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What’s in the Genes? New Research on Malignant Pleural Mesothelioma

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malignant pleural mesotheliomaCutting edge scientific research in mesothelioma is technical, intricate, and can be confusing to most of us. On February 29, 2016, in the journal Nature in the category, Nature Genetics, an article was published entitled: “Comprehensive Genomic Analysis of Malignant Pleural Mesothelioma Identifies Recurrent Mutations, Gene Fusions and Splicing Alterations”. The lead author is Dr. Raphael Bueno.

This research was a collaborative effort involving scientists, physicians, bioinformatics groups, and personnel at the tumor bank at the Brigham and Women’s Hospital. It was supported partly by grants to Dr. Bueno from the National Cancer Institute, the International Mesothelioma Program at Brigham and Women’s Hospital, and Genentech Inc.

The article is written in scientific research form. What the researchers did was analyze tissue from the tumor specimens from 216 cases of malignant pleural mesothelioma, regardless of the type of mesothelioma. Because mesothelioma is a rare cancer, previous studies have been limited by the numbers of tissue samples available. This research had the samples available to study and looked for genetic alterations in the tumors. The article states: “Understanding the genetic alterations that drive MPM [malignant pleural mesothelioma] is critical for successful development of diagnostics, prognostics, and personalized therapeutic modalities.” For example in previous studies, loss of function mutations in gene CDKN2A have been identified in a small number of samples of patients with malignant pleural mesothelioma. The scientific understanding of the mutation of genes in malignant pleural mesothelioma is limited. The article explains: “However, understanding of the mutational landscape of MPM is not yet sufficient to affect classification or treatment strategies.”

Tumors are currently classified as epithelioid, biphasic , and sarcomatoid. This research identified four distinct sub types: sarcomatoid, epithelioid, biphasic-epithelioid (biphasic-E) and biphasic-sarcomatoid (biphasic-S).

The research also identified mutations (changes) in 10 genes and recurrent mutations in several genes. They also recognized changes and alterations in signaling pathways to several genes. This information is vital in furthering research into the treatment and allowing for potentially more treatment options for patients.

What does this all mean to someone diagnosed with malignant pleural mesothelioma today?

Mesothelioma has long been difficult to diagnose and as a result most people do not get diagnosed until the disease is advanced. The diagnosis is difficult to make. Past research has proven that every person’s mesothelioma tumor is as different as every person’s fingerprint.   This research clearly identified four distinct molecular subtypes of malignant pleural mesothelioma and recurrent mutations in several genes expressed in the tumor sample. This is a building block towards taking this research and incorporating it into a clinical test or series of tests to tailor patient care to a pathway that is scientifically proven effective. This is an important step in the progress toward a cure for malignant pleural mesothelioma.

One of the potential ways that this research could impact future treatment of mesothelioma patients is in the development of drugs for specific tumor types and gene mutations.

Scientific research and progress is built on previous research. For this research 100 sources were referenced in the article.

Important research like this takes time, resources, collaboration and dedication of many people. For a patient and their families diagnosed with malignant pleural mesothelioma, this research hopefully will make treatment options more targeted and ultimately more successful.

The full text of the article is located here.

Pembrolizumab: A New Path for Mesothelioma Treatment

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What is Pembrolizumab?

PembrolizumabPembrolizumab or Keytruda is a drug manufactured by Merck Pharmaceuticals. Keytruda was given accelerated approval by the U.S. Food and Drug Administration for the treatment of patients with metastatic non-small cell lung cancer (NSCLC) on October 2, 2015. Keytrunda is a programmed death receptor-1 (PD-1) blocking antibody.   It is a humanized monoclonal immunoglobulin (Ig) G4 antibody directed against human cell surface receptor PD-1 with potential immune checkpoint inhibitory and antineoplastic activities. The NSCLC tumor must express programmed death ligand 1 (PD-L1) as determined by an FDA approved test, with disease progression on or after platinum-containing chemotherapy.   Patients whose cancer has certain gene mutations should receive this drug only after their disease got worse after treatment with FDA- approved therapy for the gene mutation. Pembrolizumab is also approved for melanoma that cannot be removed by surgery or that has metastasized.

How does Pembrolizumab work with the Immune System?

Pembrolizumab works with your immune system in a very specific way. It will not work with all cancers. At this point Clinical Trials are being conducted for its indications in other cancers. The cancers that Pembrolizumab is being trialed on include bladder, breast, colorectal, esophageal, gastric, head and neck, hematology, lung, and melanoma.

Pembrolizumab and Mesothelioma

Mesothelioma tumors are all different.   By finding and understanding the proteins that the tumor secretes it is hoped that the drug can target the immune system cancer-specific antigens. Once targeted the drug will then activate the immune system to seek out the cancer targets. Research is continuing in the sustainability of the treatment. If sustainable, is it a cure?   This is all research that needs clinical trials to follow patients over time and measure the results.

Pembrolizumab is administered intravenously. The dose is 2mg per kilogram. A person weighing 170 pounds would receive 155mg. It would be infused intravenously over 30 minutes every 3 weeks.

Side effects include fatigue, decreased appetite, dyspnea- and cough.

Adverse reactions include immune mediated pneumonitis, colitis, hepatitis, nephritis.

More information can be found about Pembrolizumab on www.cancer.gov/about-cancer/treatment/drugs/pembrolizumab

Pembrolizumab and Mesothelioma Clinical Trials

Presently there are 3 Clinical Trials listed on www.ClinicalTrials.gov involving mesothelioma and Pembrolizumab. We strongly encourage you to consider these clinical trials. Immunotherapy can be a promising treatment option against mesothelioma. The only way for this potentially exciting treatment option to be proven for mesothelioma is participation in a Clinical Trial.

The Immune System, Immunotherapy and Mesothelioma

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immunotherapyThere are new ads on TV announcing new, exciting drugs for the treatment of certain types of lung cancer. The ads show people that are with their families seeing the news of another option for therapy. What are they talking about? How does it relate to mesothelioma? Not only are they new drugs they are in a new class of cancer treatments. Immunotherapy is a new class of therapies to treat certain types of cancer.

In order to understand the use of immunotherapy for cancers, such as mesothelioma, it is important to first understand the human immune system.

The Immune System

As researchers make progress toward treating cancer one system in the body plays an integral part in targeting new therapies. The immune system is a sophisticated, complex, system that functions to prevent or limit infections. It can be confusing and overwhelming when your Doctor starts talking about possible treatments that involve the immune system. We also hear and see ads that talk about boosting our immune system with certain products and supplements. What does it all mean? What should you be doing or not doing? Does a certain lifestyle contribute to making you more susceptible to a compromised immune system? How does the immune system work every day to help us stay healthy? What causes the immune system to turn bad on us- develop diseases such as “auto immune diseases’? Is the future to treating and controlling cancer in targeting the immune system?

Let’s start with a definition of what the immune system is. According to www.Merriam-Webster.com: Medical Definition of immune system

  • : the bodily system that protects the body from foreign substances, cells, and tissues by producing the immune response and that includes especially the thymus, spleen, lymph nodes, special deposits of lymphoid tissue (as in the gastrointestinal tract and bone marrow), lymphocytes including the B cells and T cells, and antibodies

The immune system is not located in one place, like your lungs, but it is a collection of organs, special cells, and substances that act to protect the body from infections. It is located in skin, bone marrow, blood stream, thymus, lymphatic system, spleen, mucosal tissue of the G.I. tract.

The cells start in the bone marrow and develop into mature cells through a series of changes that occur in different areas of the body. The largest organ of the body, our skin, is the first line of defense against potential harmful bacteria. Skin cells produce and secrete antimicrobial proteins, immune cells, which can be found in specific layers of skin.

Bone marrow is located deep inside our bones. Stem cells are found there, they can develop into a variety of cell types. “The common myeloid progenitor stem cell in the bone marrow is the precursor to innate immune cells- neutrophils, eosinophils, basophils, mast cells, monocytes, dendritic cells, and macrophages- important first-line responders to infection.” www.niaid.nih.gov/topics/immuneSystem

Lymphocytes are a type of white blood cells that are very important to the entire immune system. The lymphocyte determine how and what the response will be to infectious organisms and other foreign substances.

Lymphocytes may have immunological memory and also can mount an immediate defense. Natural killer (NK) cells share features of both innate and adaptive immune cells. Lymphocytes are B, T, and NK cells. B cells and T cells are adaptive immune cells. They have a memory- immunological memory- they respond to previous encounters they have had with microbes.

The blood stream has immune cells circulating throughout it. A reflection of how the body is in balance is when a complete blood count (CBC) is drawn. The lab is able to give a white blood count (WBC) and other cell counts to indicate if there is a problem. In adults lymphocytes make up approximately 20 to 40 per cent of the total number of white blood cells.

The thymus is located in the chest, behind the sternum and between your lungs. It has two lobes and reaches a maximum weight of I ounce, around puberty. After puberty it shrinks and turns into a fat deposit. The thymus is important in the production and maturation of T cells. T cells are a specific type of white cells.   All T cells are produced by the time of puberty. The thymus is responsible for secreting a hormone, thymosin, necessary for T cell development and production. From the thymus the T cells migrate to the lymph nodes, throughout the body. Hodgkin disease and non-Hodgkin lymphomas, are examples of lymphocytes that have gone bad and develop into cancers.

Lymph is a fluid outside the cell- extracellular – that helps connect the lymphatic system with lymphoid organs, such as lymph nodes. The lymphatic system is how communication happens between tissues and the blood stream. Lymph nodes are where immune cells converge, lymph nodes are throughout the body. Lymph nodes become swollen when a foreign substance invades the body and the cells then activate, replicate, and leave the lymph node to find the pathogen.

The spleen is an organ located under the rib cage in the upper far left of the abdomen, left of the stomach. It is on average about 4 inches long. The spleen functions as a filter for blood. Old red cells are recycled in the spleen, platelets and white cells are stored there.

Mucosal associated lymphoid tissue (MALT) is found along the mucosal lining of the respiratory tract and the G.I. tract. Mucosal surfaces are where pathogens can gain entrance. It also is recognized as the most extensive component of lymphoid tissue. Examples of these tissues are the tonsils, peyers patches within the small intestine, and the veriform appendix.

What is Cancer Immunotherapy?

Immunotherapy is an exciting new class of treatments for specific cancers. The immune system is a complex system of the body, involving many moving parts. The immune system functions to protect us from foreign substances that might produce infections, diseases, and upset the steady state of our bodies. It is known that the cells of the immune system have specific tasks that they perform.   Some of the components of the immune system are the dendritic cells, B cells, cytokines, regulatory T cells, CD4+Helper T Cells, CD8+ Killer T Cells, antibodies. All have specific functions. For example CD8 + Killer T Cells function to kill harmful cells such as cancer cells. They can seek out and kill the cells, such as viruses and proteins that are expressed by the cancer cells. A way to help fight cancer is to target those cells to kill the cancer cells, and enhancing them to eliminate the cancer and sustain the therapy, leading to a cure.

How does Cancer Immunotherapy work?

The way the treatments work is to use the immune system in a few targeted ways. The drugs are designed to take the way the immune system works for the good and enhance that. The first way is to stimulate your own immune system to work harder to attack cancer cells. The second way is to give your immune system components, such as man-made immune system proteins to help fight cancer. Some researchers are predicting that immunotherapy will be the way of the future in treatment of certain cancers.

Immunotherapy for Mesothelioma

Overall, immunotherapy is targeted to be very specific and precise. It is targeted for specific proteins expressed by certain types of tumor cells. In mesothelioma it is known that the cancer expresses certain proteins. When using the drug Pembrolizumab, in a clinical trial of patients with mesothelioma, Pembrolizumab, a monoclonal antibody, is used to block a protein called programmed cell death 1 (PD-1). It is theorized that it will then stimulate an immune response and kill tumor cells. This particular immunotherapy is given intravenously at 2-3 week intervals.

With the complexity of the immune system, scientists are very excited that they are seeing positive results from this new class of treatments for cancer. Mesothelioma is a complex tumor and breaking it down with this entire new treatment option, has given hope to a cure.

Mesothelioma Clinical Trial Review – Pembrolizumab at University of Chicago

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u-chicagoOn www.ClinicalTrials.gov there are 3 listings involving mesothelioma and Pembrolizumab.

The first clinical trial listed is for malignant mesothelioma patients only.

We will be featuring this trial below. This is the only mesothelioma-exclusive clinical trial listed.

The second trial is not yet recruiting. It will include other cancers as well. The title is: A Trial of CDX-1401 in Combination With Poly-ICLC and Pembrolizumab, in Previously Treated Advanced Solid Tumor Patients.

The third trial is ongoing and recruiting, it involves other cancers besides mesothelioma, is at multiple sites, and for people whose cancers have progressed on standard therapy. It is titled: Study of Pembrolizumab (MK-3475) in Participants with Advanced Solid Tumors (MK-3475-158/KEYNOTE-158)

Clinical Trial- NCT02399371

Pembrolizumab in Treating Patients With Malignant Mesothelioma

Official Title: A Phase II Study of the Anti-PD-1 Antibody Pembrolizumab in Patients with Malignant Mesothelioma

Listing on www.clinicaltrials.gov

Sponsor- University of Chicago

Principal Investigator- Hedy L Kindler M.D.

Contact: Hedy L. Kindler 773-702-0360 hkindler@medicine.bsd.uchicago.edu

Number of Participants- 65

Purpose:

This clinical trial is for patients with malignant mesothelioma. It is for both peritoneal and pleural mesothelioma, and for cell types, (epithelioid, biphasic , sarcomatoid) the most common ones. It also includes recurrent peritoneal and pleural mesothelioma. It is a Phase II trial. The drug Pembrolizumab is a monoclonal antibody. The way monoclonal antibodies work is by blocking a protein called programmed cell death 1 (PD-1) which may stimulate an immune response and kill tumor cells.

Screening:

Pemnrolizumab focuses on a protein called PD-L1 which is expressed by mesothelioma types of tumors. You must have enough tissue for diagnosis so 3 biomarkers can be studied. You must have an archived specimen of your tumor or you will need to have a biopsy . Your disease must be measurable. A recent CT scan could have the information required. You must have had chemotherapy and either finished treatment or were unable to tolerate chemotherapy. Your tumor specimen will be submitted to Merck and will be tested for the bio-markers. This process takes approximately 3-4 weeks.

Eligibility Criteria

Age 18 or older, male or female, histologically or cytologically confirmed pleural or peritoneal malignant mesothelioma, epithelial, sarcomatoid, or biphasic subtypes. Only for part B-PD-L1 selection should a PD-L1expression threshold have been defined in Part A and potentially additional mesothelioma trial data; there will be no PD-L1/biomarker selection for Part A, no more than 2 prior lines of cytoxic therapy, which should have included pemetrexed and a platinum. Enrollment of treatment naïve patients who refuse standard chemotherapy or are intolerant may be permissible if reviewed and deemed clinically appropriate by the principal investigator.

Disease progression on or after pemetrexed and cisplatin or carboplatin (These are the first ones listed there are more- check on www.clinicaltrials.org ).

Exclusions:

Patients who are currently participating in or have participated in a study of investigational agent or have used an investigational device within 2 weeks (4 weeks for monoclonal antibodies) of the first dose of treatment. Also, patients that: have had side effects from prior treatment which have not resolved to =

How the Research Study is Designed to Work:

Pembrolizumab is infused through an I.V. over 30 minutes on day 1. Treatment repeats every 21 days for up to 24 months in the absence of disease progression or unacceptable toxicity. Patients may be eligible for up to 1 year of additional pembrolizumab therapy if they progress after stopping pembrolizumab.

As with any clinical trial you are free to withdraw at any point during the process.

Reminder to Mesothelioma Caregivers: Don’t Forget About Yourself

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post-thumbnailMesothelioma is a diagnosis that affects not only the patient but also the caregiver. When one person in the family is sick, everyone feels it; everyone is affected. One day everything is “ok” and the next day your life has changed; it is unexpected and it can feel traumatic.

Most often the caregiver is the one who takes on the role of the patient’s treatment manager. The one who makes appointments, manages medications, does the research, attends all appointments, takes notes, asks the questions and keeps family and friends updated on progress. However, life outside of the disease does not stop. “Regular life”, pre-mesothelioma, still goes on. You still need to pay bills, cook meals, clean the house, go to work or take care of children on top of your new role as caregiver and all the duties it entails. This can lead to what is known as caregiver stress. What does caregiver stress look like? How does it manifest itself?

It manifests itself in many different ways. For example, the caregiver feels fatigued, weighed down. They put the patient’s needs first and their own needs last. The caretaker often neglects their own health; cancelling their own doctor’s appointments, not exercising regularly, eating on the run or eating more comfort food. In addition, stress can affect one’s sleep. The caregiver has so much on their mind it’s often hard to “shut it off” in order to get to sleep. Poor sleep can lead to irritability and having less patience than you normally would.

In addition, caregivers spend a great deal of time emotionally supporting the patient, leaving caregivers feeling emotionally depleted and without much left for themselves. It is important to recognize and acknowledge that caregivers willingly and lovingly take on the caregiver role but it is not without an emotional price tag.

So, caregivers remember: pay some attention to yourselves, if for no other reason than to have enough stamina left to be a caregiver.

Mesothelioma Center Review – Brigham & Women’s Hospital

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It is recommended that when you or your family member is diagnosed with mesothelioma that you be evaluated at an academic, multi-disciplinary mesothelioma center. In order to become familiar with what a center can offer, we feature one center a month.

Brigham & Women’s Hospital

Brigham and Women’s Hospital
75 Francis Street
Boston, MA 02115
International Mesothelioma Program- IMP-
www.brighamandwomens.org | www.impmeso.org

b-w-mesoThe International Mesothelioma Center (IMP) at Brigham and Women’s Hospital was founded by Dr. David Sugarbaker, an international expert on mesothelioma in 2002. It has grown to become the largest center for mesothelioma care in the world. The mesothelioma team of 80 caregivers, scientists, and support staff all work toward the mission of the IMP. According to the web site, www.impmeso.org, the three- part mission is :

• Our clinical team “goes for broke” to develop and employ the most effective, cutting edge treatment strategies to offer quality life extension for patients.
• Our scientists bring together basic, translational, and clinical research to understand how and why mesothelioma develops and translate their findings into improved patient care.
• Our supportive staff includes social workers, chaplains, and patient coordinators whose work helps improve the quality of life for our patients and their family and friends.

Dr. Raphael Bueno is the Chief of the Thoracic Surgery Division of the Brigham and Women’s Hospital. He is also the Director of the International Mesothelioma Program; Vice- Chair of Surgery for Cancer and Translational Research; Co-Director, Brigham and Women’s Hospital Lung Center; and Professor of Surgery, Harvard Medical School. Dr. Bueno has been with the IMP since its inception.

The team that works with the IMP includes oncologists from the Dana Farber Cancer Institute, radiologists with the Brigham and Women’s Hospital and Dana Farber. Support team members including chaplains, social workers, and nurses. All of these professionals have an interest in improving the lives of mesothelioma patients.

According to Dr. Bueno “We’re on the brink of incredible breakthroughs in the diagnosis and treatment of mesothelioma. Having been at the International Mesothelioma Program (IMP) since its inception, and now serving as director of this world-renowned program, I’m incredibly proud of our progress to date. Thanks to the incredible talent and dedication of our staff, we’re able to provide comprehensive, cohesive, life-extending mesothelioma care to our patients. Here at the IMP, we believe that mesothelioma should ultimately be treated as a chronic disease. This means taking a long-term view of the patient/provider relationship, knowing that, just like other chronic illnesses, patients’ symptoms must be managed on an ongoing basis. To that end, our staff remains involved with patients long after they leave Brigham and Women’s Hospital, maintaining strong ties to them and their families in the event that further treatment is needed.”

The International Mesothelioma Program has seen patients from all over the world. More than 2,200 patients representing all 50 states and many foreign countries have come to Boston to the IMP.

Research is a vital part of the IMP. The research focus of the IMP is collaboration. This is very important as mesothelioma is a very rare cancer, thus not commanding the funding of other cancers. The goal is to bring together researchers to help understand how and why mesothelioma develops and to translate the findings into improved patient care.

Scientists at the IMP are currently conducting research using the IMP Tumor Tissue Bank, which contains sample vials of about 1,000 patients. These scientists are able to perform genetic tests and genomic sequencing to aid in the diagnosis and prognosis of mesothelioma.

Clinical trials are the way that mesothelioma treatment advances. The IMP is involved, along with their partners in a number of collaborative clinical trials. Some of the partners are Verastem, Genetech and Castle Biosciences.

The IMP also provides a new patient orientation for patients and families, housing support while in the Boston area, support groups for caregivers, chaplaincy and social work support.

The number to call for new patients is 1-617-732-5922. This will connect you with the Division of Thoracic Surgery New Patient Coordinator, or request an appointment on line by going to www.impmeso.org and clicking on New Patient Appointment /Referral Form.

Mesothelioma Clinical Trial Review

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c-trialsWe encourage participation in clinical trials for research leading to a cure for mesothelioma. It is known that nationally the statistics for participation in adult cancer trials is between 3-5% of adults who have a cancer diagnosis.

For mesothelioma patients and families who are interested in clinical trials, researching clinical trials and eligibility can be a time consuming barrier to participation.   The information about clinical trials is available on www.clinicaltrials.gov .

Our goal is to feature one mesothelioma clinical trial monthly and break it down to understandable terms, to decipher the eligibility requirements, and to possibly encourage participation in these trials.

CLINICAL TRIAL – NCT02004028

Window of Opportunity Study of VS-6063 (Defactinib) in Participants With Surgical Resectable Malignant Pleural Mesothelioma

Official Title- An Open Label Window of Opportunity Phase 11 Study of the FAK Inhibitor VS-6063 in Participants With Surgical Resectable Malignant Pleural Mesothelioma

Listing on www.clinicaltrials.gov

Sponsor-Verastem Inc.

Location- Brigham and Women’s Hospital Boston Massachusetts

Principal Investigator- Raphael Bueno M.D.

Contact- Julianne Barlow- 617-525-8541 jbarlow1@partners.org

Number of Participants- expected to be around 25

Purpose- This clinical trial is for people who have been diagnosed with malignant pleural mesothelioma and are a candidate for surgery. It is a drug given at specific times before surgery to participants who meet the eligibility criteria. The drug is a FAK inhibitor, named Defactinib. This drug will be given prior to surgery. Current therapy is surgery followed by chemotherapy and other treatments. The drug is a type of enzyme inhibitor that blocks the activation of specific signaling pathways in the body. The theory is that blocking these path ways may prevent tumor cells from growing and migrating to different areas of the body. After taking this drug, surgery will be scheduled about 7 days after completion.

Screening- Some of these tests you will undergo if you are considering surgery with or without this clinical trial.

  • A medical history
  • physical exam
  • vital signs
  • performance status
  • pulmonary function tests
  • quantitative ventilation-perfusion scan
  • PET scans
  • MRI for evaluation of your tumor
  • blood tests for biomarkers in addition to routine blood draws, biomarkers are genes or proteins that may predict how your body will respond to the study drug,
  • EKG
  • Pregnancy test if needed.

Eligibility Criteria

  • The patient must have a confirmed diagnosis of malignant pleural mesothelioma. The disease is confined to one side of the chest.
  • Be older than 18, male or female, not pregnant, be a candidate for surgery.
  • Tissue is required prior to enrollment. If patient was diagnosed outside and tumor tissue is not available, a pleural biopsy for frozen tissue collection is required.

Exclusions

  • Participants who have had chemotherapy or radiotherapy for mesothelioma any time prior to entering the study.
  • Patients receiving chemotherapy type drugs for benign conditions can participate in this trial. History of upper gastrointestinal bleeding, ulceration, or perforation within 12 months prior to the first dose of the study drug.
  • Known history of Gilbert’s Syndrome or any current hyperbilirubinemia of any cause.
  • Known history of stroke or cerebrovascular accident within 6 months prior to the first dose of the study drug.
  • Known infections with human immunodeficiency virus (HIV) or Acquired Immune Deficiency Syndrome (AIDS).
  • Confirmed Hepatitis A, B, or C.
  • Being actively treated for a secondary malignancy or any malignancy within the last 3 years, with the exception of nonmelanomatous skin cancer or localized, definitively treated cervical cancer.
  • Men under observation for local prostate cancer are also eligible if they have had stable disease for at least 1 year.
  • Uncontrolled or severe cardiovascular disease, including myocardial infarct or unstable angina within 6 months prior to study treatment.
  • Known history of malignant hypertension.
  • Uncontrolled intercurrent illness including symptomatic congestive heart failure, cardiac arrhythmias, or psychiatric illness/ social situations.

How the Research Study is Designed to Work

If you are eligible, a biopsy will be done if you don’t have previous tissue available to evaluate the specimens and biomarkers. After the biopsy- the participant starts taking the study drug by mouth twice a day for 35 days. The participant will have a study drug dosing diary. The tumor will be assessed by scans – CT, MRI, and a PET- CT at different points in the study. Different days will require clinic visits at specific times during the trial.

With any clinical trial, all participation is voluntary. Before enrollment a detailed consent form will be reviewed with the participant and signed.

The participant can withdraw from a clinical trial at any point in time. Think about participating if able, the only way progress to a cure for mesothelioma can be made is through clinical trials.

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Your message to us will be held in strict confidence. All requests for information by mesothelioma patients and their family members will be answered within 24 hours. Mesothelioma Treatment and Care Guides are sent to mesothelioma patients and families by overnight delivery.

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