Mesothelioma-Related News Archive
We provide you the most recent news on mesothelioma cancer, asbestos exposure, and Mesothelioma settlements and verdicts. Our experienced writers cover new research, surgical procedures, clinical trials, asbestos litigation, asbestos products, current exposure sites, and the best mesothelioma doctors and cancer treatment facilities.
Malignant Mesothelioma is commonly diagnosed in people between the ages of 50 and 75 years old. There are 2,500-3,000 fatal Mesothelioma cases diagnosed each year in the United States.
Appeals court upholds jury’s verdict in Johnson’s Baby Powder case, while reducing the damages J&J must pay by more than half
J&J said in May it will stop selling talc-containing baby powder in the U.S. and Canada.
PHOTO: TIFFANY HAGLER-GEARD/BLOOMBERG NEWS
By Peter Loftus June 23, 2020 3:15 pm ET
A Missouri appeals court on Tuesday upheld a jury verdict that Johnson & Johnson’s talcum powder caused ovarian cancer in 22 women, though the court reduced by more than half the $4.69 billion in damages J&J was ordered to pay.
The Missouri Court of Appeals reduced total damages to about $2.1 billion. J&J earlier Tuesday said the new amount was about $2.2 billion but subsequently said it was $2.1 billion.
The 2018 verdict, following a six-week trial in state court in St. Louis, was the biggest award of damages in a series of trials arising from lawsuits over the safety of Johnson’s Baby Powder, as well another talc-containing powder, Shower to Shower, that J&J used to sell.
J&J said the 2018 trial in St. Louis “was a fundamentally flawed trial, grounded in a faulty presentation of the facts.” The company said it will pursue further review of the case by the Supreme Court of Missouri.
A New Study Suggests Tainted Talcum Powder Can Cause a Rare Cancer. Here’s How That Could Play Out in the Courtroom
BY JAMIE DUCHARME
UPDATED: OCTOBER 18, 2019 2:06 PM ET | ORIGINALLY PUBLISHED: OCTOBER 15, 2019 1:37 PM EDT
Anew 33-patient case study published in the Journal of Occupational and Environmental Medicine provides some of the strongest proof yet that exposure to asbestos-tainted talcum powder may cause malignant mesothelioma, a rare and deadly cancer that affects tissues lining internal organs.
This isn’t only an important scientific discovery—it could also give new ammunition to plaintiffs in the thousands of cases brought against brands selling talcum-powder-based products alleged to cause cancer, like Johnson & Johnson’s Baby Powder.
“It’s very, very hard, in general, to prove exactly what caused your specific case of disease,” says Steve Gold, a professor at Rutgers Law School who specializes in toxic and hazardous substances. “If a credible physician and researcher is willing to testify and has published that these individual cancers appear to be caused by asbestos exposure from talcum powder, that’s evidence that is usually not available to plaintiffs. That’s very powerful.”
Asbestos is a group of naturally occurring fibrous minerals that’s considered a human carcinogen by the World Health Organization and other public health groups. It is linked to mesothelioma, ovarian cancer and lung cancer. Among other places, it’s found in building supplies, insulation, some car parts—and the talc from which talcum powder is made. (Talc also turns up in cosmetics like blush and facial makeup.) Since the 1970s, manufacturers have pledged to use talc that is free from detectable levels of asbestos, but there is still little regulation over the cosmetic industry, and concerns about asbestos contamination persist. A bombshell 2018 Reuters report also found that J&J knew for decades that some of its Baby Powder was tainted by asbestos, but did not report that information publicly or to federal regulators.
October 02, 2020
Today, the U.S. Food and Drug Administration approved Opdivo (nivolumab) in combination with Yervoy (ipilimumab) for the first-line treatment of adults with malignant pleural mesothelioma that cannot be removed by surgery. This is the first drug regimen approved for mesothelioma in 16 years and the second FDA-approved systemic therapy for mesothelioma.
“Today’s approval of nivolumab plus ipilimumab provides a new treatment that has demonstrated an improvement in overall survival for patients with malignant pleural mesothelioma,” said Richard Pazdur, M.D., director of the FDA’s Oncology Center of Excellence and acting director of the Office of Oncologic Diseases in the FDA’s Center for Drug Evaluation and Research. “In 2004, FDA approved pemetrexed in combination with cisplatin for this indication, and now patients now have an important, additional treatment option after more than a decade with only one FDA-approved drug regimen.”
Malignant pleural mesothelioma (MPM) is a life-threatening cancer of the lungs’ lining caused by inhaling asbestos fibers that about 20,000 Americans are diagnosed with each year. MPM accounts for most mesothelioma diagnoses, and most patients have an unresectable (unable to be removed with surgery) tumor at time of diagnosis. With currently available therapy, overall survival is generally poor. Opdivo and Yervoy are both monoclonal antibodies that, when combined, decrease tumor growth by enhancing T-cell function.
October 8, 2020 Susan Moench, PhD, PA-C
UHRF1 is overexpressed in several human malignancies, and may drive tumorigenesis by silencing tumor promoter genes through hypermethylation.
Regulation of expression of the protein called ubiquitin-like with plant homeodomain and ring finger domains 1 (UHRF1) may impact survival in patients with malignant pleural mesothelioma, according to findings published in the Journal of Thoracic Oncology.
UHRF1 is a protein encoded by the UHRF1 gene. It is a component of multiprotein complex that is involved in recruiting DNMT1, a DNA methyltransferase, that catalyzes the transfer of methyl groups to specific CpG structures in DNA. UHRF1 is overexpressed in several human malignancies, and may drive tumorigenesis by silencing tumor promoter genes through hypermethylation, as well as activating endogenous retroviral sequences through hypomethylation.
The aim of this study was to investigate the potential role of UHRF1 as an epigenetic driver in malignant pleural mesothelioma.
By Stella Porter
Published: Sep. 8, 2020 at 2:57 PM PDT
(WZAW) – Each year, an estimated 3,000 Americans are diagnosed with mesothelioma, a rare type of cancer that forms in the lining of major organs in the chest or stomach. Over 70% of people diagnosed with mesothelioma have been exposed to asbestos, making it the leading cause of the disease.
The most common form is malignant pleural mesothelioma, but less than 30% of patients were candidates for surgery to remove the tumor, according to a SEER-Medicare data set analysis in elderly MPM patients, opening the door for new and innovative treatments. In 2019, the FDA approved a new treatment for MPM called Optune Lua, which is the first treatment approved by the FDA for the disease in more than 15 years. Optune Lua is a wearable and portable cancer treatment that delivers Tumor Treating Fields to the region of the tumor. TTFields are low-intensity alternating electric fields tuned to specific frequencies that continuously disrupt cancer cell division.
Date: June 11, 2020
Source: Science News Johns Hopkins Medicine
Inoperable malignant pleural mesothelioma, is a rare and aggressive cancer of the protective lining of the lungs, or pleura, often caused by exposure to asbestos. At the annual meeting of the American Society of Clinical Oncology (ASCO), held virtually from May 29-31, 2020, a researcher from the Johns Hopkins Kimmel Cancer Center presented findings from a multicenter study that evaluated the efficacy of an immunotherapy-plus-chemotherapy combination for the disease.
According to Patrick Forde, M.B.B.Ch., associate professor of oncology at the Johns Hopkins University School of Medicine, director of the Kimmel Center’s thoracic cancer clinical research program and a Bloomberg~Kimmel Institute for Cancer Immunotherapy investigator, the study looked at 55 patients from 15 U.S. cancer centers who received the immunotherapy drug durvalumab in combination with two anticancer chemotherapies — cisplatin and pemetrexed — to create a novel first-line treatment.
10-Jun-2020 1:15 PM EDT, by Johns Hopkins Medicine
Johns Hopkins Kimmel Cancer Center thoracic cancer and cancer genomics experts reported promising new findings and studies in mesothelioma, lung cancer and melanoma at the annual meeting of the American Society of Clinical Oncology (ASCO), the world’s leading professional organization for physicians and oncology professionals caring for cancer patients. Two of this year’s presenters include winners of ASCO Young Investigator and Merit Awards. The meeting was held virtually May 29–31.
— Chemotherapy/Immunotherapy Combo for First-Line Treatment of Mesothelioma
A clinical study, called PrE0505, evaluated the efficacy of an immunotherapy-plus-chemotherapy combination for inoperable malignant pleural mesothelioma, a rare and aggressive cancer of the protective lining of the lungs, or pleura, often caused by exposure to asbestos. The study, presented by Patrick Forde, M.B.B.Ch., associate professor of oncology, director of the Kimmel Cancer Center’s thoracic cancer clinical research program and a Bloomberg~Kimmel Institute for Cancer Immunotherapy investigator, included 55 patients from 15 U.S. cancer centers who received the anti-PD-L1 immunotherapy drug durvalumab in combination with the anticancer chemotherapies cisplatin and pemetrexed as a first treatment.
Patients received six treatments of the combination therapy every three weeks followed by treatment with the immunotherapy durvalumab for up to one year in total. The chemo-immunotherapy combination improved overall survival from historical expected survival of 12 months with chemotherapy alone to 20.4 months with the chemo-immunotherapy combination. This is the first study to show survival exceeding 20 months for patients with inoperable mesothelioma. Treatment was well-tolerated overall with no unexpected side effects reported.
Date: April 29, 2019
Source: Science News
European Society for Radiotherapy and Oncology (ESTRO)
Mesothelioma patients are twice as likely to survive for two years or longer, if they are treated with a high dose of radiation to the affected side of the trunk.
Mesothelioma patients are twice as likely to survive for two years or longer, if they are treated with a high dose of radiation to the affected side of the trunk, according to research presented at the ESTRO 38 conference.
Mesothelioma is a rare but aggressive form of cancer that grows in the layers of tissues surrounding the lungs. It is usually caused by exposure to asbestos. Patients typically only live for a year or two following diagnosis and treatment options are very limited.
The study looked at patients whose cancers could not be completely removed with surgery and the researchers say their findings have the potential to change treatment and outcomes for this group of patients.
The study was led by Dr Marco Trovo MD, chief of the Radiation Oncology Department at University Hospital of Udine, Italy. He said: “There is an urgent need for more effective treatments for mesothelioma. Surgery can be given to these patients, but it is often impossible to remove all of the tumour.
“Patients with mesothelioma are sometimes given radiotherapy to help control their symptoms. However, radiotherapy has evolved dramatically in the last few years so we wanted to see if it could now be used to prevent the cancer from spreading to nearby tissue, hopefully bringing improvements in survival.”
The study involved 108 patients with malignant pleural mesothelioma who were treated at the National Cancer Institute of Aviano, Italy, between 2014 and 2018. All were given surgery to remove some tumour tissue, followed by chemotherapy.
Susan Moench, PhD, PA-C March 6, 2020
Although some studies have addressed rates of mesothelioma in women, few have provided correlation with physical evidence of asbestos exposure.
Results of a retrospective study of a series of patients with malignant diffuse mesothelioma from a single institution showed that most women with the disease had a history of household exposure to a worker in industries that used asbestos. These findings were reported in the American Journal of Surgical Pathology.
Although the association between asbestos exposure and mesothelioma, occurring in either the pleura or peritoneum, has been well established, the focus of many of the studies of patients with mesothelioma has been on men exposed to asbestos through their occupation. Although some studies have addressed rates of mesothelioma in women, few have provided correlation with physical evidence of asbestos exposure, and data related to the location and histopathology of the disease in women, their history of asbestos exposure, as well as their survival are scarce.
In this study, cases of mesothelioma histologically confirmed between 1983 and 2010 were identified through a review of a medical records database from a single institution. Of the 2858 cases identified, 354 (12.4%) occurred in women, with 78% and 22% of these cases diagnosed as pleural mesothelioma and peritoneal mesothelioma, respectively.
By Jef Feeley | February 28, 2020
Johnson & Johnson was ordered by a Florida jury to pay $9 million to an 82-year-old woman who blamed asbestos-tainted talc for her cancer, the latest court loss for the company in U.S. litigation over its iconic baby powder.
Jurors in Miami concluded on Thursday that asbestos in baby powder used by Blanca Mure-Cabrera over her lifetime contributed to the development of her mesothelioma, said David Jagolinzer, one of her lawyers. That type of cancer has been specifically linked to asbestos exposure.
The trial loss is the second for J&J this year over claims the company knew some of its talc-based products were laced with asbestos and hid it from consumers. Earlier this month, a jury in J&J’s hometown of New Brunswick, New Jersey, ordered the company to pay $750 million in punitive damages to four people. A judge later reduced that award to $186.5 million.
J&J — the world’s largest maker of healthcare products — said it will appeal the jury’s liability finding and damage award.
“Today’s verdict is at odds with the decades of evidence showing the company acted responsibly and was guided by sound science,” Kim Montagnino, a company spokeswoman, said in an emailed statement.
J&J still faces almost 18,000 lawsuits over the 135-year-old baby powder. A majority of the cases allege women who used the product got ovarian cancer, while a smaller number claim links to mesothelioma.
The talc litigation may eventually cost the company as much as $10 billion, according to Bloomberg Intelligence. Though baby powder accounts for only a small fraction of J&J’s annual revenue, it’s been a core brand for the company for more than a century.
ARTICLE Feb 25, 2020 | By Colin Ruggiero
Micrograph of mesothelioma with ferruginous bodies.
Technology and cancer
Oncology, like other areas of healthcare, relies on technology. Three dimensional (3D) bioprinting and artificial intelligence (AI) have been fundamental technologies for understanding disease and contributing to groundbreaking research. Within the past year, technological developments have provided opportunities for early diagnosis and targeted treatment for mesothelioma patients.
Mesothelioma patients are typically diagnosed in the late cancer stages, leaving them with inadequate treatment options. As with any disease, early diagnosis is paramount. However, since mesothelioma has a prolonged latency period, it may not be discovered for over 45 years after initial exposure.
Although researchers are looking into other potential causes, asbestos exposure is the most apparent and thought to be the most common cause of mesothelioma. Asbestos was a mineral previously used in a variety of products, as well as being a common additive in homes and buildings from the 1930s to 1980s, due to its low price, flame-resistant properties, and suitability for industrial projects. It continues to threaten society through second and third-wave exposure due to deterioration and construction. The United States Environmental Protection Agency (EPA) aims to protect the public from exposure to asbestos; today the USA tolerates just 1% of asbestos in commercial goods.
Although there are only 3,000 new mesothelioma cases each year, veterans make up 30% of this population. Additionally, every year 1.3 million construction workers come into contact with asbestos. Other at-risk occupations include civil engineers, making up 3.9% of mesothelioma deaths in 1999, and research indicates that any worker exposed to asbestos has a 10% chance of developing mesothelioma.
For those who encountered this carcinogenic fiber, their prognosis is then cut by both age and the tumor’s growth to inoperable and inaccessible organs. However, developments in AI and 3D bioprinting have led to the possibility of a revised treatment plan, with which mesothelioma patients could have an improved chance at survival.
January 15, 2020 – Price tags of life-saving treatments are continuing to increase, with nearly $150 billion being spent nationally per year for cancer care, four times more than treatment for other common health conditions, according to a report from The Mesothelioma Center.
Sixty-three percent of cancer patients faced financial struggles following a cancer diagnosis.
Cancer treatment costs were reported highest among preventable cancers such as lung cancer, colorectal cancer, breast cancer, and mesothelioma. Specifically, the lifetime cost of lung cancer was an estimated $282,000 while mesothelioma was a reported $150,000.
50 patients with malignant mesothelioma of both the pleura and peritoneum: A single-institution experience
Annals of Surgical Oncology — Letica-Kriegel AS, Leinwand JC, Sonett JR, et al. | December 24, 2019
Researchers sought to determine the overall survival from the initial operative intervention in 50 patients with both pleural and peritoneal mesothelioma treated with the intent to prolong survival. The patients had the median overall survival of 33.9 months from the initial intervention. Independent predictors of overall survival were female gender and intraperitoneal dwell chemotherapy. As per findings, a survival benefit could be achieved in well-selected patients with both pleural and peritoneal mesothelioma over palliative treatment that is similar to that observed in the single-cavity disease. Multimodality treatment aimed at prolonging survival should not be contraindicated in the presence of disease in both cavities, whether the disease is diagnosed synchronously or metachronously. Among patients with an initial diagnosis of single cavity disease, the second-cavity disease occurred most frequently within the first year after diagnosis.
January 15, 2020 – Leah Lawrence – Cancer Therapy Advisor
Variants in DNA damage repair genes may play a role in the pathogenesis of malignant pleural mesotheliomas, according to a recent study by researchers from Memorial Sloan Kettering Cancer Center.
The investigators used the MSK-IMPACT next-generation sequencing platform to screen 84 patients with mesothelioma for cancer-predisposing genes.
Using blood samples, they found that 12% of the patients had a pathogenic variant. The majority of mutations found were associated with DNA damage repair.
Although clinical characteristics were similar between patients with and without variants, those with variants were more than twice as likely to have 2 first-degree family members with cancer than those without (40% vs 12%; P <.05).
Among the novel variants identified with the testing were MSH3, BARD1, and RECQL4. Also confirmed were several variants that had been identified in previous studies including BAP1 (4%), BRCA2 (1%), and MRE11A (1%).
Reviewed by Kate Anderton, B.Sc. (Editor) Jan 8 2020
Exposure to asbestos is the major risk factor for malignant mesothelioma, a type of aggressive cancer that mostly affects the pleura – the tissue that lines the lungs – and the peritoneum – the tissue that lines the abdomen. This has been known for decades, yet the molecular characterisation of mesothelioma is barely known and treatment options are scarce. A study carried out by researchers at the Spanish National Cancer Research Centre (CNIO) on key molecular processes in this type of cancer identified two drugs that, used in combination, could be effective against the most aggressive type of mesothelioma. The compounds are already being used in clinical trials for other tumours, a fact that might help speed up studies on mesothelioma patients.
PR Newswire – January 21, 2020
OSLO, Norway, Jan. 21, 2020 /PRNewswire/ — Targovax ASA (OSE: TRVX), a clinical stage immuno-oncology company developing oncolytic viruses to target hard-to-treat solid tumors, today announces the first set of clinical results from the randomized phase I/II trial of ONCOS-102 in combination with standard of care chemotherapy in malignant pleural mesothelioma (MPM).
The trial is an open label, exploratory phase I/II adding ONCOS-102 to standard of care (SoC) chemotherapy (pemetrexed/cisplatin) in first and second (or later) line MPM to assess safety, immune activation and clinical efficacy of the combination treatment. In total, 31 patients have been enrolled in the randomized trial design, with 20 patients in the experimental group receiving the ONCOS-102 and SoC combination, and 11 patients in a control group receiving SoC only. All patients have completed the treatment phase (4 months for the control group and 5 months for the experimental group) and the first data have been analyzed. The combination treatment with ONCOS-102 and SoC was well tolerated, with no safety signals beyond what is expected from SoC alone.
Am J Surg Pathol. 2019 Dec 23
We reviewed 354 cases of malignant diffuse mesothelioma (MM) in women from a database of 2858 histologically confirmed MM cases. There was a pleural predominance with 78% pleural MM and 22% peritoneal MM. The pleural tumors consisted of 72% epithelioid, 19% biphasic, and 9% sarcomatoid variant. The peritoneal tumors consisted of 82% epithelioid, 13% biphasic, and 5% sarcomatoid. The immunohistochemical profile was typical of what is well-accepted and previously described for MM. When examining tumor subtype and location, there was a trend toward epithelioid subtype and peritoneal location; however, this did not reach statistical significance. Age at the time of diagnosis ranged from 19 to 93 years with a mean of 60 years. The median age at time of diagnosis for pleural MM was 65 years and for peritoneal MM was 52 years. A further look at age and histologic subtype showed no statistically significant difference in age between MM subtypes. Survival was greatest for epithelioid variant, and this was magnified in the peritoneum. A majority of our cases were exposed to asbestos through a household contact. Asbestosis and parietal pleural plaque were present in 5% and 50% of cases with data, respectively. Fiber analysis data was available in 67 cases; 38 cases had elevated asbestos fiber burden, and tremolite was the most common asbestos fiber type detected. Commercial and noncommercial amphibole asbestos fibers were elevated in nearly equal numbers of cases.
By ERIC TUCKER October 31, 2018 AP News
FILE – In this May 14, 2013, file photo, the Department of Justice headquarters building in Washington is photographed early in the morning. The Trump administration has stepped up scrutiny of asbestos trust funds out of concern of fraud and abuse. The Justice Department worries the pots of money intended to help pople exposed to the hazardous substance are being depleted by fraudulent claims _ harming victims, businesses and the government. (AP Photo/J. David Ake, File)
WASHINGTON (AP) — The Trump administration has stepped up scrutiny of asbestos trust funds, concerned that the pots of money intended to help people exposed to the hazardous substance are being depleted by fraudulent claims, harming victims, businesses and the government.
The Justice Department in the last two months has demanded trust documents as part of a civil investigation, opposed the creation of another trust it said lacked sufficient safeguards, and argued against the appointment of a lawyer it said was too conflicted to represent victims.
The actions take aim at a system that over decades has paid out billions of dollars to the sick and cancer-stricken, but that critics say is opaque and prone to fraud and manipulation by well-connected lawyers. The government’s intervention aligns it with business groups who have long complained about the process.
“We have an interest in fraud and consumer protection, so if there is fraud happening out there that is cognizable under federal law, that’s the type of thing the Justice Department tends to get interested in,” acting Associate Attorney General Jesse Panuccio said in an interview.
Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries
Freddie Bray BSc, MSc, PhD Jacques Ferlay ME Isabelle Soerjomataram MD, MSc, PhD
First published: 12 September 2018
This article provides a status report on the global burden of cancer worldwide using the GLOBOCAN 2018 estimates of cancer incidence and mortality produced by the International Agency for Research on Cancer, with a focus on geographic variability across 20 world regions. There will be an estimated 18.1 million new cancer cases (17.0 million excluding nonmelanoma skin cancer) and 9.6 million cancer deaths (9.5 million excluding nonmelanoma skin cancer) in 2018. In both sexes combined, lung cancer is the most commonly diagnosed cancer (11.6% of the total cases) and the leading cause of cancer death (18.4% of the total cancer deaths), closely followed by female breast cancer (11.6%), prostate cancer (7.1%), and colorectal cancer (6.1%) for incidence and colorectal cancer (9.2%), stomach cancer (8.2%), and liver cancer (8.2%) for mortality. Lung cancer is the most frequent cancer and the leading cause of cancer death among males, followed by prostate and colorectal cancer (for incidence) and liver and stomach cancer (for mortality). Among females, breast cancer is the most commonly diagnosed cancer and the leading cause of cancer death, followed by colorectal and lung cancer (for incidence), and vice versa (for mortality); cervical cancer ranks fourth for both incidence and mortality. The most frequently diagnosed cancer and the leading cause of cancer death, however, substantially vary across countries and within each country depending on the degree of economic development and associated social and life style factors. It is noteworthy that high‐quality cancer registry data, the basis for planning and implementing evidence‐based cancer control programs, are not available in most low‐ and middle‐income countries. The Global Initiative for Cancer Registry Development is an international partnership that supports better estimation, as well as the collection and use of local data, to prioritize and evaluate national cancer control efforts. CA: A Cancer Journal for Clinicians 2018;0:1‐31. © 2018 American Cancer Society
By SENTINEL AND ENTERPRISE CONTRIBUTOR and SENTINEL AND ENTERPRISE |
PUBLISHED: November 24, 2018 at 12:00 am | UPDATED: July 11, 2019 at 12:00 am
By Dr. Andrea McKee
Lung cancer is the leading cancer killer in the U.S. even though it is highly curable if detected at an early stage.
Yet less than 2 percent of the at least 9 million Americans who are eligible for lung-cancer screening are getting tested for the disease. And according to a study reported last month, the benefits of lung-cancer screening are even greater than the medical community realized, reducing mortality by 26 percent for high-risk men and up to 61 percent for high-risk women.
The low lung-cancer screening rates are in stark contrast to the over 70 percent of women eligible for breast-cancer screening who have undergone a mammogram within the past two years. The medical community agrees early detection through screening has contributed to the significant decline in breast cancer death rates since the late 1980s. While the overall death rate from cancer in the U.S. has declined over the last two decades thanks to advances in primary prevention, early detection, and treatment, work must now be done by medical centers across the country to raise the low screening rates for those at high risk of developing lung cancer.
The American Lung Association recommends high-risk individuals get screened annually. Those considered at “high risk” for developing lung cancer are 55-80 years of age, have smoked one pack of cigarettes a day for 30 years or two packs a day for 15 years and are a current smoker or have quit within the last 15 years. Screening is done with a low-dose CT scan, which uses approximately ten times less radiation than traditional tests, to scan the body and create detailed pictures of the lungs. Clinicians then review the images to look for signs of lung cancer.
June 2019, Volume 27, Issue 6, pp 2321–2327
- Corli – A. Roberto – N. Corsi – F. Galli -M. Pizzuto
Opioid switching is a possible strategy for inadequate analgesia or unmanageable side effects. Its effectiveness ranges from 50 to 90% and is still debated.
We analyzed the impact of opioid switching in a cancer pain population treated with strong opioids for pain.
This is a post hoc analysis from a multicenter, randomized, four-arm, controlled, phase IV clinical trial. Outcome variables included the percentages of switches, the reasons for the switch, the dose changes before and after the switch, depending on the starting opioid, the response in case of inadequate analgesia, and unmanageable toxicity, and the variability of response among and within patients.
We analyzed 498 patients. The opioid was switched in 79 patients (15.9%) 87 times, mainly for uncontrolled pain (52.3%), adverse opioid reactions (22.1%), both of these (4.8%), and dysphagia (20.8%). The reasons for switching varied depending on the starting opioid. Pain reduction was good after 51.45% of switches and control of opioid side effects was good after 43.5%. The relief of opioid-induced toxicity varied among adverse events and within each patient. The daily doses were higher after switching oral opioids and lower after transdermal drugs.
The Justice Department will continue to look for opportunities to increase the transparency of asbestos trusts and protect the interests of legitimate claimants and the United States.
Thursday, September 13, 2018
The Department of Justice today filed a Statement of Interest in In re Kaiser Gypsum Co. in the United States Bankruptcy Court for the Western District of North Carolina. In the case, Kaiser Gypsum Company and Hanson Permanente Cement Inc. propose the establishment of a new asbestos trust under 11 U.S.C. § 524(g), a section of the Bankruptcy Code that provides the framework for responding to the unique issues associated with asbestos liability.
“In recent years, alarming evidence has emerged of fraud and mismanagement inside asbestos trusts,” said Principal Deputy Associate Attorney General Jesse Panuccio. “Asbestos victims should feel certain that they will receive compensation when they are promised it, but fraudulent claims and mismanagement call that promise into question. In addition, the United States and all who depend on Medicare are harmed when Medicare is not reimbursed for treatment costs that have been paid by trust funds. With today’s Statement of Interest, the Department sends a clear message that we will not tolerate fraudulent conduct that cheats asbestos victims and the United States. This is just one action the Department will take to increase the transparency and accountability of asbestos trusts, and we are grateful for the many partners we have in that mission, including the many state attorneys general who have brought attention to this issue. We encourage anyone with information about fraud or mismanagement of asbestos trusts to report it to the Department of Justice.”
Congress enacted 11 U.S.C. § 524(g) to create a comprehensive mechanism for addressing injuries caused by asbestos. Under section 524(g) plans, asbestos-related claims may be channeled to a special trust created under the bankruptcy plan of reorganization, which then assumes responsibility for both the defense and payment of those claims. The trusts are managed by trustees, who often must secure support for major decisions from a “trust advisory committee” (TAC), whose members are often the same attorneys who represented asbestos claimants during the bankruptcy. Since 1994, more than 60 such trusts have been established by chapter 11 debtors with asbestos-related liabilities. According to the Government Accountability Office, asbestos bankruptcy trusts paid $17.5 billion from 1988 through 2011, and more recent studies estimate higher amounts.
Non-ablative hypofractionated hemithoracic radiation—a new standard of care in mesothelioma?
Marc de Perrot1 , John Cho2 1 Division of Thoracic Surgery, 2 Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada Correspondence to: Marc de Perrot, MD, MSc, FRCSC. Division of Thoracic Surgery, Toronto General Hospital, 9N-961, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada. Email: firstname.lastname@example.org. Provenance: This is an invited Editorial commissioned by the Section Editor Laura Chiara Guglielmetti (Cantonal Hospital Winterthur, Kantonsspital Winterthur, Winterthur, Switzerland). Comment on: Parisi E, Romeo A, Sarnelli A, et al. High dose irradiation after pleurectomy/decortication or biopsy for pleural mesothelioma treatment. Cancer Radiother 2017;21:766-73. Submitted Sep 16, 2018. Accepted for publication Sep 25, 2018. doi: 10.21037/jtd.2018.09.131 V
The role of radiation therapy in malignant pleural mesothelioma (MPM) has been explored for the past 50 years. Originally, MPMs were thought radioresistant tumors. However, experimental evidence suggested otherwise (1). For instance, in vitro studies have shown that mesothelioma cell lines were more sensitive to radiation than non-small cell lung cancer cell lines, experiments in mice models of mesothelioma have shown response to radiation therapy, clinical studies have demonstrated benefit of radiation in the palliative setting when specific areas of the chest were targeted, and hemithoracic radiation have shown good local control when combined with radical surgery [see review in (1) for specific references]. While palliative radiation has been delivered with hypofractionated regimen of at least 3 Gy per daily fraction, normofractionated doses (2 Gy per daily fraction) has typically been used in the setting of conventional hemithoracic radiation. The publication from Parisi and colleagues with accelerated hypofractionated hemithoracic radiation in the adjuvant setting after pleurectomydecortication (PD) or tumor biopsy as well as our experience with accelerated hypofractionated hemithoracic radiation in the induction setting raise the question as to whether hypofractionated rather than normofractionated radiation should be used for hemithoracic radiation (2,3). Hypofractionated radiation has several advantages.
Brain-derived neurotrophic factor, a new soluble biomarker for malignant pleural mesothelioma involved in angiogenesis
Published: 11 October 2018 – Molecular Cancer volume 17, Article number: 148 (2018)
Malignant pleural mesothelioma (MPM) is a rare and aggressive cancer related to asbestos exposure. The discovery of soluble biomarkers with diagnostic/prognostic and/or therapeutic properties would improve therapeutic care of MPM patients. Currently, soluble biomarkers described present weaknesses preventing their use in clinic. This study aimed at evaluating brain-derived neurotrophic factor (BDNF), we previously identified using transcriptomic approach, in MPM. We observed that high BDNF expression, at the mRNA level in tumors or at the protein level in pleural effusions (PE), was a specific hallmark of MPM samples. This protein presented significant but limited diagnostic properties (area under the curve (AUC) = 0.6972, p < 0.0001). Interestingly, high BDNF gene expression and PE concentration were predictive of shorter MPM patient survival (13.0 vs 8.3 months, p < 0.0001, in PE). Finally, BDNF did not affect MPM cell oncogenic properties but was implicated in PE-induced angiogenesis. In conclusion, BDNF appears to be a new interesting biomarker for MPM and could also be a new therapeutic target regarding its implication in angiogenesis.
Scientific Reports volume 8, Article number: 14321 (2018) Published: 25 September 2018
Malignant mesothelioma (MM) is strongly associated with a previous asbestos exposure. To improve timely detection of MM in asbestos workers, better screening tools – like minimally-invasive biomarkers – are desirable. Between 2008 and 2018 2,769 patients with benign asbestos-related diseases were recruited to participate in annual screens. Using a nested case-control design the protein markers calretinin and mesothelin were determined by enzyme-linked immunosorbent assays in prediagnostic plasma samples of 34 MM cases as well as 136 matched controls from the cohort. Conditional on a pre-defined specificity of 98% for calretinin and 99% for mesothelin the markers reached individual sensitivities of 31% and 23%, respectively, when including the incident cases with samples taken between one and 15 months before diagnosis. The combination of both markers increased the sensitivity to 46% at 98% specificity. Marker complementation increased with earlier sampling. The marker combination improves the sensitivity of the individual markers, indicating a useful complementation and suggesting that additional markers may further improve the performance. This is the first prospective cohort study to evaluate a detection of MM by calretinin and its combination with mesothelin up to about a year before clinical diagnosis. Whether an earlier diagnosis will result in reduced mortality has yet to be demonstrated.
Wiley Online Library – First published: 07 October 2018
We evaluated postoperative mortality and complications after extrapleural pneumonectomy (EPP) and pleurectomy decortication (P/D) to better understand their effectiveness in malignant pleural mesothelioma (MPM).
A meta‐analysis was done to evaluate 30‐day mortality and postoperative complications. In addition, in‐patients data of 500 eligible patients with MPM who underwent EPP or P/D was extracted from the New York Statewide Planning and Research Cooperative System (SPARCS). Multivariate analyses and propensity matching were used to compare in‐hospital mortality and postoperative complications in EPP vs P/D.
The meta‐analysis showed a statistically significant difference in 30‐day mortality (5% [95% CI: 4‐6] vs P/D 2% [95% CI: 1‐3]), proportion of complications (46% [95% CI: 36‐56] vs 24% [95% CI: 15‐34]) and postoperative arrhythmias (20% [95% CI: 12‐31] vs 5% [95% CI: 2‐8]) for EPP vs P/D. In‐hospital mortality (OR adj: 2.6; 95% CI: 0.86‐7.75) and postoperative complications (OR adj: 1.1; 95% CI: 0.68‐1.86) were not different in EPP compared with P/D while supraventricular arrhythmia was significantly more frequent after EPP vs P/D (OR adj: 5.2; 95% CI: 2.34‐11.33).
Mesothelioma Stratified Therapy (MiST) : A Multi-drug Phase II Trial in Malignant Mesothelioma (MiST)
Study Description Brief Summary: January 28, 2019
MiST is a British Lung Foundation funded, University of Leicester Study, a multi-arm stratified therapy based clinical trial for patients with relapsed mesothelioma.
The goal of MiST is to enable acceleration of novel, effective personalised therapy as a basis for improving survival outcomes for patients with mesothelioma.
Stage 1 – molecular pre-screening:
The MiST Master protocol describes the identification of patients, biomarker testing and analysis. Patients with relapsed mesothelioma will be offered to consent for molecular panel testing of their diagnostic tumour block for predictive biomarkers. The results of this assessment will be used to classify patients into one of several possible molecularly defined treatment arms. Patients will therefore be offered a specific study treatment determined by their molecular profile. Patients, who exhibit positive testing in more than one biomarker, will potentially be eligible to subsequently be treated on a different treatment protocol upon disease progression or treatment failure.
Stage 2 – Treatment:
The MiST treatment protocol will be specific to the treatment allocated to the patient – based on the results of their biomarker testing in stage 1.
Specific agent(s) will be detailed separately in each of the separate treatment protocols.
Stage 3 – Molecular Profiling :
In order to understand the genomic basis of drug response in the MiST trial, archival tumour tissue from all patients enrolled will be interrogated using molecular inversion probe- based microarray analysis of the somatic copy number aberrations. Optional re-biopsy of patients who progress on treatment, followed confirmed radiological response, will be offered, to investigate genomic interrogation of tumours at the time of acquired resistance. For arms 3 and 4, immune checkpoint, transcriptomic and gut microbiome correlative studies are planned.
Survival by Histologic Subtype of Malignant Pleural Mesothelioma and the Impact of Surgical Resection on Overall Survival
Science Direct – November 2018, Pages e901-e912
For the 3 histologic subtypes of malignant pleural mesothelioma (MPM)—epithelioid, sarcomatoid, and biphasic—the magnitude of benefit with surgical management remains underdefined.
Materials and Methods
The National Cancer Data Base was queried for newly diagnosed nonmetastatic MPM with known histology. Patients in each histologic group were dichotomized into those receiving gross macroscopic resection versus lack thereof/no surgery. Kaplan-Meier analysis evaluated overall survival (OS) between cohorts; multivariable Cox proportional hazards modeling assessed factors associated with OS. After propensity matching, survival was evaluated for each histologic subtype with and without surgery.
Overall, 4207 patients (68% epithelioid, 18% sarcomatoid, 13% biphasic) met the study criteria. Before propensity matching, patients with epithelioid disease experienced the highest median OS (14.4 months), followed by biphasic (9.5 months) and sarcomatoid (5.3 months) disease; this also persisted after propensity matching (P < .001). After propensity matching, surgery was associated with significantly improved OS for epithelioid (20.9 vs. 14.7 months, P < .001) and biphasic (14.5 vs. 8.8 months, P = .013) but not sarcomatoid (11.2 vs. 6.5 months, P = .140) disease. On multivariable analysis, factors predictive of poorer OS included advanced age, male gender, uninsured status, urban residence, treatment at community centers, and T4/N2 disease (all P < .05). Chemotherapy and surgery were independently associated with improved OS, as was histology (all P < .001).
Anna C. Bibby Nick A. Maskell – First published: 01 August 2018 – SERIES ON PLEURAL DISEASES
This article aims to review the evidence from recent clinical trials in mesothelioma, and to provide an overview of relevant clinical trials that are currently in progress.
Ovid MEDLINE, 1946 to present.
Clinical trials of therapeutic interventions were considered for inclusion, regardless of phase. Of 258 papers identified in the literature search, 88 were potentially eligible based on abstract screening. Following evaluation of full‐text articles, 35 were selected for inclusion in the review.
Since the original trial that demonstrated the efficacy of pemetrexed and cisplatin in mesothelioma, multiple trials have been conducted that have further informed management options. Anti‐angiogenesis agents such as bevacizumab and nintedanib appear promising as adjuncts to first‐line chemotherapy. Meanwhile, immunotherapy, anti‐mesothelin agents and molecular targeted therapies are potential areas for development, with ongoing trials promising to deliver interesting results over the next few years. Current evidence does not support surgical intervention; however, investigations are ongoing as to the role of extended pleurectomy/decortication, and surgery in the context of trapped lung. Finally radiotherapy is effective as a palliative measure for pain control, but is not indicated prophylactically to prevent the development of procedure tract metastases.
Science Direct – June 2018, Pages e265-e267
A 55-year-old man with malignant pleural mesothelioma underwent multimodality treatment comprising induction chemotherapy followed by extrapleural pneumonectomy and radiation therapy. After 2.5 years, focal recurrence occurred, with computed tomography revealing a tumor in the left cardiophrenic angle. Surgery was considered a problem for the patient because of the previous extrapleural pneumonectomy and difficult tumor location. Radiofrequency ablation was therefore performed; the course was uneventful, and there was no recurrence. Radiofrequency ablation should be considered an option to treat recurrence of malignant pleural mesothelioma.
A Clinical Trial of TumorGlow to Identify Residual Disease During Mesothelioma Pleurectomy and Decortication
Presented at the Late-Breaking Session of the Fifty-fourth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 27–31, 2018.
Macroscopic complete resection can improve survival in a select group of patients with malignant pleural mesothelioma. During resection, differentiating residual tumor from inflammation or scar can be challenging. This trial evaluated near-infrared (NIR) intraoperative imaging using TumorGlow (a novel NIR imaging approach utilizing high-dose indocyanine green and delayed imaging) technology to improve detection of macroscopic residual disease.
Twenty subjects were enrolled in an open-label clinical trial of NIR intraoperative imaging with TumorGlow (Indocyanine Green for Solid Tumors [NCT02280954]). Twenty-four hours before pleural biopsy or pleurectomy and decortication (P/D), patients received intravenous indocyanine green. All specimens identified during standard-of-care surgical resection and with NIR imaging underwent histopathologic profiling and correlative microscopic fluorescent tomographic evaluation. For subjects undergoing P/D (n = 13), the hemithorax was evaluated with NIR imaging during P/D to assess for residual disease. When possible, additional fluorescent lesions were resected.
Of 203 resected specimens submitted for evaluation, indocyanine green accumulated within 113 of 113 of resected mesothelioma specimens, with a mean signal-to-background fluorescence ratio of 3.1 (SD, 2.2 to 4.8). The mean signal-to-background fluorescence ratio of benign tissues was 2.2 (SD, 1.4 to 2.4), which was significantly lower than in malignant specimens (p = 0.001). NIR imaging identified occult macroscopic residual disease in 10 of 13 subjects. A median of 5.6 resectable residual deposits per patient (range, 0 to 11 deposits per patient), with a mean size of 0.3 cm (range, 0.1 to 1.5 cm), were identified.
Mesothelioma Statute of Limitations
If you have a family member that has died from Mesothelioma cancer, immediately consult with an experienced Mesothelioma lawyer about your available compensation from asbestos trust funds.
It is VERY IMPORTANT that you file your Mesothelioma claim within your states Statute of Limitations.
We have seen many families lose their right to file a lawsuit because their Statute of Limitations had expired while they were grieving. Although there is a tremendous mourning period with the loss of a loved one, it is crucial not to let your Statute of Limitations expire before filing a Mesothelioma lawsuit. In most states, the Statute of Limitations is 2-3 years. Some states have a 6-year Statute of Limitations.
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