Australian Mesothelioma Survivor Disease Free Seven Years After Diagnosis

It’s not common, but some people diagnosed with malignant mesothelioma manage to live for years with the disease.

In a recent article in the Journal of Medical Case Reports, Australian researchers report the remarkable case of a 48-year-old Australian woman who remains alive and disease free more than seven years after diagnosis of peritoneal mesothelioma, a cancer of the lining of the abdominal cavity. Both peritoneal mesothelioma and the more common type, pleural mesothelioma, a cancer of the lining of the lung, are signature cancers of asbestos exposure.

The doctors at the University of New South Wales attribute the unnamed woman’s long survival to a combination of factors including early cancer detection, complete removal of the cancerous tumors and treatment of the abdominal cavity with a heated chemotherapy solution—a technique called hyperthermic intraperitoneal chemotherapy. Similar heated chemotherapy treatments are also used on some mesothelioma patients in the U.S.

The current median survival for patients with peritoneal mesothelioma is 10 months. But with the current combined approach of surgical removal of tumors and chemotherapy, about one out of six patients now lives five years, the researchers said.

When the Australian woman was 40, she presented herself to her doctor with abdominal pain, a bad taste in her mouth and tiredness. A CT scan revealed a tumor on the lining of her abdominal cavity, but there were no indications that the disease had spread. When doctors performed surgery, they observed that the mesothelioma affected the small bowel, colon and diaphragm. They removed the cancer tissue from those organs. They then washed the patient’s abdominal cavity for 90 minutes in a warm bath of cisplain and Adriamycin, two powerful chemotherapy drugs.

Two years later, the woman experienced further abdominal pain and underwent another surgical procedure in which small amounts of atypical cells that resembled mesothelioma cells were treated with heated chemotherapy solution. A subsequent CT scan revealed no signs of cancer.

In reviewing the case, the doctors said that three key factors contributed to the woman’s survival. She had a less aggressive form of malignant peritoneal mesothelioma and one that was more responsive to chemotherapy. The cancer had not spread. The patient had the epithelioid type of mesothelioma which is less aggressive than sarcomatous or mixed type of mesothelioma.

In addition, the patient’s tumor tissue had a high expression of estrogen receptor, a genetic switch that appears to suppress te growth of malignant mesothelioma cancer cells, as other recent research suggests. Italian researchers reported that expression of estrogen receptor proteins in mesothelioma patients may help doctors predict how patients will respond to treatment. The manipulation of these proteins may offer a new mode of therapy for treatment of mesothelioma.

Mesothelioma Treatment Requires More Than Cancer Targeting Drugs

Mesothelioma is a serious, asbestos-caused cancer of the membranes that surround many of the body’s vital organs. The most common form is pleural mesothelioma, where cancer attacks the tissue surrounding the lungs. There is no known cure for mesothelioma. However, with an early diagnosis and appropriate care, patients may get some relief from their symptoms.

Treatment for mesothelioma is complex and, depending on the stage of the disease, typically involves a multi-modal approach including surgery, radiation and chemotherapy. While these treatment options are vital for fighting the disease, they can come with pain and side effects and may deplete the body of much needed nutrients. As a result, additional medications must be added to the cancer-fighting arsenal to help the patient fight off infection and fatigue and keep them as comfortable as possible during the difficult treatment regimen.

Anti-Nausea Drugs

The most common side-effects of chemotherapy treatment are nausea, vomiting and diarrhea. Fortunately, there are many drugs that a doctor can prescribe to prevent, lessen, or relieve the GI discomfort. The drugs can be given in pill form, through an IV, a patch, under the tongue, or even in a shot. In some cases the medicine is given via IV prior to receiving the chemotherapy treatment. Some common anti-nausea medicines include:

aprepitant (Emend®)
dolasetron (Anzemet®)
granisetron (Kytril®)
ondansetron (Zofran®)
proclorperazine (Compazine®)
lorazepam (Ativan®)
metoclopramide (Reglan®)
famotidine (Pepcid®)
ranitidine (Zantac®)

The Multi-Uses of Steroids

Cortisol-type steroids are used to treat many conditions and symptoms that arise from cancer and the associated treatments. Prednisone is one of the most common steroids prescribed and can be used for any or all of the following:

Shrink tumors and fight the cancer in addition to the chemotherapy;
Relieve inflammation and reduce swelling;
Reduce allergic reactions from chemotherapy and other infusions – often given via IV prior to the primary drug infusion;
Reduce nausea associated with chemotherapy and radiation;
Increase appetite and stimulate weight gain;
Induce sleep.

Pain Medications

Mesothelioma is a painful cancer and the pain associated with the disease varies from patient to patient and depends on the type of mesothelioma. Over half of the pleural mesothelioma patients suffer pain in the lower, back and sides of the chest. Sufferers of peritoneal mesothelioma may experience pain in the abdominal area, whereas pericardial mesothelioma patients experience the most pain with symptoms including chest pain, heart palpitations, shortness of breath, and constant and acute coughing.

Pain treatment varies depending on the severity.

Mild pain is typically treated with over-the-counter drugs containing ibuprofen, aspirin, naproxen or acetaminophen.
Moderate pain often involves the use of opioid medications that are sometimes used in combination with NSAIDs. Opioid products are hydrocodone, codeine, methadone or oxycodone.
Severe pain is often experienced following surgery and is typically managed through “patient-controlled analgesia” where the patient can manage the dosage of the painkiller. Most often this is a morphine drip. Higher doses of the moderate pain relievers may be used or other drugs can be prescribed including morphine, fentanyl and hydromorphone.

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Researchers Test Gastric Cancer Drug for Treatment of Pleural Mesothelioma

Malignant pleural mesothelioma is an aggressive respiratory cancer and remains difficult to control. Researchers keep searching for new treatment options to help mesothelioma patients live longer with the disease.

In a recent article in the medical journal Cancer, Chemotherapy and Pharmacology, Japanese researchers explore the effectiveness of a new anti-tumor drug known as S-1 for treating malignant pleural mesothelioma, which is closely associated with breathing asbestos.

The incidence of malignant mesothelioma is increasing worldwide with an expected peak in 2030 to 2040 in Asia and sooner in the U.S. and Europe. Complicating the treatment of mesothelioma is the fact that symptoms of asbestos-related cancer such as coughing, fluid around the lungs and chest pain are common to other conditions and mesothelioma often isn’t diagnosed until the disease has reached an advanced stage. In addition, mesothelioma patients are typically older and in weaker health. The standard treatment for advanced mesothelioma is a one-two punch of the chemotherapy drugs, pemetrexed and cisplatin. Yet, the overall prognosis for mesothelioma patients remains poor.

S-1, a chemotherapy drug that is taken orally, was developed by the Japanese drug manufacturer, Taiho Pharmaceutical Co. and is sold under the brand name Teysuno. It is used to treat patients with gastric cancer in Japan, Korea, China and other Asian countries. It was recently recommended for approval as a first line treatment for gastric cancer in Europe, but is not yet available in the U.S.

S-1 is designed to prevent the growth of cancer cells and also to enhance the effectiveness of another anti-cancer medication, 5-FU. To test the drug’s effectiveness on mesothelioma, researchers at the University of Tokushima implanted malignant mesothelioma cells into the chest cavities of mice. Their intent was to see whether S-1 would reduce the growth of cancerous tumors and the occurrence of bloody pleural fluid caused by mesothelioma.

The researchers reported that treatment with S-1 significantly reduced tumor growth in mice with certain lines of mesothelioma cells and prolonged their survival. One of the key compounds in S-1 is CDPH, which enhances the antitumor activity of 5-FU as well. Since human patients are typically diagnosed in the later stages of mesothelioma, the researchers delayed treating the mice until their tumors were advanced. They still responded to the chemotherapy and it prolonged their survival, suggesting that S-1 may be applicable for treatment of human mesothelioma patients in a clinical setting.

The research suggests that S-1 may be an effective therapy for controlling malignant pleural mesothelioma.

Amino Acids Diet Could Slow Mesothelioma Tumors

Mesothelioma Patient Survives More than Seven Years After Diagnosis with Rare Tumor

Mesothelioma, a cancer associated with inhaling asbestos, typically appears as malignant tumors in the lining of the lung or the lining of the abdomen. The cancer also can appear in the lining of the heart, though it’s uncommon. This form is called pericardial mesothelioma and accounts for only 1 percent of mesothelioma cases.

In the medical journal Rare Tumors, doctors at the University of Virginia report on the case of a 59-year-old man who has survived more than seven years since being diagnosed with pericardial mesothelioma. The man appeared at the hospital in 2003 after experiencing symptoms of periodic chest pain and fatigue after exertion. An x-ray of his heart revealed a large mass in the lining of the heart attached to the right ventricle.

Doctors performed surgery and removed much of the mass, but couldn’t remove all of it because of its involvement with the heart muscle. Lab tests confirmed it to be malignant mesothelioma. Typically, malignant tumors in the lining of heart are the advance guard of a cancer spreading from the lung, breast or elsewhere. Mesothelioma tumors originating in the lining of the heart are rare.

The patient received chemotherapy for three years, but his disease continued to advance. The initial chemotherapy consisted of eight cycles of gemcitabine and cisplatin. The combination of gemcitabine and cisplatin is one of the most common chemotherapy treatments for mesothelioma patients. After doctors observed the malignant mass growing again in January 2005, the patient received an additional six cycles of chemotherapy consisting of gemcitabine and carboplatin. Doctors observed that the mesothelioma was spreading again in November 2005; an MRI revealed that the mass had increased in size.

The patient received high-dose radiation treatment and tolerated the treatments well. The mass shrank in size after radiation. The patient has survived 50 months since the completion of radiation with no evidence of the mesothelioma returning. It has been 86 months since the initial diagnosis.

While the doctors acknowledge the outcomes are often less striking than this case, the doctors recommend high dose radiation for patients with inoperable or recurring pericardial mesothelioma.

About 2,500 to 3,000 Americans are diagnosed with mesothelioma each year, many of them workers who were exposed to asbestos decades ago in the workplace. The most common form of mesothelioma, accounting for about 60-70 percent of cases, is pleural mesothelioma, a cancer of the lining of the lung. Most of the remaining cases involve the abdominal cavity and are known as peritoneal mesothelioma.

Is It Just A Cough Or Is It Mesothelioma?

More Personalized Treatment for Mesothelioma Patients in the Future

Physicians who specialize in treating mesothelioma predict that in the next five to 10 years, researchers will identify more accurate ways to detect the disease and tailor treatment to individual patients. Mesothelioma is an incurable cancer of the lining of the lung or abdomen closely associated with exposure to asbestos. Asbestos was widely used in building materials, fireproofing and insulation through much of the 20th century.

In an article in the November issue of Clinical Lung Cancer, Drs. Linda Garland of the Arizona Cancer Center, Raja Flores of the Mount Sinai School of Medicine in New York and Anne Tsao of the M.D. Anderson Cancer Center predict that the global burden of mesothelioma will increase in the decade ahead, particularly outside the United States. In the U.S., about 2,500 to 3,000 die each year of mesothelioma. With cases of mesothelioma expected to spread, doctors need more effective treatments for the aggressive cancer and more personalized treatments for patients, they say.

Under current medical practice, doctors select mesothelioma patients to undergo radical surgery to remove cancerous tumors based on factors including the stage of the cancer, specific structure of the cancer cells, lung function and the patient’s overall health. But these factors are not very good predictors of long-term survival. Less than a third of the mesothelioma patients selected undergo radical surgery live four to five years, according to the article.

The researchers say there is an opportunity for development of tests for earlier detection of mesothelioma through telltale molecules in the bloodstream, known as biomarkers. Biomarkers are a relatively new but promising area of genetic research. One researcher has compared biomarkers to fingerprints of the disease. For example, the prevalence of a biomarker protein identified as microRNA-29c in mesothelioma tissue has been linked to longer patient survival and improved prognosis after surgery, according to an important recent study. These patients may be better candidates for tumor removal surgery, if the biomarker are validated by further research.

The article authors say that progress has been made in the last decade in the development of chemotherapy drugs for mesothelioma. Longer survival for mesothelioma patients may be possible with chemotherapy regimens tailored to the individual patients in the future. According to the studies, this may be possible if biomarkers can be pinpointed to help doctors identify which patients are receptive to individual chemotherapy drugs such as pemetrexed-based therapy.

Doctors are still awaiting the development of a break-through drug or therapy that may allow the targeting of mesothelioma tumors, according to the article. In the next five to 10 years, they say there will be promising developments toward a brighter future for mesothelioma patients.

Category: Treatments