I've heard that there isn't much research going on with Mesothelioma - because the disease itself (in time) will disappear. This is because the disease is caused by asbestos, and asbestos isn't much used anymore. Is this right?

Are there good resources to learn more about this disease and it's treatment?

-Last year I was diagnosed with this disease. Most of the research I've done shows hope in the treatment of certain severity levels of this type, but it does seem as if alot of resources are NOT being spent because of the aggressive methods for asbestos removal. My oncologist wanted to try a very aggressive chemo regimen but I personally decided against it. My lungs are full of asbestos fibers AND I smoked for 20 years (a 75% more likely chance to contract lung cancer) and it happened. I have what is considered a high severity level of asbestos. And since the carcinogen that created the cancer (asbestos) will never be removed, there isn't much hope. But there are resources such as the Mountain States Tumor Institute (MSTI)in Boise, Idaho which was a valuable resource for my research.

-The Sir Charles Gardiner Hospital here in Perth Western Australia spent quite a few years researching Mesothelioma. They did a few trials with vitamin A supplements which at one time was thought promising but I think the results were fairly negative. I don't know what they are up to now but I guess most ,if not all their reseach data will be published by now.

-I am completing a section on esothelioma for an upcoming book about lung cancer. Here are my comments.

1. SURGERY IS BEING IGNORED. Mesothelioma is more accurately called diffuse malignant mesothelioma, and the fact that there is not one discrete tumor makes surgery more difficult. However, some favorable results have been shown with early stage mesothelioma:

A group of 183 patients underwent extra pleural pneumonectomy (removal of the lung) followed by chemotherapy and radiation. There were seven deaths associated with the surgery and survival rates as follows "Survival in the 176 remaining patients was 38% at 2 years and 15% at 5 years (median 19 months (Univariate analysis identified 3 prognostic variables associated with improved survival and 15% at 5 years
(median 19 months). Univariate analysis identified 3 prognostic variables associated with improved survival: epithelial cell types (52% 2 year survival, 21% 5 year survival, negative resection margins, and exptrapleural nodes without metastasis....31 patients with 3 positive variables had the best survival (68% 2 year survival, 46% 5 year survival, median 51 months." Sugarbaker, et. al., Resection Margins, extra pleural nodal status, and cell type determine toperative long term survival in trimodality therapy of malignant pleural mesothelioma: results in 183 cases. J. Thoracic Cardiovascular Surgery 1999, Jan, 117:1, 54,65.

2. CHEMOTHERAPY SHOWS MODEST SUCCESS

The studies show response rate around 20% for chemotherapy using the same drugs prescribed for non-small cell cancer.

3. INTERFERON AND GENE THERAPY COMBINED WITH CHEMOTHERAPY DRUGS SEEMS TO SHOW THE BEST SUCCESS (After surgery for timely diagnosed disease)

A variety of clinical trials are showing good results combining interferon or gene therapy with standard chemotherapy.

15.61 Interleukin 2 and Interferon Inteferon has had some significant beneficial effect in treating mesothelioma. Interferons are proteins secreted by immune cells that "interfere" with a virus's ability to reproduce and proliferate. In the laboratory, low concentrations of interferon help boost the power of natural killer T cells. With some tumors, interferons can help inhibit the development of the blood vessels that tumors need to metastasize and grow, a process called angiogenesis. There are three main types and 17 subtypes of interferon. In a French phase II study, over 50% of the participants showed some tumor reduction from Interferon : BACKGROUND: The prognosis associated with malignant pleural mesothelioma
(MPM) is poor in spite of surgery, radiotherapy, photodynamic therapy, or chemotherapy. Therefore, new therapeutic strategies, including intrapleural immunotherapy, are being investigated. Several clinical studies have demonstrated objective antitumoral responses to intrapleural interleukin-2
(IL-2) administration in the treatment of malignant pleurisy. The maximum tolerated dose, 24 x 10(6) IU/m2/day for 5 days, was determined in a Phase I study. Based on these results, a Phase II study was conducted, in which intrapleural IL-2 (21 x 10(6) IU/m2/day for 5 days) was given to patients with MPM. METHODS: Patients with histologically documented MPM were evaluated for response 36 days after treatment by computed tomography scan and thoracoscopy with biopsies. Toxicity was recorded and graded according to World Health Organization criteria.... RESULTS: Twenty-two patients entered this study. Of the 22 cases of MPM, 19 were epithelial, 2 were mixed, and 1 was fibrosarcomatous. Three patients had Stage IA disease, 1 had Stage IB, 16 had Stage II, 1 had Stage III, and 1 had Stage IV (Butchart classification). All patients received their planned treatment. No dose reduction or interruption occurred. There were 11 partial responses and 1 complete response. Stable disease occurred in 3 patients and disease progression in 7 patients. The overall median survival time was 18 months; the median survival time of responders differed significantly from that of nonresponders (28 months vs. 8 months, P < 0.01). The 24- and 36-month survival rates for responders were 58% and 41%, respectively. CONCLUSIONS: These results confirm that intrapleural administration of IL-2 is well tolerated and has antitumor activity in patients with MPM. The authors recommend a dose of 21 x 10(6) IU/m2/day for 5 days. However, determination of the schedule of IL-2 and its superiority to conventional treatment in a Phase III study has yet to be accomplished. Astoul, Intrapleural administration of interleukin-2 for the treatment of patients with malignant pleural mesothelioma: a Phase II study, Cancer 1098 Nov, 83:10,
2099-104 A Turkish study found moderately favorable results, a response rate of
24%, combining Interferon with Cisplatin. Metintas, Cisplatin, Mitomycin, and Interferon-alpha2a combination chemoimmunotherapy in the treatment of diffuse malignant pleural mesothelioma. Chest, 1999 Aug, 116:2, 391-8:

STUDY OBJECTIVE: To investigate the therapeutic activity and toxicity of combination chemoimmunotherapy with cisplatin, mitomycin, and interferon
(IFN)-alpha2a, by comparing the responses in a group of patients with diffuse malignant pleural mesothelioma (DMPM) to the responses in a control group of DMPM patients given supportive care alone. DESIGN: Patients with histopathologically confirmed DMPM were evaluated for treatment with chemoimmunotherapy... Forty-three patients with DMPM received chemoimmunotherapy until the end of the survey; 19 patients were given supportive therapy alone after refusing chemoimmunotherapy. INTERVENTIONS: Drugs were administered according to the following schedule: IV cisplatin, 30 mg/m2 qd on days 1 and 2; IV mitomycin, 8 mg/m2 on day 1; and subcutaneous IFN-alpha2a, 4.5 million IU twice weekly.... A total of 10 objective responses
(ORs) in 43 patients (23%) were assessed, including 2 complete responses (5%), 4 partial responses, and 4 regressions. Seventeen patients had stable disease, and 16 patients had progression. The median survival time was 11.5 months for the 43 patients who received chemoimmunotherapy and 7.0 months for the 19 patients who received supportive therapy alone. The difference in survival times between the chemoimmunotherapy and supportive therapy groups was not significant. However, the median survival time for the patients who had OR was
21.3 months, which is significantly longer than that of the patients who received supportive care alone and that of patients with progressive disease (6 months). The toxicities associated with the treatment schedule of this study were, for the most part, tolerable. CONCLUSIONS: The drug combination used in this study is moderately effective and well tolerated in patients with DMPM, especially in those who responded to the treatment.

4. PATIENTS WITH MESOTHELIOMA SHOULD SERIOUSLY CONSIDER PARTICIPATION IN CLINICAL TRIALS

Since gene therapy is currently showing the most promise, patients may want to consider participating in later stage trials. Alternatively, one would want to go to a hospital with signficant specialized knowledge of chemotherapy.