John Dreier Essay

• Nancy Meredith
• Scholarship

By: John Dreier

“What are all the symptoms you have had due to LAM?” Over six hundred people have answered me, and their shortness of breath, their collapsed lungs, their cysts, their tumors, all of it- fit neatly into a column of a spreadsheet. I have graphed their pain and analyzed their suffering. However, no Cartesian coordinate system that can convey what it is like to listen to the belabored pauses between the answers as these women struggle to supply their bodies with sufficient oxygen. Yet the patients I talk to never sound dispirited. Their ragged breaths never hint at a despair one might assume would be omnipresent. To face cancer is to acknowledge the death within life- your body’s own tissue transforming into a terrible sickness. Lymphangioleiomyomatosis, or LAM, the lung disease my lab studies, occurs primarily through genetic events. You cannot prevent your genes any more than you can prevent the weather.

Mesothelioma, however, is a much more terrible, destructive lung disease (though it can affect other organs) and does not typically arise from genetic events. Asbestos, a seemingly innocuous fibrous silicate, which is the primary cause and risk factor for mesothelioma. While prevention and awareness are essential to keep people from becoming afflicted by mesothelioma, the reality is that each year 3,000 Americans are diagnosed with this frighteningly aggressive cancer. Each year 3,000 mothers, fathers, daughters and sons are forced to acknowledge the death within their lives. If we are to address mesothelioma head-on, we must not only focus on prevention and awareness, but also on treatment and, ultimately, a cure. We must endeavor to do more than merely attempt to ameliorate this disease. We must eradicate mesothelioma from the lungs of loved ones so they can take a deep, full breath of life, and acknowledge that death but visited, and his stay was just a reminder of our own mortality.

My grandmother, a spry 95 year-old, remembers when asbestos was casually mixed in with all manner of building materials. Similarly, my mother can recall playing hop-scotch on spare asbestos-laced roof shingles. While the matrons of my family are thankfully mesothelioma-free, their stories are not uncommon for many people their age. Furthermore, the buildings constructed during that time still exist – many of which may secretly harbor asbestos in their walls and ceilings. While asbestos is only harmful in an aerosolized form, asbestos materials are a lurking danger. What can we do about this danger, given its omnipresence? Counterintuitively, the safest thing is to do nothing. Keeping asbestos-laden materials in good upkeep prevents the fibers from making their way into lungs and airways. If we demolished every building with asbestos, not only would the cost be exorbitant, but it would also increase the risk of releasing the deadly fibers into the air. On the other hand, if older buildings are allowed to fall into disrepair, their deterioration too could aerosolize asbestos. Thus, many states have enacted standard policies of asbestos testing for many large building demolitions and remodeling contracts. However, anyone and everyone who has a home-improvement project in mind, or is involved in the upkeep or custodial duties of older buildings, should be aware of the dangers of asbestos. Tearing down that wall between your kitchen and your living room may give your home a modern, open-style look, but it may also release a deadly agent into the air. Spreading this knowledge is the first step in creating a mesothelioma-free world.

While prevention and awareness are a necessary step in eradicating mesothelioma, research into treatment and a cure is absolutely critical for those already afflicted with this deadly disease. Scientists are actively trying to discover new ways of combating mesothelioma. There are currently 96 open clinical trials related to mesothelioma, 57 of which are in the United States and 43 pursuing interventional strategies. Unfortunately, the road between the discovery of a drug that has cancer-inhibiting potential to FDA approval is a long one. Take everolimus, for instance, the primary drug used to treat tuberous sclerosis complex (TSC), another disorder my lab studies. In 2009 Memorial Sloan Kettering Cancer Institute began exploring the potential of everolimus to treat a certain subset of patients with malignant pleural mesothelioma (MPM). This Phase II trial (remember, a drug must pass Phase III to make it onto the market) lasted 6 years. Iin April 2015, the study concluded “Everolimus has limited clinical activity in advanced MPM patients. Additional studies of single-agent everolimus in advanced MPM are not warranted.” To put that time-frame into context, I began college in 2009 and graduated in 2013. It takes longer for a drug to be deemed ineffective than it does to get a bachelor’s degree. Consider also that less than 10 percent of patients diagnosed with mesothelioma will live past five years. With a cancer as aggressive as mesothelioma, national interest, financial support, and intense, fast-paced research are necessary for the very survival of these patients.

Having worked in a translational medicine laboratory for the last two and half years, I am more than familiar with the obstacles confronting the scientific community attempting to treat these debilitating cancers. It is not an easy process. Each step must be scrutinized carefully, because any flaw may only waste time of researchers and patients alike. Even so, I would tell a family member of someone afflicted with mesothelioma that there is hope. Personalized (sometimes referred to as targeted) medicine is the future of healthcare, and cancers will be the most susceptible to this approach. With lowered costs of genetic sequencing as well as faster and more robust algorithms combining proteomic, metabolomic, and genetic profiling – we are rapidly pushing the boundaries of not only detection of biological targets, but also therapies specifically designed for those targets. My hope as a scientist, and as a future clinician, is that increased awareness of mesothelioma will garner public attention and support for directed therapies. For now, all we can do is spread the word, and provide the resources to dedicated scientists and physicians fighting to end this deadly disease.

We cannot change the past. Asbestos is all around us – in our homes, our schools, our offices – it surrounds us. However, we can build a new future. A future in which families are aware of the dangers of older buildings and take precautions; a future in which support and funding for mesothelioma enter the national spotlight; a future in which a patient diagnosed with mesothelioma has hope for a cure, because personalized medicine has a solution specifically for them. We can build that future, but it has to start today.

References

• Alexander HR, Burke AP. Diagnosis and management of patients with malignant peritoneal mesothelioma. Journal of Gastrointestinal Oncology. 2016;7(1):79-86. doi:10.3978/j.issn.2078-6891.2015.134.
• Calabrò, Luana, Aldo Morra, Ester Fonsatti, Ornella Cutaia, Carolina Fazio, Diego Annesi, Marica Lenoci, Giovanni Amato, Riccardo Danielli, Maresa Altomonte, Diana Giannarelli, Anna Maria Di Giacomo, and Michele Maio. “Efficacy and Safety of an Intensified Schedule of Tremelimumab for Chemotherapy-resistant Malignant Mesothelioma: An Open-label, Single-arm, Phase 2 Study.” The Lancet Respiratory Medicine 3, no. 4 (2015): 301-09.
• ClinicalTrials.gov, U.S. National Institutes of Health, Web. March 20, 2016
• Mass.gov, Massachusetts Energy and Environmental Affairs, “Answers to Common Asbestos Questions,” Web. March 15, 2016