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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.

Mesothelioma Specialist Spotlight: Dr. David L. Bartlett

dr. david bartlett mesotheliomaThis month we are featuring an expert in peritoneal mesothelioma from the University of Pittsburgh.

Dr. David L. Bartlett, is the Vice Chairman for the Surgical Oncology and Gastrointestinal Services, Director of the David C. Koch Regional Perfusion Cancer Therapy Center at the University of Pittsburgh Medical Center. In addition to being the Director of the Multidisciplinary Disease Site Clinical and Research Programs for the University of Pittsburgh Cancer Institute, Dr. Bartlett is also the Bernard Fisher Professor of Surgery University of Pittsburg School of Medicine.

Dr. Bartlett received his undergraduate degree at Rice University in Houston.  He received his medical degree from the University of Texas.  He completed a residency in general surgery at the Hospital of the University of Pennsylvania, in Philadelphia, and a fellowship in surgical oncology at Sloan- Kettering Cancer Center in New York.  He is board- certified in general surgery.  An expert in cancers of the abdominal cavity,  he has helped to pioneer the delivery of chemotherapy directly to the peritoneal cavity.  His research includes new treatments for abdominal carcinomas.  He is the principal investigator in the Clinical Trial aDC1 Vaccine +Chemokine Modulatory Regimen (CKM) as Adjuvant Treatment of Peritoneal Surface Malignancies.

Dr. Bartlett has been at the forefront of research for peritoneal mesothelioma. Mesothelioma presents in two different areas of the body for most people.  Mesothelioma is a cancer of the lining of the tissue surrounding the lung and abdominal cavity.  Pleural mesothelioma is when the disease appears along the lining of the lung, peritoneal mesothelioma is when the disease is around the lining of the abdomen.  In the U.S., there are approximately 500 – 600 patients diagnosed with peritoneal mesothelioma per year.

As an expert in peritoneal mesothelioma, he has combined new therapies to help with patients who have often been told there are no options. He was one of the pioneers of the development of regional chemotherapy administered to the peritoneal cavity.  This procedure called HIPEC is Hyperthermic Intraperitoneal Chemoperfusion. Dr. Bartlett also is focused on gene therapy and the possibilities of combing therapies for a longer survival and improved quality of life for his patients.

He   leads a multidisciplinary team whose goals are to improve the lives and survival of patients with abdominal malignancies.

Dr. Bartlett is a member of many prestigious organizations including the American Medical Association, American Society of Gene Therapy and the American Association for Cancer Research. He has published extensively.

The entire mesothelioma community is grateful to have a doctor of Dr. Bartlett’s stature advocating for mesothelioma patients.

Please contact us if you have any questions.

Hope for Mesothelioma Patients: Looking forward to 2017

As we approach the end of 2016 and the beginning of 2017, the mesothelioma community has reason to be optimistic as progress is being made towards a cure. Some of the progress made in the battle against mesothelioma in 2016 continues into 2017. As we highlight a few of the accomplishments, we are reminded that none of these could be accomplished without the mesothelioma community working together to advocate for, support and educate the victims of this asbestos related disease. Participation in clinical trials is vital to advance treatment for patients with mesothelioma now and for all future victims of mesothelioma.

Mesothelioma experts have known that every mesothelioma tumor is as different as every person’s fingerprint. Women, particularly aged less than 50, have also been noted to have longer survival with mesothelioma.

Mesothelioma is a complex disease with many genetic mutations. In February of 2016, Dr. Raphael Bueno, published ground breaking research about the gene- sequencing of over 200 mesothelioma tumors. In collaboration with scientists from Genetech, they identified over 2,500 alterations and identified 10 significantly mutated genes in the mesothelioma tumors.

With this research scientists, can now design studies to examine the effects of different medications on more specific pathways – a personalized approach.

Another research study has identified mutations in the TP53 gene implicated in many types of cancer but up to this point not for mesothelioma. The researchers discovered that it was found in 2x as many women with mesothelioma then men. The estimated 5-year survival rate for women diagnosed with mesothelioma is around 22%, for men 9%. One more building block for tailored care for mesothelioma.

These are just a few examples of the progress that continues to be made and advanced for treatment options for mesothelioma patients.

There is no single magic pill that will cure mesothelioma. Progress is being made and must continue with more involvement in clinical trials at the mesothelioma centers of excellence.

Looking forward to more progress and involvement in 2017!

We wish a Happy, Healthy, and Safe New Year!

– Ellie and Lisa

Mesothelioma and the Armed Services

armed services mesotheliomaThis past weekend I had the honor of attending the Army- Navy football game. Although Army won, it was an experience of a lifetime. As we observed American finest young men and women in the prime of their young lives, healthy, it seemed like a foreign thought that some of them in the future could become victims of mesothelioma by simply choosing to serve their country.

According to the World Health Organization web site, www.iarc.fr there are about 125 million people in the world exposed to asbestos in the workplace. All forms of asbestos are carcinogenic to humans. Approximately half of the deaths from occupational cancer are estimated to be caused by asbestos.

How did asbestos become one of the most significant environmental carcinogens on our planet? How does exposure to asbestos from many years ago cause people to be diagnosed with deadly cancers and others to develop pulmonary diseases such as pulmonary fibrosis, malignant mesothelioma of the pleura and peritoneum, and others exposed to asbestos not develop diseases?

Asbestos is a naturally occurring mineral fiber that is in rock and soil. There are six major forms of asbestos: chrysotile, crocidolite, amosite, anthophylite, tremolite and actinolite. “White” asbestos is chrysotile, “blue” asbestos is crocidolite. These two forms are the primary asbestos found, with chrysotile being by far the most prevalent.

The history of using asbestos as a fire retardant goes back centuries. At some points in recent history asbestos was used in different forms for food and many building materials. Asbestos continues to be used today in many products. Although not banned in the United States, it is regulated by the Environmental Protection Agency and the Occupational Safety and Health Administration.

Exposure to asbestos can cause cancer. Approximately 33% of malignant mesothelioma victims are veterans of the armed services.

On this late Fall afternoon looking at the future leaders of our military, we are proud of these young men and women, and wish them nothing but the best. The best does not include exposure to asbestos while they are doing their job.

– Lisa

Coping With Mesothelioma During the Holidays

As we approach the holidays for many people who have been diagnosed with mesothelioma or their family members, it is difficult if not impossible to “be of good cheer.”   The constant reminders of past happy holiday seasons and the uncertainty of how future holiday seasons will be affected weighs heavy on the patient and the family.

A few weeks ago, a mesothelioma patient who had been diagnosed two years ago died suddenly after contracting what was thought to be pneumonia. The timing of his death surprised his family as they had been used to him living fully with mesothelioma for the past two years. His death the week before Thanksgiving left a void that could not be filled and having the holidays approaching has left the family reeling. Dealing with the grief accompanying their loss and at the same time, the time set aside for reflecting and giving thanks, seemed overwhelming when we texted back and forth.

There is no wrong or right way to grieve. The first holiday season after a loss is going to be difficult, prepare yourself for that reality. One of the most important things to remember, as much as you might want to “cancel the holiday,” isolating yourself does not allow you the opportunity of creating a new tradition with others. Creating a new tradition might be the last thing on your mind and you might not feel that it is appropriate, but some people find comfort in changing traditions. Allowing yourself time to grieve during this time of year, to feel joy, anger, overwhelming sadness, while surrounding yourself with people that love and support you can be helpful. Taking care of yourself, exercising, and not drinking too much is also recommended.

Our patient’s family successfully made it through Thanksgiving. Acknowledging that this experience was different and difficult they also found strength in the support they found with each other. They are now planning how they will chart the upcoming Christmas Holiday season.

Two books that deal with this topic are: James Miller: How Will I Get Through The Holidays? Twelve Ideas for Those Whose Loved One Has Died.

Drs. Clarence Tucker and Cliff Davis: Holiday Blues- A Self Help Manual on Grief Through The Holidays

For family and friends trying to support someone during this difficult time, often acknowledging that it is a difficult time and reaching out and listening, is better than any gift you might buy. Our patient’s wife communicates best through texting; ask what way your family and friend are most comfortable communicating with and reach out.

Ellie

The Use of Immunotherapy and PD-1 Inhibitors in Treating Mesothelioma

The mesothelioma community is hearing about different immunotherapy options that are currently being researched. To review – cancer immunotherapy is an emerging avenue to treat cancer. This promising line of research has become an important part of treating some cancers. Immunotherapy is treatment that uses part of a person’s immune system to fight cancer. The immune system is a unique system comprised of organs, special cells, and substances that help protect from germs that can lead to infections and diseases. The immune system is the body’s protector to help maintain health. Usually the immune system can recognize foreign substances but since some cancers are known cells that start replicating wildly, the immune system is slow to respond and doesn’t recognize cancer cells as foreign. Researchers have found different prototypes to help the immune system recognize cancer cells and strengthen its response. The main types of immunotherapy that are now being used:

  1. Monoclonal antibodies: man- made versions of immune system proteins- substances found in the immune system- designed to attack a very specific part of the cancer cell.
  2. Immune checkpoint inhibitors: drugs that take the brakes off the immune system which help it recognize and attack cancer cells
  3. Cancer vaccines: substances injected into the body to start an immune response against certain cancers
  4. Non-specific immunotherapies boost the immune system in a general way and help the system attack cancer cells.

Immune checkpoint inhibitors have the ability to distinguish between normal cells in the body and those it sees as “foreign.” These allow the immune system to attack the foreign cells while leaving the normal cells alone. PD-1 is a protein on immune T cells. It acts as a type of on and off switch that keeps T cells from attacking other cells in the body. Progress has been made in this area with drugs that target PD-1 -Pembrolizumab (Keytruda) and Nivolumab (Opdivo).

One of these types of immunotherapy- immune checkpoint inhibitors- is showing some early promising results in clinical trials. In an article written by Giovanni Luca Ceresoli, Maria Bonomi, and Maria Gratzia Sauta, “Immune Checkpoint Inhibitors in Malignant Pleural Mesothelioma: Promises and Challenges,” published in May of 2016 indicates that Phase 1 Trials involving PD-1 and PD-L1 inhibitors are ongoing with early promising results. One of the most promising statements from the article is, “the emergence of these new therapies is going to change the whole cancer therapy scenario in the next few years. Based on this upcoming evidence, therapy with immune checkpoint inhibitors is being evaluated also in patients with malignant pleural mesothelioma.”

As these early results are promising it takes time and money to continually evaluate the response of the new drugs in the treatment of malignant pleural mesothelioma. The fact that they are being used for certain cancers is an encouraging sign that they might be helpful in mesothelioma. Once again seeing these results reminds us of the vital importance of participation in clinical trials.

Lisa

 

 

 

The Strength of the Mesothelioma Community

For some patients and families being diagnosed with mesothelioma brings them in contact with other people that they would never had met before, have little in common with, live nowhere near each other, are from totally different socioeconomic backgrounds. These relationships can be some of the most comforting for both the patients diagnosed with mesothelioma, and their families.

Recently while seeing a patient at a hospitality house near the hospital, one of the patients needed immediate medical assistance. After calling for an ambulance the patient was transported to the Emergency Room for treatment. The family was being supported by another mesothelioma patient and his family that they had become friendly with. Talking to the mesothelioma patient that was at the house after the other had gone to the E.R., the concern for the other patient was paramount. He and his family were quietly reflecting on the events, how worried they were about the other patient and his family. They were sharing stories of how they had met and how close they had become over the past few weeks. There was a bond between the families as well as the patients.

The sense of community is a powerful one in the small mesothelioma community. To be diagnosed with a rare cancer, seek treatment, and live with this cancer, requires support. Often the support comes from other patients and families. These bonds between people unite them in a way that is deep and meaningful.

As we enter the Holiday season in 2016, we are reminded in many different ways, that what unites us can be as simple and important as concern for others. Mesothelioma is a cancer for which there is no cure-yet. It can also remind us about how truly important our relationships are, as we give thanks this year.

– Ellie

Mesothelioma Center Review – Mt. Sinai Medical Center

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.

MOUNT SINAI MEDICAL CENTER

1470 Madison Avenue

New York, NY 10029

212-241-9466

www.mountsinai.org

 

Mission: The mission of the Mount Sinai Health System is to provide compassionate patient care with seamless coordination and to advance medicine through education and research to many diverse communities.

The Mesothelioma Center is part of the Tisch Cancer Institute at Mount Sinai Hospital.

History:   The hospital has long history and opened 1855 and was named Jew’s Hospital. The hospital was originally serving a predominantly Jewish population. In 1866 the hospital changed its name to Mount Sinai Hospital as if grew to serve a more diverse population. Dr. Selikoff was a leading expert on occupational diseases at Mount Sinai.   Dr. Selikoff became world renowned for being an expert about diseases caused by asbestos. After his death the division was renamed the “Irving J Selikoff Center for Occupational and Environmental Medicine”.

Team: The Mount Sinai Mesothelioma Division of the Thoracic Surgery Department is lead by many world renowned physicians.

  • Raja Flores is the Chief of the division of Thoracic Surgery and Professor of Cardiothoracic Surgery.
  • Claudia Henshke, PhD, MD- Director Lung Screening Program, Professor of Radiology, head of International Early Lung Cancer Action Program which is an international group of lung cancer experts.
  • Paolo Boffetta M.D. Director, Institute for Translational Epidemiology and Associate Director for Population Sciences at the Tisch Cancer Institute of the Icahn School of Medicine. Research is focused on cancer epidemiology and prevention
  • Jorge Gomez, MD- Medical Director of Thoracic Oncology Program- medical oncologist whose research interests include incorporation of new theraputic agents into the standard treatment of lung cancer through clinical trials
  • Charles Powell MD- Chief Division of Pulmonary, Critical Care and Sleep Medicine- research centers on understanding the genetic and susceptibility factors for lung cancer and mesothelioma. He is the Chair of the Thoracic Oncology Section of the American Thoracic Society
  • Kenneth Rosenzweig M.D.- Chairman Department of Radiation Oncology- developed innovative methods for the delivery of precise doses of radiation to lung tumors , World renowned researcher has written extensively on radiation therapy.

The Mount Sinai team includes pathologists, radiologists, pulmonologists and thoracic surgeons.

Affiliations: Icahn School of Medicine at Mount Sinai and seven member hospitals of the Mount Sinai Hospital System

Research: Mount Sinai has a history of extensive groundbreaking research. Some of their focus has been on molecular pathways in mesothelioma, molecular testing, lung screening, immune-fighting cells in the lung, biological indicators of aggressive early-stage lung cancer.   In addition, Dr. Flores is involved with the Libby Epidemiology Research Program.

Support Services: Mount Sinai has many services for the patients and families. Some of the services are Hispanic initiatives, translational services, social work services, spiritual services and patient representatives.

Contact: 212-241-9466 for an appointment with Thoracic Division

___________________

Dr. Raja Flores

Chairman Department of Thoracic Surgery

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Libby Montana: How an Idyllic Town Became the Home of An Asbestos Disease Epidemic

Libby Montana Asbestos MesotheliomaThere is a beautiful place in Montana in the northwestern area named Libby. The description from the City of Libby web site speaks for itself. ” Libby Montana, is a uniquely located town in northwestern Montana where the Cabinet Mountains meet the Kootenai River. Surrounded by the public lands of the Kootenai National Forest, Libby offers pristine lakes, rivers and mountain trails unencumbered by the crowds of people you would encounter anywhere in the lower 48 states. Down hill skiing options are some of the most varied in all the Northern Rockies with four to choose from in a less than 2- hour drive. Nordic skiers can explore the solitude of the back country or enjoy groomed trails with evening skiing. Rivers and streams are filled with native fish that reproduce freely and don’t need to be restocked. Local guides float the Kootenai with fly fisherman from all over the world. Hiking trails include 1400 miles of moderate to strenuous hikes that follow huckleberry laden hills to breathtaking views of the Cabinet peaks.”   The description goes on to describe an idyllic place for all seasons.

The Environmental Protection Agency –EPA- is charged with protecting the health of people as well as the environment, air, water and land. Together with local agencies they assess, evaluate an area then act. Sites can be declared Super Fund sites that designate them for cleanup. Since the beginning of this process there has been one site that conditions have deemed it be designated as a public health emergency. On June 17th 2009, the director of the EPA determined that conditions at the Libby Asbestos site constitute a public health emergency the first and only Public Health emergency from an environmental disaster.

The idyllic place in northwestern Montana was poisoning the residents. For decades in the mountains and hills of Libby the residents made a living working at the mining operations of asbestos initially for the Zonolite Company. In 1963 W.R. Grace purchased the mining operation and greatly increased production. Production did not stop until 1990. While the mine was operating it is estimated that it produced about 80% of the world’s supply of vermiculite. Vermiculate was used in building insulation and as a soil fertilizer. The vermiculite from the Libby mine was contaminated with a toxic form of naturally occurring asbestos called tremolite-actinolite series asbestos.

The human suffering that the people of Libby have endured continues today. In 2000 the population of Libby was 4,500 people, at that time, nearly one-third of the population, some as young as 10 years old had developed asbestos related diseases from exposure to tremolites- contaminated vermiculites. Doctor Brad Black came to Libby in 1977 as a Pediatrician.   He has been a supporter of his neighbors and an advocate for continued specialized health care for the citizens of Libby. In 2000 he and fellow concerned citizens, formed the Center for Asbestos Related Disease Foundation- CARD. The work of the foundation includes research and treatment of the citizens of Libby. CARD and Dr. Black are an integral part of the Libby Epidemiology Research Program that is being conducted in conjunction with the Icahn School of Medicine at Mount Sinai New York.

There are 3 books that detail the tragedy of Libby: Fatal Deception The Terrifying True Story of How Asbestos is Killing America- Michael Bowker, Wasting Libby, The True Story of How the WR Grace Corporation Left a Montana Town to Die, Andrea Peacock: An Air That Kills- How the Asbestos Poisoning of Libby Montana, Uncovered a National Scandal, Andrew Schneider.

The period between exposure to asbestos and symptoms of mesothelioma can be anywhere from 15 to 50 years. The amount of exposure and when the exposure happened are all being studied.

Libby Montana continues to be de-contaminated by the EPA. Residents continue to be diagnosed with asbestos related diseases at the CARD clinic. Research continues, patients are being followed and cared for, and asbestos continues to be legal in the United States.

– Ellie

Mesothelioma Specialist Spotlight: Dr. Raja Flores

director-raja-flores-mdDr. Raja Flores is the Chairman of the Department of Thoracic Surgery at Mount Sinai Medical Center in New York. He is also the Steven and Ann Ames professor in Thoracic surgery at the Mount Sinai Medical Center. Dr. Flores specializes in the treatment and research for mesothelioma. He has published extensively on mesothelioma and other thoracic conditions. Dr. Flores is the Principal Investigator of the Libby Epidemiology Research Program, a 4.8 million R01 grant funded by the Agency of Toxic Substances and Disease Registry. The major goal of this research project is to focus on questions regarding the consequences of one’s health in regard to asbestos exposure.

Dr. Flores earned his undergraduate degree in biochemistry from New York University. He attended the Albert Einstein College of Medicine receiving his medical degree in 1992. Dr. Flores then spent the next 5 years completing his general surgery internship and residency at Columbia –Presbyterian Medical Center. He completed his Thoracic Oncology Clinical Research Fellowship at Brigham and Women’s Hospital in Boston along with his Cardiothoracic Surgery Residency. He also has earned a masters degree in biostatics from Columbia University.

Dr. Flores is a native New Yorker, raised in the meat packing district by his mother. He saw drugs and violence growing up but he continues to follow the path of education which led him to become a world renown surgeon, who also speaks Spanish and Arabic. Dr. Flores can relate to the patients who have mesothelioma mostly being blue collar workers. His previous job experiences included working as a doorman, working in a deli and loading packages on UPS trucks. He has seen the challenge of mesothelioma and how it devastates patients and families lives regardless of their socioeconomic status.

One of Dr. Flores interests in his extensive published research has been comparing extra-pleural-pneumonectomy, removing the lung in addition to the lining, and pleurectomy/decortication, which is removing only the lining and preserving the lung.

Dr. Flores has been a tireless advocate for the mesothelioma community for the past 20 years. One of the most frequent comments from his patients is that he listens. Dr. Flores is a very personable, experienced clinician, who also is a world-renowned expert in mesothelioma.

Mesothelioma & Asbestos Research: Libby Montana

Libby Epidemiology Research Program

Libby Montana Asbestos MesotheliomaThe Libby Epidemiology Research Program is sponsored by the U.S. Center for Disease Control. The Principal Investigator is Raja Flores M.D., who took over after the death of Dr. Stephen Levine. The study was funded by the Agency for Toxic Substances and Disease Registry (ATSDR) it was a five-million-dollar research grant that was awarded to the Icahan School of Medicine at Mount Sinai, New York. The purpose of this award was to understand the long term health effects of exposure to amphibole asbestos in Libby Montana and the surrounding communities. Working collaboratively with a local Libby health group- Center for Asbestos Related Diseases- CARD- founded and run by Dr. Brad Black, together with researchers from Idaho State University and Montana State University at Missoula, to help understand the uniqueness of Libby Amphibole disease

The study was a comprehensive five year look at three major areas of health of the residents of Libby. Those residents suffered environmental exposure not as a direct result of participation in W.R. Grace and Company mining operation, just by living and playing in their community. The three parts of the study were designed to see if the effect on the immune system, lung development and lung scarring, and whether these health complications overlap with exposure.

The program was broken down into three separate studies. The Pre-Adult Latency study examined the health consequences of exposure on young people whose lungs were still developing and maturing. This study will examine those exposed 15 years after the initial exposure.

The Cat Scan –CT – Progression Study- this study follows the progression of lung scarring as seen on CT scans. In addition to Dr. Flores from Mount Sinai, the study has two other experts in radiology from Mount Sinai. Dr. Claudia Henschke and Dr. David Yenkelevitz. Through the expertise of these specialists and Mount Sinai’s experience with other people exposed to a different form of asbestos, using thorough progressive CT scans over time, they are trying to determine if scarring on the lungs from Libby Amphibole pleurall scarring progresses more rapidly. This can have important implications for all asbestos related diseases- if it is proven that disease progression is different with different types of asbestos, treatments and treatment plans can be devised to intervene earlier than is currently done.

The third part of this study focuses on what effect the possible exposure has on developing auto immune diseases. In August of 2016 the results of this part of the trial were announced. The results indicated as much as a 10 x increase in the risk of lupus, scleroderma, and rheumatoid arthritis in people that had been exposed to amphibole asbestos.

All three parts are closed to additional patients and the data is being compiled with the results to be used to help further specialized treatments for asbestos related diseases. The report is expected by year end on the lung development in children portion of the study. The pleural lining study is on hold at this point.

Working in collaboration with local agencies, new data findings with regards to exposure to certain asbestos fibers in Libby have furthered the understanding of exposure to asbestos and its long term effects.

  • This field is for validation purposes and should be left unchanged.

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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