Mesothelioma is a cancer of the cells that make up the lining around the outside of the lungs and inside of the ribs (pleura), or around the abdominal organs (peritoneum).
What does asbestos have to do with mesothelioma?
The only known cause of mesothelioma in the U.S. is previous exposure to asbestos fibers. Asbestos manufacturers knew about the hazards of asbestos seventy years ago - but they kept this knowledge to themselves. The first warnings to workers exposed to asbestos were given in the mid-1960s, and they were terribly inadequate. Even today, workers are not always told they are working around asbestos and are at risk for asbestos disease.
What can someone with mesothelioma do?
- Seek out the best and most up-to-date information.
- Seek out the best medical care.
- Early screening for mesothelioma diagnosis.
- Stay in close contact with your doctor.
- Consider whether or not you want to bring a lawsuit because of this asbestos-related injury.
- Remember that resources are available to you through community and medical support groups, asbestos victims' organizations, your place of worship, as well as your family and friends.
Treatment of mesothelioma :
Doctors specializing in mesothelioma treatment frequently adopt a multimodal approach: they treat a patient with a combination of therapies. Due to the relative lack of effectiveness of single-modality treatment in affecting patient survival, the multimodal combination of treatments holds more promise for survival of malignant mesothelioma patients.
The December 1999 issue of the medical journal, Chest, published a clinical case presentation that illustrates a fairly typical multimodal treatment. The patient was a 52-year-old man with an early diagnosis of Stage I pleural mesothelioma. Doctors performed a pleurectomy (i.e. surgery) and then delivered intrapleural doses of chemotherapy drugs. Then he received additional localized radiation and chemotherapy. Two years after the surgery he did not show evidence of the tumor.
The author concluded that Aggressive trimodality therapy for mesothelioma is presented as a successful treatment option.
In recent years, there has been some progress made in the management of malignant mesothelioma, particularly in the area of combination of agents and treatment methods used. .
The following discussion of mesothelioma treatments is organized into separate sections (surgery, photodynamic therapy, radiation, etc.) so that each component of a combination of treatments (multimodality therapy) can be better understood.
Mesothelioma Treatment Options - Surgery
There are two main types of surgical treatment for pleural mesothelioma: extra-pleural pneumonectomy (EPP) and pleurectomy/decortication.
EPP involves the removal of the pleura, diaphragm, pericardium, and the whole lung involved with the tumor. Pleurectomy/decortication involves the removal of the pleura without removing the entire lung.
Which treatment is recommended depends on many factors, including the stage of the tumor. (The NCI has a detailed description of mesothelioma stages.) However, it is unclear if EPP provides significantly greater benefits than pleurectomy/decortication, and indeed if either is significantly more effective than non-surgical options.
A recent study followed about 400 mesothelioma patients who, between 1983 and 1998, had pleurectomy/decortication, or extra-pleural pneumonectomy (EPP), or thoracotomy. The results indicate that no one type of surgery was more effective than another in extending the survival rate. Rather, other factors seemed to determine how long people survived. These factors included the stage and cell type of the tumor, the gender of the patient, and the type of treatment(s) given together with the surgery.
Surgery can provide symptomatic relief and sometimes the bulk of the tumor can be removed. Surgery is often used in combination with other treatments (known as multi-modal treatments), but its value is very limited if the tumor is near any vital organs.
Both EPP and pleurectomy/decortication are complex surgeries, not performed frequently by most surgeons. They require referral to centers dedicated to such treatments. Many of these centers also specialize in other forms of mesothelioma treatment, either alone or in combination (multi-modal therapy.) You should discuss referrals with your doctor.
Mesothelioma Treatment Options - Radiation Therapy (Radiotherapy)
This treatment involves the localized use of high-dose radiation (like x-rays) on malignant tumors. Usually, it is not a primary treatment but is used in conjunction with other therapies such as surgical resection and chemotherapy. It is generally used to reduce the size of the symptomatic tumor and help relieve symptoms like pain and shortness of breath.
Factors which can limit the application of this treatment include the volume of the tumor and how near it is to vital organs.
Mesothelioma Treatment Options - Photodynamic Therapy
Photodynamic therapy (PDT) is a treatment method often used in combination with other treatments, such as drugs or surgery. PDT uses light to kill cancerous cells. Photodynamic therapy is still in an experimental stage for treatment of mesothelioma.
Initially, the patient receives a photosensitizer which collects in cancerous cells but not in healthy cells. (A photosensitizer is a drug which makes malignant cells vulnerable (sensitive) to light of specific wavelengths.) After the cells have been sensitized, fiberoptic cables are placed in the body (usually through open-chest surgery) in order to focus light of just the right frequency on the tumor. This causes the photosensitizer to produce a toxic oxygen molecule which kills the cell.
Mesothelioma Treatments - Immunotherapy & Gene Therapy
Also referred to as biological therapy, is based on the theory that it is possible to mobilize the body's own immune defenses against cancerous cells. Another name often applies to this therapy, biological response modifiers (BRMs).
This a new treatment which is currently in clinical trials. Using an adenovirus for delivery, a "suicide gene" is inserted directly into the tumor. This gene makes the cells sensitive to a normally ineffective drug, such as glanciclovir. Treatment with the drug then destroys those cells that are rapidly dividing - which are the cancer cells - leaving the healthy cells unharmed.
In theory, this approach allows treatment to target the tumor specifically, as opposed to treatments such as chemotherapy which also kill healthy cells.Gene therapy for mesothelioma is being researched at the University of Pennsylvania, with Dr. Steven Albelda as the principal investigator. This treatment is not without risk, as became apparent in the death of Jesse Gelsinger, a University of Pennsylvania gene therapy trial participant. (Note that Mr. Gelsinger was not a participant in the mesothelioma trial.)
Cytokines - Interferons (IFN) and Interleukins (IL):
Cytokines are small proteins that occur naturally in the human body. They are similar to hormones and have specific effects on the behavior of other cells.
In 1976 Dr. Robert Gallo (later head of the National Cancer Institute, and famous for his work on HIV) isolated a cytokine protein molecule called interleukin-2 (IL2) which is capable of stimulating the growth of immune system cells called T-cells. T-cells are sometimes called "killer cells" because they search out malignant or virally infected cells and kill them. Using IL2 as a treatment for pleural mesothelioma is still in the experimental stages, but researchers hope that injecting IL2 intrapleurally will promote a significant anti-tumor response.
Interferons are also naturally occuring cytokine proteins, but they inhibit the growth of malignant cells as well as enhance the immune system. Like interleukins, these immune system promoters are being tested to see if they help increase the body's response to what is often an extremely resistant malignancy, mesothelioma.
Mesothelioma Treatment Options - Angiogenesis Therapies
Cancer cells, like other cells in the human body, rely for their growth on a rich supply of blood. They must be surrounded by an effective network of capillaries and larger blood vessels that nourish the cells. The medical term for the process of developing this network is angiogenesis.
In fact, fast-growing cancers are highly efficient at promoting angiogenesis. They produce angiogenesis promoters that create capillaries and a network of blood vessels around the tumor. The tumor is nourished with an increasing supply of oxygen-rich blood, and it grows and spreads (or metastasizes).
Understanding that angiogenesis is fundamental to the process of how tumors grow and metastasize, medical researchers started to investigate how they could slow down, stop, or reduce angiogenesis. If they could do this, they reckoned, they could starve the tumor to death - or at least slow its growth significantly. The National Cancer Institute has created an illustrated teaching tool to better understand how angiogenesis works.
A number of antiangiogenesis drugs, also called angiogenesis inhibitors or angiogenic inhibitors, have been developed. When administered to laboratory animals with tumors, they have caused the tumors to shrink or even disappear. Endostatin, combrestatin, angiostatin, thrombospondin, and vascular endothelial growth inhibitor (VEGI) are among these experimental drugs.
A few of these drugs are now being tested on humans. One of them, combrestatin, destroys the lining of blood vessels around tumors. Another, endostatin, acts by impeding the growth of new blood vessels around the tumors. For endostatin there have been some promising developments. Harvard's Dana-Farber Cancer Institute released an updated report on Phase 1 trials of the angiogenic inhibitor and says it exhibits virtually no toxicity even at high doses, while shrinking tumors in two of 28 advanced cancer patients and slowing disease progression in four others for more than six months.
This area of cancer research holds promise for the treatment of mesothelioma tumors, but it is very much in the early and experimental stages.
Mesothelioma Treatment Options - Unconventional Treatments
A number of mesothelioma treatments are outside the mainstream of both established and experimental therapies. As lawyers, not doctors, we are not qualified to judge the value of such unconventional or unproven treatments. In our experience, most doctors disapprove of these treatments, and there is no clear, non-anecdotal evidence of the success of any of these treatments. However, we believe you have the right to all the information available so that you can discuss all possibilities with your physician and make an informed decision about your options.
Dr. Stanislaw Burzynski has been working on antineoplastons as a treatment for cancer since 1967. Antineoplastons are naturally occurring peptides which Dr. Burzynski claims can "reprogram" cancerous cells to behave like "normal" cells again. The success of antineoplaston treatments has been highly controversial, however. The American Cancer Society reports that they have no reliable evidence of the objective benefits of antineoplastons. Dr. Burzynski was also charged in 1995 with fraud and violation of Federal Drug Administration regulations. The Burzynski Research Institute is currently conducting clinical trials of antineoplastons.
2. Cancell (also called Entelev or Cantron)
Cancell is a chemical mixture which is intended to deprive cancerous cells of their ability to get energy. Developed by chemist James Sheridan, proponents claim that Cancell has successfully treated people and animals for cancer for over 30 years without serious side effects. However, supporters of Cancell also recommend avoiding certain vitamins and claim that chemotherapy negates the effect of Cancell. The National Cancer Institute has found no evidence of a biological effect. The American Cancer Society strongly urges against using Cancell as a treatment method.
3. Foreign Clinics
There are numerous clinics, usually located outside of the United States, which claim to use innovative and allegedly successful techniques to cure cancer. Most of these clinics are expensive, and none of them have proven to be effective.
4. Immuno-Augmentive Therapy (IAT) Centre, Freeport, Grand Bahama Island
Treatment at the IAT Centre consists of the daily administration of a specially-prepared blood serum which is claimed to boost the immune system and reverse the cancer process.
Lawrence Burton (he has a Ph.D. rather than an M.D.) developed the treatment and is its main advocate. It is disallowed in most of the United States, and the FDA imposed an import ban in 1986. In 1985 the clinic was closed by the Bahamian government due to evidence of HIV, bacterial and hepatitis-B contamination in IAT products. It was reopened the next year when IAT acquired HIV-testing equipment, but since the products are not tested regularly by an independent laboratory, the current risk of biologic contamination is not known.
The benefits of immuno-augmentative therapy remain unverified, although there are numerous testimonials to its effectiveness. In fact, no independent clinical trial of IAT's products has ever been performed, despite direct attempts by the NCI and the Office of Technology Assessment. The American Cancer Society advises against immuno-augmentative therapy. In addition to significant treatment fees, patients must pay for room and board.
5. American Biologics-Mexico SA Medical Center, Tijuana, Mexico
The first mesothelioma patient to be treated at this clinic was the actor, Steve McQueen. Since then, there have been anecdotal reports of the success of their treatment , but no conclusive evidence. Treatment consists of an "individualized approach" to "metabolic therapy", consisting of diet, vitamins, exercise, and other techniques. They claim to "control" cancer and numerous other diseases rather than "cure" them. The AB-Mexico clinic is associated with the Bradford Research Institute.
6. Gerson Therapy: Center for Integrative Medicine at Centro Hospitalario Internacional Pacifico (CHIPSA), and Hospital Meridian de Playas de Tijuana, Mexico
There are two clinics in Tijuana, Mexico, which provide treatment based on Gerson Therapy: the Center for Integrative Medicine at Centro Hospitalario Internacional Pacifico (CHIPSA) and Hospital Meridian de Playas de Tijuana. The therapy was developed by Dr. Max Gerson in 1945, and his daughter, Charlotte Gerson Strauss, has continued the therapy since his death in 1959.
Using diet (fresh, raw juices consumed continuously for 13 hours a day ), enemas (including coffee enemas) and other therapies, the Gerson Therapy clinics claim to detoxify the body and restore its natural cancer-fighting abilities.
According to the National Cancer Institute, Dr. Gerson's methods were reviewed and no convincing evidence of effectiveness against cancer was found. No other independent studies have found that Gerson Therapy is effective against cancer. Until 1989, the dietary regimen included raw calf liver juice, and the use of this juice was associated with several infections due to contamination. Coffee enemas have also been associated with serious side effects such as fluid and electrolyte abnormalities.
CHIPSA combines Gerson Therapy with treatment methods devised by Dr. Josef Issels. They call it Issels-Gerson Combination Therapy.
7. Alivizatos Greek Cancer Cure
The Greek Cancer Cure was developed thirty years ago by a microbiologist, Dr. Hariton-Tzannis Alivizatos. His treatment consisted of a blood test which supposedly diagnosed the location and extent of the cancer, followed by injections of a serum which were meant to boost the immune system and "dissolve" the tumor. Before his death in 1991, Dr. Alivizatos had his license to practice medicine revoked by the Greek government several times due to his use of the serum. He never responded to the National Cancer Institute and American Cancer Society's request for information on his treatment. He never published his results or allowed an independent review of his claims. When a Seattle doctor posing as a patient discovered that the serum was a mixture of niacin (a B-vitamin) and water, his clinic was closed by the Greek government.