.S. with 405,399 lives lost. The number of U.S. military personnel killed in the Korean War was 33,686, and in the Vietnam War 58,209. Current U.S. wars in Iraq and Afghanistan have claimed over 7,000 American lives.

Still more lost their lives long after the battlefield or service from injuries or illnesses, such as mesothelioma, suffered from their service. Some U.S. soldiers have successfully ended their military career only to be stricken with health issues later due to exposure to toxic materials, including  asbestos.

According to the U.S. Department of Veterans Affairs, veterans who served in any of the following occupations may have been exposed to asbestos: mining, milling, shipyard work, insulation work, demolition of old buildings, carpentry and construction, manufacturing and installation of products such as flooring and roofing. In addition, the VA reports that the latest generation of war veterans, those who served in Iraq and other countries in that region, could have been exposed to asbestos when older buildings were damaged and the contaminants were released into the air.

The inhalation of asbestos fibers has been associated with lung cancer and mesothelioma. Pleural mesothelioma is a rare cancer affecting the lining of the lungs that is extremely difficult to treat and is virtually impossible to cure. Although nearly 3,000 new cases are reported annually in the U.S., statistics show that military veterans account for over one-third of those cases.

All of us at MesotheliomaHelp encourage all Americans to take a moment out of your busy Memorial Day to honor those who have served our country. In coordination with the National Moment of Remembrance, observed at 3:00pm local time, “pause for one minute … to remember and reflect on the sacrifices made by so many to provide freedom for all.”

Sources

• U.S. Department of Veterans Affairs
  http://www.publichealth.va.gov/exposures/asbestos/index.asp
• National Moment of Remembrance
  http://www.usmemorialday.org/?p=97

Protein Identified As Target to Halt Spread of Mesothelioma and Other Cancers

• Lisa Hyde-Barrett
• Featured News, Mesothelioma

Time and again mesothelioma patients discover that while their cancer treatment initially appeared effective, cancer cells slipped away and spread to other areas of their body. It is this metastasis that eludes scientists. Now, researchers report they have identified a protein they can target that will prevent the spread of cancer cells.

The LTBP3 protein, known to fuel blood vessel growth, in effect, spurs cancer cells to spread beyond the initial tumor site by traveling in these new “highways” through the body, according to a Feb. 16 press release from the Scripps Research Institute. Patients who had lower levels of this protein had a better prognosis, leading the researchers to focus on finding a way to target LTBP3.

The research team looked more closely at LTBP3 and TGFβ, a molecule that has been linked to both growth and suppression of cancer.  They knew the two “partner” to regulate TGFβ, but they wanted to find if the two worked in concert to spread cancer. However, because TGFβ is both good and bad, they had to find a way to suppress the molecule’s harmful effects, without interfering with the benefits for slowing cancer growth.

Using chick embryo and mouse models, they suppressed LTBP3 and discovered that without it, primary tumor cells could not metastasize efficiently. This indicated that LTBP3 is involved very early in the metastasis process. The team concluded “LTBP3 levels can indicate better overall survival” in some cancer patients.

The team reports that LTBP3 is a good “upstream” drug target for early stage tumors without affecting the role of TGFβ. Their next step is to determine how LTBP3 and TGFβ partner in the induction of new blood vessels deep within a tumor.

Finding a way to halt the spread of deadly cancer cells is critical for improving survival in mesothelioma patients. In fact, according to the American Cancer Society, “With upwards of 90% of all cancer suffering and death associated with metastasis, it is the single most significant challenge to management of the disease.”

Nearly 3,000 Americans are diagnosed with mesothelioma each year. Finding an effective  way to stop the cancer from spreading, as opposed to treating the cancer after it has spread, brings hope to the mesothelioma community.

Find out more about the Scripps study in the January 19 issue of Oncogene.

Sources:

• January 19 issue of Oncogene
  https://www.nature.com/articles/s41388-017-0075-1
  
• Scripps Research Institute
  https://www.scripps.edu/newsandviews/e_20180216/deryugina.html

Mesothelioma Patients Eye Combination Therapy Given FDA Priority Review for Bringing “Significant Survival Benefit” To Lung Cancer Patients

• Nancy Meredith
• Featured News, Mesothelioma

In October 2016, MesotheliomaHelp reported the U.S. Food and Drug Administration approved the immunotherapy drug atezolizumab (TECENTRIQ, Genentech Oncology) for the treatment of patients with metastatic non-small cell lung cancer (NSCLC) whose disease progressed after platinum-based chemotherapy. Now, Genentech reports the FDA has granted priority review for Tecentriq when used in combination with bevacizumab (Avastin), paclitaxel and carboplatin (chemotherapy), for lung cancer patients.

The status was given based on results from the Phase III IMpower150 study, according to the May 6 press release from Genentech announcing the approval. The trial was established to evaluate the safety and efficacy of Tecentriq with the triple drug combination compared with patients receiving the triplet without Tecentriq. Tecentriq is designed to target PD-L1 expressed on tumor cells and tumor-infiltrating immune cells and to enable the activation of T cells, according to the company.

“Our Phase III results showed TECENTRIQ in combination with Avastin, paclitaxel and carboplatin has the potential to provide a significant survival benefit in the initial treatment of metastatic non-squamous non-small cell lung cancer,” said Sandra Horning, M.D., chief medical officer and head of Global Product Development. “We are working closely with the FDA to bring this treatment regimen to people with this type of lung cancer as soon as possible.”

Lung cancer is by far the leading cause of cancer death among both men and women in the U.S., according to the American Cancer Society. The ACS estimates about 234,030 new cases of lung cancer will be diagnosed in 2018, with approximately 154,050 Americans dying from the cancer. Nearly 3,000 Americans are diagnosed with mesothelioma, with close to the same number losing their lives to it each year.

Pleural mesothelioma is an asbestos-caused cancer affecting the lining of the lungs. Although there are clinical differences between lung cancer and mesothelioma, the treatment protocol for the two cancers are similar. Mesothelioma is a terminal cancer with limited treatment options. Any new breakthrough or approval in the treatment of NSCLC is considered a win for mesothelioma patients as well.

A Priority Review designation will direct overall attention and resources to the evaluation of applications for drugs that, if approved, would be significant improvements in the safety or effectiveness of the treatment, diagnosis, or prevention of serious conditions when compared to standard applications, according to the FDA.
https://www.fda.gov/ForPatients/Approvals/Fast/ucm405405.htm

A Priority Review designation means FDA’s goal is to take action on an application within 6 months. Genentech reports the FDA is expected to make a decision on approval by September 5, 2018.

Find out more about the IMpower150 clinical trial at ClinicalTrials.gov.
https://clinicaltrials.gov/ct2/show/NCT02366143

Sources :

• Genentech
  https://www.gene.com/media/press-releases/14715/2018-05-06/fda-grants-priority-review-to-genentechs
• American Cancer Society
  https://www.cancer.org/cancer/non-small-cell-lung-cancer/about/key-statistics.html