Largest-Yet Mesothelioma Study Shows Survival Benefit with New Drug

Researchers with the largest phase III trial to date for mesothelioma, an aggressive cancer affecting the lining of the lung, reported results showing that patients on a new chemotherapy drug regimen live longer and have less pain than those on an older drug. The findings were announced at the annual meeting of the American Society of Clinical Oncology meeting in Orlando, Fla., on May 20, 2002. (NOTE: The final data were subsequently published in the July 15, 2003, issue of the Journal of Clinical Oncology; see the journal abstract).

Pemetrexed (brand name Alimta™) is a novel antifolate, a class of drugs that targets the folic acid metabolic pathway, which effects availability of certain B complex vitamins. The results of the trial show that tumors shrank in 41 percent of patients on pemetrexed in combination with a more commonly used chemotherapy agent called cisplatin. Only 17 percent of patients receiving cisplatin alone experienced tumor shrinkage. Additionally, those on the pemetrexed combination lived nearly three months longer than those on cisplatin alone.

According to lead author, Nicholas J. Vogelzang, M.D., University of Chicago Cancer Research Center, "This is the largest clinical trial ever conducted in this disease and the 25 to 30 percent improvement in survival for patients on the combination therapy is the first time anyone has documented a significant improvement in patients treated for mesothelioma."

Malignant pleural mesothelioma is associated with a history of asbestos exposure in about 70 to 80 percent of all cases and there is no approved or very effective chemotherapy for the disease. Researchers hypothesized that pemetrexed might prove effective in treating this disease because it targets key enzymes (molecules that speed up chemical reactions in the body) thought to play a role in allowing the rapid growth of this tumor.

Early phase I trial results in 11 patients tested with pemetrexed and cisplatin were promising and a definitive randomized phase III trial was developed. Since there are no established therapies for this condition, a standard chemotherapy agent called cisplatin that has shown efficacy in treating other diseases, was used as the control group. The phase III study initially planned to enroll 456 patients from April 1999 to March 2001. However, after enrolling 150 patients, a high rate of severe toxicity and death was associated with the pemetrexed and cisplatin arm of the trial. Elevated levels of homocysteine, a chemical byproduct that results when proteins are broken down in the blood, were found, which provided a basis for redesign of the trial to reduce the dangerous drug side effects.

Two hundred and eighty patients were enrolled to the revised protocol. Using a strategy to reduce drug side effects that has been successful in the past, this new protocol added folic acid to the regimen because pemetrexed as an antifolate agent reduces levels of this important vitamin. Folic acid was given prior to and during the trial, and vitamin B12 was given only during the trial. Both vitamins should boost folic acid levels, reduce homocysteine formation, and hence reduce toxicity to pemetrexed. "We now have a significantly less toxic regimen than the one we started with," said Vogelzang.

Because of the presumed importance of the vitamins to the study, the researchers examined not only the combination therapy versus the single drug therapy, but also looked at the results of patients on the vitamin supplements versus those early enrollees who had not initially received vitamins.

Standard treatment for malignant mesothelioma has been surgery. Surgical treatment rarely results in cure and long-term survival is unusual. Use of radiation therapy and/or chemotherapy following surgery has not improved survival for patients but radiation treatments may alleviate some pain associated with the disease

Mesothelioma is a critical and fatal cancer. It is caused by direct exposure to asbestos. Mesothelioma cancer is categorized into three categories: pleural mesothelioma, peritoneal mesothelioma and pericardial mesothelioma. This destructive cancer damages the mesothelium which is a membrane that forms the lining of several body cavities like the pleural (thoracal cavity), peritoneum (abdominal cavity) and pericardium (heart sac).

Pleural mesothelioma

Pleural mesothelioma is one of the most common forms of mesothelioma. More than 75% of victims fall in this category. This cancer affects the outer lining of the lungs and the chest cavity and makes it thicket. Symptoms of pleural mesothelioma are very common like difficulty in breathing, pain in the chest, fatigue, swelling of the face and neck, trouble when swallowing, cough and weight loss. These symptoms are shown by other diseases also and hence it becomes difficult to diagnose this cancer. Lining of the lungs are made up of two layers, parietal which covers the chest wall and visceral which covers the lungs. Mesothelium cells grow and produce a tumor which enlarges the space, causing it to fill with fluid. This extra thickness in layers is known as pleural effusion which leads to discomfort and pain in the chest. The pain may also be felt in the arms and the shoulders.

After the diagnosis of pleural mesothelioma you can opt for several mesothelioma treatment options. The factors like the patient’s age and history, location of the tumor, and stage of the cancer are to be noted while treating the patient. The different treatments available for the pleural mesothelioma are radiation, chemotherapy, pneumonectomy, and palliative therapies. Pneumonectomy means removing the cancerous lung or parts of the diaphragm where the disease has spread. In this treatment parts of chest and surrounding tissue which may be affected by the cancerous cells are also removed. This treatment can be carried out depending on the patients overall health, the amount of asbestos inhaled and the spread of the disease.

The next form of treatment is radiation. In this treatment the area affected by the cancer is exposed to the radioactive source. These radiations destroy the cancerous cells. Radiation therapy do not cause any harm to the healthy cells. Chemotherapy is one of the common treatments for pleural mesothelioma. In this treatment high power drugs are given to the patients either by injecting it or in the forms of pills. These drugs may cause some side effects such as vomiting, hair loss, nausea, weight loss and fatigue. The disadvantage in this treatment is that the drugs administered have to make their way to the cancerous cells, unlike radiation therapy where the radiation is directly targeted to the affected area. This may cause harm to the healthy cells as well.

Palliative therapies involve extracting extra fluid by needle and suction from the affected areas. In order to keep fluid accumulation under control, drugs are used. Researches are being performed to find new ways to treat this deadly cancer and so you should always keep yourself updated with these treatments and researches.

An intensive care and support is always most vital for mesothelioma patients. They sometime work more than medicine and doctor. Mesothelioma is a rare cancer. The main cause for this cancer is due to inhalation of dangerous fiber called asbestos which was used in many industries in twentieth century. These asbestos, when inhaled for long time, trigger the formation of malignant cells in the internal organs. Although scientists have no clue how exactly the asbestos works and creates this deadly cells. But they do know that as soon as asbestos reaches inside, there is big chance that the person, who inhaled the asbestos, will suffer from mesothelioma anytime soon.

Mesothelioma patients may have different symptoms such as consistent cough, chest pain, breathing problem, anemia, problem in bowl, sudden loss in weight and others. These symptoms are visible in the patients, but this may be related to other diseases. To confirm, there are various ways to find out. Doctors suggest doing CT scan, X-ray and MRI. Furthermore, a biopsy is suggested to make more confirmation. However, the symptoms are usually seen after many years, and at that time, it might be too late. A regular checkup in hospital, click from experienced doctors is always recommended.

The treatment of mesothelioma cancers are started as soon as they are diagnosed. Mesothelioma patients are given Chemotherapy, Radiotherapy and do Surgery when possible. Surgery is done when the cancer is in its initial stage. When the cancer crosses second stage and reaches third, the mesothelioma patients are given chemotherapy which is very good and help in increase lifespan. However there are many other treatments which are practiced by doctors and other medical practitioners with mesothelioma patients. Those treatments have some benefits for some patients. Most importantly, the early detection is the way to eliminate the cancer from the root. With the positive attitude and confidence, mesothelioma patients can fight it and win the battle.

1. There are three options available, for Mesothelioma. One is surgery (taking out the cancer).
2. Chemotherapy (using drugs to combat the cancer).
3. The last is radiation therapy, by which high-dose X-rays or other high-energy rays are used to kill the cancer cells.
4. Surgery is one of the options available, but it has largely proved disappointing. For better success, it can be combined with chemotherapy and radiation. The most common surgery is a pleurectomy / decortication – the removal of the lining of the chest.
5. Another kind of surgery available is the extrapleural pneumonectomy (EPP) – the removal of the lung, lining of the chest’s inside, the pericardium, and the hemi-diaphragm.
6. Radiation is used post-operation as a consolidative treatment. Radiation is given to the hemi-thorax region, sometimes with chemotherapy.
7. Chemotherapy is perhaps the most effective treatment.
8. Immunotherapy is also used – the body is injected with intrapleural inoculation of Bacillus Calmette-Guerin (BCG), though this has not proven very effective.
9. Mesothelioma cells can be treated with in-vitro lysis by LAK cells, following activation by interleukin-2 (IL-2), but this may have side effects.
10. Heated intraoperative intraperitoneal chemotherapy is also used. As much of the tumor as possible is removed, then a chemotherapy agent is directly administered, temperature of between 40 and 48 degrees Celsius, to the abdomen.
11. Chest tube drainage is used for the case of pleural effusion – building up of fluid.
12. Chemical pleurodesis is used in the case of pleural effusion – by this, a sclerosing agent is used to abrade the pleural surface, and this produces an adhesion between the parietal and visceral pleurae. Talc is the most effective agent for pleurodesis.
13. The pleural space is closed by the chest tube drainage treatment.
14. Thoracoscopy and Pleurodesis are used, with VATS, using a powdered form of talc, versus talc slurry. This will only prove effective if the lung is not encased by any tumor, this restricts the expansion.
15. Pleurectomy is performed if extensive surgery is ruled out. In such cases, all the tumor visible will not be removed. This is extremely effective for controlling pleural effusion if disease restricts the expansion of the lung.
16. In Pleuroperitoneal Shunt, a catheter is placed, running from under the skin from the pleural to the peritoneal cavity.
17. Extrapleural Pneumonectomy is a more radical surgical approach, which is currently being combined with chemotherapy and/or radiation, or even new approaches like gene therapy and photodynamic therapy.
18. For peritoneal Mesothelioma, cytoreductive surgery is performed, which aims to remove all or nearly all the gross or visible tumor in the peritoneal cavity. The remaining cancer cells are treated with Intra-Peritoneal Hyperthermic (heated) Chemotherapy (IPHC), which is then sent to the abdominal cavity.
19. The neoadjuvant approach is used in chemotherapy – where Alimta is used with Cisplatin, for patients who have malignant pleural Mesothelioma. This has been specially approved by the Food and Drug Administration.
20. Chemotherapy is administered intravenously, through a vein. A thin needle is inserted into a vein in the lower arm, or in the hand – and drugs rapidly enter into the blood stream. They may also be delivered through catheters and/or ports.

Management options both for patients who bonk had surgery and those for which surgery is not an option nearly ever includes chemotherapy and radiotherapy. This communicating way uses irradiation to punish cancerous cells; it is perhaps the oldest non-surgical direction for malignance in Western medicine. Radioherapy can be effectual in killing human cells but it is not a real finespun discipline, so the emission beams lean to terminate rubicund cells contiguous to the malignant cells on which it is targeted.

Because of the limitations for emission - precision and the depth to which it can be operative - a medico performing a resection machine on a patient may accomplish a syndrome management for mesothelioma piece the uncomplaining is soothe in surgery and the position of the disease is exposed. Withal emission treatments are included in virtually any management show for mesothelioma, whether surgery is interested or not. Radioactivity is old to battle cancerous cells and to ply both of the symptoms much as pleural gush associated with mesothelioma.

One of the thwarting facts near malignant mesothelioma is the opposition of the someone cells generated by the disease to chemotherapy and therapy handling. Physicians are constantly investigating new medications as wellspring as alone new concepts for speed or halting the sex of cancerous cells, as intimately as methods of destroying them. New uses of ingrained engineering proceed into attempt, much as the exercise of the magnitude modulated radiation technique for therapy. Factor therapy and immunotherapy both initiate to utilize the body's born methods of warring invasive disease for the intention of targeting somebody cells.

Much of the investigating for new communicating modalities centers on chemotherapy: both new drugs and new methods of delivering the drug effectively to the diseased paper. All new medications to be oversubscribed in the Joint States moldiness go finished a clinical attempt deliver antecedent to beingness approved by the Food and Drug Administration (FDA). In galore cases, anti-cancer drugs utilised for mesothelioma discourse are medications that score been expressly authorized for a taxon of soul discourse, but not for use with mesothelioma. Using an authorised human treatment for a non-approved mansion handling is not unaccustomed, nor contraband low FDA guidelines.

Clinical trials are also conducted simply to see if there are surmount discourse options to be institute using tools that are already getable for battle someone. That's why numerous clinical trials for mesothelioma are experiments to see if the use of existing constellation drugs in one combination or added instrument be effectual in combating asbestos house. Substance from FDA commendation, a decent conducted clinical run instrument launch the transparent valuate of one organise of communication or added because it meets the professional medical standards for much tests

Chemotherapy for Mesothelioma

There is a lot deed on in mesothelioma chemotherapy search; the different types of chemotherapy feature evolved as physicians someone learned nigh the types of malignant cells that are attending with mesothelioma. There are ninefold variants of human cells, all of which score contrasting strengths and weaknesses. There are two types of cells related with mesothelioma; epithelioid and sarcomatoid: they move to divers types of treatments. With accelerative frequence, mesothelioma diagnoses are display cases with both types of cells - a shape called biphasic mesothelioma.

There bonk been and speak to be mesothelioma clinical trials that mix chemotherapy drugs to hit many strong treatments for mesothelioma mansion cells. There are also a few new drugs in the try form that are specifically organized for mesothelioma house cells; the archetypal of these is Alimta, or pemetrexed. The reports on these trials ordinarily take them a success if the tried communicating sentience extends the life of the uncomplaining by a point of a few months. That fact illustrates the limits to mesothelioma discourse that chemotherapy incomparable can furnish.

There love been whatsoever successes treating peritoneal mesothelioma using postoperative removal of as untold cancerous paper as feasible and combining it with intraperitoneal hyperthemic chemotherapy. This typewrite of post-surgical communication involves vaporization and delivering the chemotherapy drugs directly to the diseased expanse with several represent of shunt. Utilization of this technique resulted in a norm selection point of nearly trio years in one rumination and over quatern period in other.

Tuesday, July 22, 2008 Source:

Us News And World Report

U.S. News and World Report has recently written about a clinical trial for an experimental mesothelioma treatment that is being conducted at the Mesothelioma Center at New York-Presbyterian Hospital and Columbia University Medical Center.

The trial is investigating the combined use of chemotherapy and radiation in the treatment of pleural mesothelioma, which is a departure from the standard therapies that normally specify some form of curative surgery. Patients who are enrolled in the trial will receive multiple cycles of a chemotherapy regimen consisting of either cisplatin and doxorubicin orcisplatin and pemetrexed (alimta). The latter chemotherapy regimen is the current standard of care in chemotherapy for mesothelioma. All of these patients will receive radiation that is targeted directly at the pleural tissue on the lung.

Although the treatment regimen does not specify curative surgery, it will be available for patients who elect to undergo it. Patients can choose between extrapleural pneumonectomy and pleurectomy/decortication.

The trial is investigating whether this regimen will demonstrate any improvements in overall patient outcome than do the standard therapies.

The Mesothelioma Center at New York-Presbyterian Hospital and Columbia University Medical Center is the only cancer center in the country to offer this therapy.

posted by Belluck & Fox

Chemotherapy is the use of drugs to fight mesothelioma cancer. It is one of the major therapeutic options available for cancer treatment and many of the great success stories in the recent fight against the disease are due to improvements of the chemotherapy agents. To understand how these drugs work we have to understand what cancer is and how it works.

Cancer including mesothelioma is the name of a family of diseases whose fundamental behavior involves the uncontrolled division of cells and the subsequent invasion of these cells into other parts of the body. It's a cellular growth that will never stop without intervention. Although people often speak of cancer as if it were a single entity, it is in fact a number of highly-individualized diseases that all work along these same two principles. For our discussion of chemotherapy, the nature of cell division and replication is the most important area to understand about cancer because this is the domain that chemotherapy targets for treatment.

As we said above, chemotherapy refers to the use of drugs and other chemical (“chemo” is a derivative of “chemical”) agents to fight cancer. Most traditional chemotherapy drugs fight cancer by inhibiting the process of cell division (mitosis) among rapidly dividing cells, although some drugs may work along a different framework. There are drugs which enhance the apoptotic process by which malformed cells are removed from the body and others that target different phases in the cell cycle.

In all cases, successful chemotherapy cures the body of cancer by arresting the production of new cancer cells and killing off whatever malignant structures remain. As such, chemotherapy drugs are considered cytotoxic agents which means drugs that kill cells.

But one of the biggest problems with chemotherapy is its lack-of-specificity for cancer cells. Chemotherapy is considered a broad-scope treatment because it attacks all rapidly dividing cells—not just cancer cells. This is the primary reason for the side effects that are commonly associated with it, such as anemia, digestive disorders and hair loss. The natural activity of bone marrow cells, as is also the case with the cells that control the growth of hair follicles and those that line the digestive track, is also characterized by rapid division, so they, too, are affected by chemotherapy. Science is only now beginning to map the different internal structures between normal cells and cancerous ones, so traditional cancer treatments, such as chemotherapy, have been unable to distinguish between these cell types in meaningful ways. Even as recent years have shown a great increase in the overall efficacy of many chemotherapy agents—as well as a reduction in the severity of many of the side effects associated with treatment—chemotherapy is still considered a systemic therapy because of the wide scope of cells that are subject to its cytotoxic effects.

Within the standard framework of cancer treatments, chemotherapy is considered the most effective single modality for the treatment of mesothelioma and is likely to be the most commonly deployed treatment as well. Most people who are diagnosed with the disease in its later stages are not eligible for “curative” surgeries, so chemotherapy becomes their best chance at extending life. For patients who are diagnosed in an earlier stage or are otherwise candidates for surgery, chemotherapy is likely to be used along with surgery and radiation therapy.

Even though chemotherapy can be effective at extending life, it is not a curative treatment for the disease because mesothelioma has not cure at this time. Even as advancements in our treatments have led to longer survival times and better control of patient symptoms, the disease continues to resist long-term management and survival.