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Pembrolizumab & Mesothelioma
Pembrolizumab shows promise in treatment of mesothelioma
Pembrolizumab, an antibody drug already used to treat other forms of cancer, can be effective in the treatment of the most common form of mesothelioma, according to a new study led by investigators from the Perelman School of Medicine at the University of Pennsylvania. The study, published this month in The Lancet Oncology, is the first to show a positive impact from checkpoint inhibitor immunotherapy drugs on this disease.
Malignant pleural mesothelioma is a rare and aggressive cancer that represents about 90 percent of all malignant mesothelioma cases. It’s primarily caused by the inhalation of asbestos, a fiber commonly found in some forms of insulation, vinyl floor tiles, and other material. Tumors form in the pleura, a thin membrane of cells that line the lungs and chest wall. Most patients survive less than a year. This poor prognosis is partially due to the fact that most patients are not diagnosed until they are already at a late stage of the disease. The standard first-line therapy treatment involves chemotherapy, and currently there is no approved second-line therapy.
“There have been a lot of studies looking at different drugs, but researchers have not seen positive results,” said the study’s lead author Evan Alley, MD, PhD, chief of Hematology and Medical Oncology at Penn Presbyterian Hospital. “But we’ve found this new class of drugs, checkpoint inhibitors, seems to be more effective than what’s been available in the past.”
Checkpoint inhibitors are a class of drugs designed to free the body’s immune system to fight back against cancer. Pembrolizumab, in particular, has been used to treat melanoma, non-small cell lung cancer, and in some cases, head and neck cancers.
Alley and his team presented data from KEYNOTE-028, an ongoing trial involving 13 different research sites in six different countries all looking at the effect of pembrolizumab on patients with advanced malignancies, including malignant pleural mesothelioma. The study evaluated 25 patients with pleural mesothelioma, all of whom were over the age of 18 and had either already been treated with chemotherapy or were unable to receive it. Patients who had already received another checkpoint inhibitor were not included in the study.
Beginning with the first enrollees two years ago, doctors gave each patient a dose of pembrolizumab every two weeks. The tumor reduced in size in 14 of those patients. On average, patients went about six months without their disease progressing, and overall survival was about 18 months. Fourteen patients passed away during the study, while four were still undergoing treatment as of the study’s writing.
“Most patients who receive a second-line therapy have a life expectancy of about six or seven months, so to have four patients still ongoing at two years is very encouraging,” Alley said.
The most common side-effects reported were fatigue, nausea, loss of appetite, and dry mouth.
“One great sign in this study is that none of the patients had to stop treatment because of side-effects,” Alley said. “Some had temporary stoppages, but they were able to continue. The drug appears to be well-tolerated.”
There are multiple studies going on right now to confirm these findings, which the authors note is a necessary step before the drug can become a standard second-line therapy.
“This study provides evidence that some patients can have long-term disease control with this drug, which we haven’t seen before,” Alley said. “We need to better understand what we can do next to make immunotherapy more effective for more patients.”
Alley said there are already plans for trials that will test combination therapies, which will utilize pembrolizumab in conjunction with other treatments. Those studies are expected to launch later this year, including two at Penn.
Materials provided by Perelman School of Medicine at the University of Pennsylvania. Note: Content may be edited for style and length.
What is Mesothelioma?
Malignant mesothelioma is an extremely rare cancer that arises in the cells which line the body’s internal organs, known as the mesothelium. All forms of mesothelioma have one demonstrated cause: Asbestos Exposure. There are three types of mesothelioma recognized by the medical and scientific communities.
Mesothelioma is a sudden and devastating form of cancer caused by asbestos exposure. This terminal disease occurs unexpectedly usually 20 to 40 or more years after asbestos exposure. Anyone can be exposed from everyday locations, such as homes, workplaces, schools, and even by direct contact with someone who has asbestos dust contamination on their clothes. Wives and children of workers that were exposed to asbestos have also been shown to be at risk of this disease as a result of personal exposure to asbestos dust on their loved one’s clothing. According to the Occupational Safety and Health Administration (OSHA), the National Institute of Occupational Safety and Health (NIOSH), the Environmental Protection Agency (EPA) and the International Agency for Research on Cancer (IARC), there is no evidence of any asbestos exposure level that is considered safe. In conclusion, there is not a certain level of exposure that can decrease your chance of developing the disease. All levels will may lead to this unfortunate disease.
If you or a loved one has been exposed to asbestos and are experiencing symptoms, seek out a mesothelioma experienced physician as soon as possible in order to receive proper treatment. If diagnosis is early you will have access to a wider array of treatment opportunities with more promising results. Additional information and statistics about mesothelioma can be found within this section.
Types of Mesothelioma
Pleural mesothelioma arises in the membrane which surrounds the lung, called the pleura. Pleural mesothelioma is the most common form of this deadly cancer.
Peritoneal mesothelioma develops in the lining of the abdominal cavity, called the peritoneum. Peritoneal mesothelioma is less common but is more often found in women than in men.
Pericardial mesothelioma originates in the pericardium, which lines the heart.
How to Get Diagnosed
For Mesothelioma, cancer specialists will approach a mesothelioma diagnosis by first testing symptoms. This initial testing is usually to see if symptoms are being caused by a more common disease. As part of this process, the doctor will obtain a full medical history from the patient. This usually will include asking the patient about any exposure to asbestos.
After these steps have been taken, the doctor will usually perform a series of tests, some of these tests could include imaging scans and blood tests. Most of the time if these tests indicate a potential for mesothelioma, a biopsy will be taken. Biopsy Tests are normally the only way to give a definitive Mesothelioma Diagnosis.
All forms of Mesothelioma have a poor long term prognosis. Catching the disease early on can potentially improve life expectancy. Having mesothelioma diagnosed before it spreads can increase the effectiveness of treatments and clinical trial options.
In light of the current difficulty in curing the disease, most research and development around all forms of mesothelioma is focused around improving early detection and diagnosis of the disease. This includes recent developments of new biomarker blood tests, which can detect the presence of substances that indicate mesothelioma may be present in the body.
Mesothelioma Staging by Type
An approved staging distinction program is present only for pleural mesothelioma, the most common form of Mesothelioma cancer. No approved staging systems are identified for peritoneal, pericardial, or testicular mesothelioma. There are no staging systems for less common forms of mesothelioma, the American Joint Committee on Cancer (AJCC) has published general guidelines for staging cancer in its AJCC Cancer Staging Manual. Even when doctors do not have guidelines for a specific form of cancer, they can still refer to the general guidelines to help determine the stages of extremely rare cancers like peritoneal mesothelioma and pericardial mesothelioma.
Mesothelioma cancer Staging happens at medical diagnosis of the illness through a medical professional. Although the cancer may recede or progress, the stage of mesothelioma at diagnosis will not change. If a Stage 1 mesothelioma tumor spreads to other parts of the body, it is called Stage 1 with metastasis. If a Stage 4 mesothelioma tumor reduces in size or goes into remission, the stage will not change. While the initial treatment program may depend on the mesothelioma stage, actual treatment may vary depending on how the disease progresses.
Common Mesothelioma Stages
Mesothelioma Staging demands a variety of diagnostic examinations to identify the tumor area, overall size, and whether it has spread beyond the immediate location. The four stages of pleural mesothelioma cancer vary marginally within each system, but they could be generalized as suggested below. Please click into the individual pages to get more information about each stage.
Within Stage 1, the mesothelioma tumor is generally in one location, and the cancerous cells have not dispersed to lymph nodes or other body organs and tissues. In general, surgical treatment may be an option for eliminating the cancerous growth.
Within Stage 2, the mesothelioma tumor is larger and has probably intruded on surrounding organs, such as the lung or even diaphragm. Lymph nodes could additionally be included. In this case, surgical reapportion might still be feasible, however much more difficult depending on the scope of the growth.
Within Stage 3, mesothelioma cancer has infested a region or perhaps location, like the chest wall, esophagus or lymph nodes. Surgical treatment is typically not an option as a curative therapy, however various other treatment options may be attempted.
Within Stage 4, the mesothelioma has dispersed to numerous locations, such as various other organs and tissues throughout the body. Surgical treatment is no longer an alternative, and most treatments at this stage concentrate on minimizing discomfort and pain.
Mesothelioma Treatment Options
After being diagnosed with Mesothelioma, it is suggested that treatment options should be aggressively explored with mesothelioma experienced physicians. There are a number of treatment options for Mesothelioma through surgery, radiation therapy and certain chemotherapy. Several surgeons have pioneered progressive surgical options for mesothelioma victims, including Dr. Harvey Pass, (NYU Langone Cancer Center), Dr. David Sugarbaker (Baylor College of Medicine) and Dr. Raphael Bueno (Brigham and Women’s Hospital). Research on the most effective chemotherapy regimens continues and to date Alimta and Cisplatin have been shown to be very helpful in some patients. ALIMTA is a treatment for malignant pleural mesothelioma (MPM), a cancer that affects the inside lining of the chest cavity. ALIMTA is used with cisplatin, another anticancer medicine (chemotherapy), when surgery is not an option.
Some Mesothelioma patients may want to explore the latest experimental treatment options and clinical trials. Certain non-conventional alternative therapies are being studied and may provide some benefit to patients with Mesothelioma. Understanding that all forms of Mesothelioma are rare and are considered a form of lethal cancer, it is critical to discuss all available treatment options with your family and the best Mesothelioma expert treating internists, pulmonologists, oncologists and surgeons.
Mesothelioma Treatment Advice
On behalf of the Asbestos Cancer Organization, we would prefer if you consulted a professional medical physician for any advice related to treatment options and care. We care deeply about your situation and only want the very best for you & your family. We have some of Top Mesothelioma Doctors & Clinical Trials listed on our website. Why not check out the Top Mesothelioma Doctors page or even the Clinical Trials page for more accurate information on who can help you & what clinical trials are available to apply for. We also have some of the Top Cancer Centers listed on our website as well.
Regarding your health, it is always best to make final decisions when speaking to a professional medical doctor. Please contact us and we will do our best to connect you with a Top Mesothelioma Doctor.
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Asbestos Exposure & Cancer
The only known cause of Mesothelioma is Asbestos Exposure. Asbestos dust and particles that have been inhaled or ingested cause inflammation and disruption of normal cell growth on a microscopic level. This can lead to the development of mesothelioma cancer. Thousands of industrial, commercial and consumer products were manufactured with asbestos from the 1940’s through as late as the 1990’s in some cases. Most of these companies knew the deadly effects that exposing their employees and customers would cause and yet still continued to use the deadly substance due to corporate greed. For this reason many lawsuits have been brought against these companies on behalf of Mesothelioma Victims. Understanding that Mesothelioma is a lethal cancer, this directly means that whoever exposed you or your loved one to Asbestos dust is responsible for their death.
Here at the Asbestos Cancer Organization we have teamed up with a Top Mesothelioma Law firm. The Lawyers at Goldberg, Persky & White have been fighting and winning Mesothelioma cases for Mesothelioma clients for over 40 years. We strongly suggest that if you or a loved one has been diagnosed with Mesothelioma that they seek legal consultation with our partners at Goldberg, Persky & White. They are the best of the best. Their experienced Mesothelioma lawyers will continue fighting Mesothelioma cases for their clients and assist all persons diagnosed with Mesothelioma.
Most asbestos exposure originates from the thousands of products that contained asbestos. People who worked in industries like steel mills, foundries, power plants, chemical plants, refineries, paper mills, glass manufacturing, iron smelting and aluminum manufacturing from the 1940s through the 1990’s were most likely exposed to asbestos dust. A lot of the insulation, refractories and friction products used by these industries during this time period contained asbestos. Construction workers including laborers, insulators, brick layers, electricians, machinists, millwrights, plumbers, pipefitters, steamfitters, iron workers, boilermakers, carpenters, plasterers, drywall workers and even superintendents, engineers and architects who worked in any form of construction from the 1940’s through the 1990’s could have been exposed to Asbestos dust. There were numerous asbestos containing construction materials sold by the asbestos companies.
The chances of being exposed to asbestos particles in these settings does not decrease even if a worker was never personally handling asbestos containing products. If someone worked in the same area where work with asbestos products was conducted they also inhaled the deadly toxins. Most companies that manufactured or sold asbestos products did not provide warnings to their customers, many workers unwittingly introduced asbestos dust into their homes on their contaminated work clothing, subjecting their wives and even their children to enough asbestos exposure to cause mesothelioma. It has recently been found that some common talcum powders, including baby powder, shaving powders, cosmetic and hygiene talcum powders, contained dangerous levels of asbestos sufficient to cause mesothelioma.
Top Mesothelioma Doctors
Only the best, just for you.
Dr. Raphael Bueno is the Chief, Division of Thoracic Surgery and Vice Chair of Surgery for Cancer and Translational Research at Boston’s Brigham and
Dr. Harvey Pass is a renowned thoracic surgeon that has dedicated his career to bringing increased awareness of the dangers of asbestos exposure.
Dr. Robert Brian Cameron currently serves as the Director of Thoracic Oncology at University of California, Los Angeles School of Medicine, Department of Surgery.
Dr. David Sugarbaker is a world-renowned doctor and certified thoracic surgeon widely credited for developing the first tri-modal treatment approach for malignant pleural mesothelioma.
Dr. Lary A. Robinson is currently the Director of the Division of Cardiovascular and Thoracic Surgery at the H. Lee Moffitt Cancer Center and Research Institute in Tampa, Florida.
As director of the mesothelioma program at the M.D. Anderson Cancer Center at the University of Texas in Houston, Anne Tsao M.D. is one of the nation’s foremost authorities on malignant mesothelioma.
Mesothelioma Treatment Costs
As with all types of cancer, Mesothelioma costs can be extremely high, often hundreds of thousands of dollars. The costs associated with the disease can be lumped into several categories: Diagnostic Testing Costs, Treatment Costs, Follow up, Recovery and Care Expenses.
How much a family spends on mesothelioma care will likely depend on a variety of factors. Some of these factors include, but are not limited to: the exact diagnosis, the stage when the disease is diagnosed, what is covered by insurance, and even where the patient lives. Asbestos exposure is the only proven cause of mesothelioma, those who are diagnosed with this deadly cancer may be able to receive financial assistance for many different things, from lost income to medical costs, as well as damages for pain and suffering related to the disease. On behalf of the Asbestos Cancer Organization, we would like to recommend that if you or a loved one has been diagnosed, you should strongly consider taking legal steps to help offset this potential financial burden.
Learn more about the financial assistance that is available if you or a loved one has been diagnosed with Mesothelioma. Financial aid options available to you can include Mesothelioma trust fund claims and a lawsuit against responsible members of the asbestos industry. Companies that exposed you or your loved one to Asbestos dust are directly responsible for your current condition. You should explore your legal right to compensation from asbestos companies liable for your exposure to asbestos. Here at the Asbestos Cancer Organization we have teamed up with a Top Mesothelioma Law firm. The Lawyers at Goldberg, Persky & White having been fighting and winning Mesothelioma cases for Mesothelioma clients for over 40 years. We highly suggest that if you or a loved one has been diagnosed with Mesothelioma that they seek legal consultation with our legal partners at Goldberg, Persky & White. They are the Best of the Best. Their experienced Mesothelioma lawyers will continue fighting Mesothelioma cases for their clients and assist anyone who develops Mesothelioma.
We’ve collected a database of the Top Mesothelioma Doctors from around the country. Search for them here.
Mesothelioma is often Misdiagnosed
All forms of Mesothelioma cancer are often misdiagnosed in early stages. This is partially due to the fact that many mesothelioma symptoms resemble the symptoms of other diseases. Mesothelioma is extremely rare and doctors may be more inclined to diagnose a more common disease first. Misdiagnosis can differ depending on the form of mesothelioma a patient may have or how common the displayed symptoms may be with other diseases.
On behalf of the Asbestos Cancer Organization, we strongly recommend you consult a Mesothelioma experienced medical physician for any advice related to treatment options and care. We care deeply about your situation and only want the very best for you & your family. We have some of Top Mesothelioma Doctors & latest Clinical Trials listed and linked on our website. Why not check out the Top Mesothelioma Doctors page or even the Clinical Trials page for more accurate information on who can help you & what new clinical trials are available to apply for. We also have some of the Top Cancer Centers listed and linked on our website.
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