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Mesothelioma Specialist Spotlight – University of Maryland

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The University of Maryland School of Medicine Mesothelioma and Thoracic Oncology Treatment and Research Center

University of Maryland Medical CenterMesothelioma is a very rare disease. It is estimated that it affects less than 1% of all patients with a cancer diagnosis. For many years there were no options for patients and families facing mesothelioma. When dedicated physicians and scientists started to research this rare disease, progress started to happen.

This month we will feature two internationally known and respected leaders in the field of mesothelioma treatment and research. Together they are working in one mesothelioma center that is moving forward to work for a cure.

The University of Maryland School of Medicine Mesothelioma and Thoracic Oncology Treatment and Research Center is a new center under the Directorship of Joseph Friedberg M.D. Dr. Friedberg is an international expert in malignant pleural mesothelioma. Before coming to the University of Maryland he was at the University of Pennsylvania. This biographic information came from the web site of the University of Maryland, www.umaryland.edu

Dr. Friedberg joins another international expert in mesothelioma at the University of Maryland, H. Richard Alexander, MD., who is Professor of Surgery at the University of Maryland School of Medicine. Dr. Alexander is an expert in peritoneal mesothelioma and he is the Associate Chairman for Clinical Research.

Dr. Friedberg graduated with his bachelor’s degree from the University of Pennsylvania College of Engineering and Applied Science. He received his M.D. from Harvard Medical School. He has completed residencies at Massachusetts General Hospital and the Mass Eye and Ear Infirmary. He also completed a fellowship in cardiothoracic surgery at Brigham and Women’s Hospital. Dr. Friedberg returned to the University of Pennsylvania Presbyterian Medical Center. He has developed many research interests with mesothelioma, including photodynamic therapy. In addition he has been at the forefront of a new type of therapy called “photobrachytherapy” that combines immunotherapy, radioisotopes, and other photosensitizers . Dr. Friedberg was the Chief of Thoracic Surgery, co-director of the Penn Mesothelioma and Pleural Disease Program and an associate professor of thoracic surgery at the University of Pennsylvania’s Perelman School of Medicine. Dr. Friedberg’s publications are many as are his awards noting his many contributions to researching to a cure.

Dr. Alexander received his MD degree from Georgetown University. From Georgetown he entered into the Navy where he completed his residency in general surgery at the National Naval Medical Center in Bethesda Maryland. Following that he did a fellowship in surgical oncology at the Memorial Sloan-Kettering Cancer Center. He has spent 16 years at National Institute of Health where he was the deputy director of the NCI’s Center for Cancer Research. During this time he developed an interest in new and effective ways to treat cancers that few were researching. Dr. Alexander is an expert in the treatment of peritoneal mesothelioma. He has published extensively, and has lectured both nationally and internationally.

By joining forces, these two distinguished physicians and their respected teams have built a world-class mesothelioma center at the University of Maryland for both pleural and peritoneal mesothelioma patients.

Please let us know if you have any questions.

Peritoneal Mesothelioma & Quincy Jones

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mesotheliomaOn the Ellen DeGeneres show on March 15, 2016 comedian Quincy Jones appeared and told his story of being diagnosed with peritoneal mesothelioma in August of 2015. He is a young comedian, 32, with a very positive outlook on a deadly cancer that has affected his life. Last year he was suffering from abdominal pain and distension that eventually took him to his local emergency room. For 6 months he had been in and out of hospitals with the same complaints. He was told that he had ascites- fluid in his abdomen-and that it should be tapped. Since he had no insurance, he was told to go to another hospital that could provide this treatment. He has spent 6 months a couple of times a week getting his abdomen drained, 4-7 liters at a time. This procedure is designed to keep him comfortable. A biopsy was performed during those 6 months and stage IV peritoneal mesothelioma was the diagnosis. He was also told that most people with his diagnosis only live a year.

Peritoneal mesothelioma is one of four types of malignant mesothelioma. It develops in the peritoneum which is the lining of the abdomen. There are about 500 cases a year of peritoneal mesothelioma in the United States.   Early symptoms of peritoneal mesothelioma include abdominal swelling, pain, diarrhea and constipation.

A thorough detailed history and physical exam should be performed when a patient presents with these symptoms. In almost all cases, other much more common diseases are usually the problem.

Peritoneal mesothelioma is difficult to diagnose and treat. When diagnosed it is advised that you go to a mesothelioma center that has an expert in peritoneal mesothelioma. Once diagnosed, and staged, there are treatment options that might be appropriate to your case. The options include chemotherapy, radiation and surgery. A promising option is intra op heated chemo, (HIPEC) and surgery. The goal of surgery is to remove all the tumor visible to the naked eye. It is assumed that there are microscopic cancerous cells still in the area where the tumor cells are removed that is why a heated chemotherapy solution is instilled. The dwelling time for the solution is 60- 90 minutes. The side effects are less than what others experience from traditional chemotherapy. During surgery abdominal catheters are placed so that chemotherapy can be infused after surgery. There is no known cure for mesothelioma. With early aggressive treatment, survival time has increased for some patients. By definition, Stage IV peritoneal mesothelioma means that the cancer has spread throughout the body. Surgery is not an option at this point, as the cancer is more advanced.

Quincy Jones, like most people faced with their mortality, examine what they want to be remembered for. What difference have they made during their life? What will he leave behind?   He decided to focus on what he is passionate about – comedy.

He decided he would like to tape a one hour comedy show and have it aired on HBO or Netflix. Having shared his idea with friends, they started a Kickstarter page to raise the money necessary to make his dream a reality.

During the appearance on the Ellen DeGeneres show on March 15, 2016 he told his story, explained his positive outlook, and what his dream was. He also said he is undergoing chemotherapy every three weeks and is nauseous at times. Ellen praised him for his humor, courage and his amazing attitude. Quincy also stated that he was given the diagnosis and the prognosis on August 6, 2015. Six months have gone by, and he “doesn’t think it is going to happen,” referring to dying. He was presented with a check for ten thousand dollars from Shutterfly.

On March 21st 2016 he appeared again on the Ellen show. His dreams are going to be realized. On Monday April 4, 2016 at The Teragram Ballroom 1234 West 7th Street Los Angeles California Quincy is going to tape his show. Ellen has also worked with HBO and they will air his show. Once again in conjunction with Shutterfly she presented him with a check for fifteen thousand dollars.

We salute Mr. Quincy Jones and Ellen DeGeneres’ show and his friends for making his dreams a reality.

Mesothelioma does not typically affect a 32 year old rising comedian. He has taken the saying, “laughter is the best medicine,” and made his dreams a reality.

Mesothelioma Specialist Spotlight – Dr. Hedy Kindler

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Mesothelioma Specialist Spotlight – Dr. Hedy Kindler, University of Chicago

uch_005457-1Dr. Hedy Kindler is a Professor of Medicine at the University of Chicago. She is also the Medical Director, Gastrointestinal Oncology, Mesothelioma Program. Dr. Kindler is an internationally known and respected expert in the care of mesothelioma patients. She is active in the mesothelioma community having served as immediate past president of the International Mesothelioma Interest Group (IMIG).

Dr. Kindler is a graduate of the State University of New York in Buffalo Medical School. Her intern and residency years were at The University of California at Los Angeles Medical Center. Her Fellowship was done at Memorial Sloan Kettering Cancer Center in New York.

Since being in practice since 1995, she has been recognized by her peers and patients alike. She is an associate editor of Lung Cancer.   Her many accomplishments include articles, research, awards and speaking engagements, are her very devoted and grateful patients. Dr. Kindler serves on the Science Advisory Board of the Mesothelioma Foundation, a non-profit for mesothelioma, dedicated to supporting patients and scientists through research for a cure for mesothelioma. She has also been awarded the Selikoff Lifetime Achievement Award by the Asbestos Disease Awareness Organization for her work on behalf of mesothelioma victims.

Dr. Kindler is passionate about improving the quality of life for mesothelioma patients. She is leading clinical trials that are showing promising results.

We recently reviewed in detail one of Dr. Kindler’s current mesothelioma clinical trials using the drug Pembrolizumab. For information about that clinical trial and to read our review click here.

On a personal note, Dr. Kindler is easily accessible via email and devoted to improving patient outcomes.

Mesothelioma Center Review – University of Chicago

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u-chicagoIt is recommended that when you or your family member is diagnosed with mesothelioma that you be evaluated at an academic, multi-disciplinary, mesothelioma center. Here is the latest edition of our monthly review of a mesothelioma cancer center:

 

The University of Chicago’s Medicine Comprehensive Cancer Care Center

The University of Chicago Medicine

5841 S. Maryland Avenue

Chicago, IL 50637

Click here to visit website

The University of Chicago’s Medicine Comprehensive Cancer Care Center, includes an active mesothelioma program.

According to its web site, “Our primary goal at the University of Chicago Medicine is to identify and develop treatment regimens to improve the quality of our patient’s lives and to eradicate mesothelioma as a life- threatening disease. The opportunities in our clinical research program to deliver focused, targeted therapies give us confidence that survival of mesothelioma patients will continue to improve the quality of our patient’s lives and to eradicate mesothelioma as a life-threatening disease.” Started over 25 years ago, the center was one of the first mesothelioma treatment centers.

Led by Hedy Lee Kindler M.D. Professor of Medicine, Medical Director, the program is one of the largest in the United States. Dr. Kindler is an internationally-recognized leader in the mesothelioma community. The physician team consists of surgeons Dr. Mark Ferguson and Dr. Christopher Wigfield, pathologist Dr. Aliya Husain, radiation oncologist Dr. Renuka Malik, radiologists Dr. Alexandra Funaki, Dr. Brent Greenberg, Dr. Steven Montner, Dr. Christopher Straus, Dr. Steven Zangan and Dr. Heber MacMahon, MB, BCh. The University of Chicago Medicine uses the team approach as the basis for its treatment protocols. Under the direction of Dr. Kindler, they have weekly meetings to review treatment options for their patients.

As one of the largest programs in the United States, and the largest in the mid-west, research is an important part of their program. The program has an active research component with eight Clinical Trials listed on its web site, which states: “The opportunities in our clinical research program to deliver focused, targeted therapies give us confidence that survival of mesothelioma patients will continue to improve as they have in the past.”

University of Chicago – Resources for Mesothelioma Patients

Resources to support patients while getting treatment at the University of Chicago include a “Welcome to The University of Chicago Medicine” brochure, which lists area hotels, maps, restaurants, directions, and other practical information.

To request an appointment and a Welcome to The University of Chicago Medicine brochure, call the new patient coordinator at 855-702-8222.

If you choose to attend the University of Chicago for treatment, they offer a large list of resources. There are many hotels available ranging from an affordable to very expensive. If you are a cancer patient, many hotels will offer a reduced rate. For more information on that please contact the Cancer Resource Center at 877-824-0660

Like many hospitals there are many volunteer services that may help you out while you are visiting the University of Chicago medical center. For example you possibly could get a haircut from their local barber or hairdresser.

There may be situations where your loved one is getting treatment, testing or resting and you are bored or anxious. There is local gym for the use of 10 dollars per day. This may a good idea to alleviate some stress and just take a deep breath. You may contact Ratner Athletic Center at 773-702-7684

There is a pharmacy located in the medical center as well as a Walgreens pharmacy that is open 24 hours a day. 773-667-1177 (It is always best to fill new prescriptions as soon as possible)

If you still continue to have to keep up to date on your work-life there are computers, wifi, and a notary public if one is needed.

Sometimes you and your loved one may find some downtime during visits. You may want to check out some of the local tourist attractions. Chicago official tourism site is www.explore.chicago.org

Mesothelioma Patient Empowerment: Charting Your Path

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mesotheliomaWhen diagnosed with mesothelioma or any disease, the search for information begins. What should you do? What should you not do? Where should you go? Who do you trust? Are you doing the right thing? There are so many questions and information to be sorted out. All during this process, you and your loved ones are dealing with the emotional turmoil that the diagnosis delivers.

In 2016, most of us will “Google” the topic to get information. Not all the information is right, not all the information is current, and not all applies to you and your case of mesothelioma. Information is designed to empower people. The concept of patients being an active participant in their care is one that historically has not happened in dealing with the health care system. Your parents did not question the doctor if he said that you had a disease, or needed a therapy – that is what happened. We have progressed from the past to where the medical community now is actively seeking patients to be involved in their own care – patient empowerment.

The definition of patient empowerment, from a researchers point of view, is not agreed upon as of yet. A definition from the McGraw-Hill Concise Dictionary of Modern Medicine, “patient empowerment is the providing of information regarding therapeutic options so a patient can actively participate in the decision on whether to undergo a diagnostic or therapeutic procedure, or pursue alternatives.”

Where does a person diagnosed with a rare life threatening disease turn?

Allow others in. Seek out a medical center, where you will be treated by a team of professionals. You are the focus of the team. The team should include a doctor who specializes in mesothelioma, experts in the fields of oncology, radiology, pulmonologists, nurses, social worker, and a chaplain. Have someone with you for your meetings and appointments. Have a spouse, partner, child, or friend that can listen and take notes if possible. Once presented with recommendations by the medical team, ask questions. Remember, you are the expert of your life.

The road on the journey of mesothelioma is not always smooth, simple, or what we planned. Get as much information as you are comfortable with. Engage in as much emotional support as you need. The decisions that you need to make are difficult. Be at peace that these decisions are yours to make. You have weighed your options and made decisions based on your wishes. That is patient engagement in the year 2016. Sometimes the decisions that patients make are not what is expected.

A patient from another state, this past month had a complicated post-op course.   His wife had been at his side the entire time, she had lost weight, was both physically and emotionally exhausted. He had progressed and, although weak, was ready for discharge. It was assumed by the team that they would stay locally for a short while and then return home. The patient, knowing the stress his wife was under, knowing how he felt, and the amount of assistance he still needed, explored his options. He decided to send his wife home, but chose to go to a rehab close to the hospital with his team. He needed the time to focus on regaining his strength. He would not be worried about his wife, driving back and forth. She would go home and visit on weekends, with friends. They would talk frequently on the phone. When we visited him at rehab he was getting stronger, had gained a small amount of weight, was sleeping at night and did not have one complaint regarding the rehab facility. His wife was much better at home. He reported that she was able to rest and now was anxiously awaiting his return home. He was at peace with his decision to go to a local rehab and it had worked the way he wanted. Without his active participation in his care he would have returned home after his surgery. By knowing his situation and asking questions he was able to seek out and make decisions that were right for him .

Like life– things do not always go according to plan!

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.

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