Mesothelioma Blog

Personalized cancer care has been growing by leaps and bounds in the past few years. Frequently, new technologies and treatments are being developed to help oncologists sub-classify patients beyond general types of cancer and provide improved treatment on a case-by-case basis.

One of the newest technologies currently in development is a class of products known as microfluidics microchips. Such computer chips allow scientists to capture rare types of tumor cells and isolate minute gene expressions that could potentially help dictate viable treatment options.

Presently, such microchips are in clinical trials as a treatment aid for prostate cancer. The study, being conducted at the Genitourinary Oncology Service at Memorial Sloan-Kettering Cancer Center, will consist of prostate cancer patients that have responded poorly to other forms of treatment.

Through microchip analysis, a comprehensive genetic profile will be provided for each participant. As Martin Fleisher, chairman of Department of Clinical Studies at Sloan-Kettering, suggests: the goal of this gene analysis is to determine which “genes are over-expressed and whether or not [the participants] would be candidates for certain types of targeted therapies that would beat down their cancer.”

Gene profiling is currently used to dictate treatment regiments for several cancers. For example, Herceptin is typically only used on breast cancer patients that have a specific protein present in their tumors.

However, prior to microfluidics, doctors were required to obtain a biopsy to obtain a proper gene profile. Such a luxury is not always available. As a workaround, scientists have longed for a reliable way to identify and isolate the low concentrations of tumor cells present in the bloodstream. Sloan-Kettering’s microchip seems to be the solution.

The microfluid chip Sloan-Kettering is employing for the study is manufactured by Fluidigm. The technology is remarkably advanced, with the ability to filter DNA from each cell into one of 96 microscopic channels. Reagents entering from the opposite side combine with the cells to create 9,000 simultaneous reactions. These reactions indicate differences in gene expression, and serve to effectively profile cancer cells.

For the prostate cancer study, researchers will analyze approximately 30 key genes in each patient. Expression of these genes, many related to testosterone production and cell signaling, have previously responded well to dasatinib in animal models. Dasatinib is a chemotherapy drug that is currently used to treat chronic myelogenous leukemia.

Once the most promising candidates for the drug have been identified through microfluidics, clinical trials will be initiated to test the predictive effectiveness of this burgeoning technology.

Resource: http://www.technologyreview.com/biomedic…

New DNA sequencing technology at the Brigham and Women’s Hospital (BWH) has identified several new unique genetic mutations in mesothelioma cancer cells that were previously unidentified.

The findings serve as promising evidence that the improved sensitivity and effectiveness of DNA sequencing technology is providing more pertinent and rapid results in relation to cancer gene profiling. Successful identification of over-expressed genes, for both mesothelioma and other types of cancer, can help dictate the best course of cancer treatment.

As lead author of the BWH study, David Sugarbaker, explains: “after spending a year and a half to develop the methodology and software for the pipeline, new tumors can be analyzed over the course of about a month. Knowing which genes are mutated opens the door to better understanding and the discovery of more targeted and effective patient-specific treatments in real time.”

In the initial mesothelioma analysis, tissue samples were taken from four patients with malignant pleural mesothelioma, one patient with lung cancer and one with normal lung tissue. All expressed genes from each sample were sequenced (numbered in the billions). With no preconceived notions of which genes may be indicators of mesothelioma, 15 new mutations were identified in the four mesothelioma tumor samples.

Moreover, it was found that each tumor had unique genetic mutations not shared by any other tumor sampled. This suggests that mesothelioma tumors are singularly unique, much like our fingerprints.

Ultimately, this study exhibits the promise of advancements in DNA sequencing technology. One day such technologies may be a standard procedure for all cancers used for the purpose of identifying tumor mutations and dictating treatment. As Fleisher envisions it: “every patient’s tumor will be directly sequenced to determine its mutations and optimal treatment just as we now identify the cause of an infection before selecting the best antibiotic to treat it.”

Resources: http://www.brighamandwomens.org/PressRel…

President Obama announced plans to contribute $5 billion in medical research grants that the White House says will cumulatively provide “cutting-edge medical research in every state across America.”

The funds will be provided via Obama’s $787 billion economic stimulus plan, and will largely be used to aid research into cancer, heart disease and autism.

The president made the announcement while visiting the National institutes for Health on September 30. As he puts it, the goal of this stimulus package is “to unlock treatments to diseases that have long plagued humanity, to save and enrich the lives of people all over the world.” Obama also noted that this is the “single largest boost to biomedical research in history.”

One billion dollars of the package will be set aside for cancer research geared towards understanding genetic causes associated with cancer and improving personalized treatment mechanisms. To facilitate this goal, $175 million has already been set aside for grants devoted to the Cancer Genome Atlas.

The Cancer Genome Atlas is an initiative currently underway to extensively map the unique genetic changes that affect cancer. Specifically, the money will be used to collect tens of thousands of cancerous tissue samples and subsequently sequence the entire DNA strands of over 20 forms of cancer.

President Obama stresses that the more than 12,000 grant awards will largely take place at not-for-profit institutions such as the National Institutes for Health. By eliminating profit incentives, the president hopes to spur unbiased research.

Beyond touting the potential for significant advancements in the study of cancer and other medical ailments, Mr. Obama noted that the $5 billion package will serve to “create new jobs, tens of thousands of jobs” for medical workers, researchers, educators and medical equipment manufacturers.

Along with discussing the stimulus package, Obama highlighted the importance of his health care reform package. As he puts it, all the medical advancements achieved through the package “make no difference to the family that is dropped from an insurance policy when a child gets sick.”

Coal dust inhalation has been linked to a handful of debilitating lung diseases, including pneumoconiosis (black lung) and silicosis. Despite the fact that these diseases are 100 percent preventable, countless coal miners and quarry workers continue to be diagnosed with these fatal illnesses each year.

Since 1995, the National Institute for Occupational Safety and Health (NIOSH) has recommended that coal mine dust exposure be limited to a concentration of 1.0 mg/m3 TWA for up to 10 hours a day over a 40-hour work week. Well over a decade after this recommendation was first made, the Mine Safety and Health Administration (MSHA) continues to mandate a concentration of 2.0 mg/m3.

It is estimated that even at the 1.0mg/m3 level, dozens of mine workers will continue to be diagnosed with black lung and related diseases each year. At the present heightened level, even more hard-working miners are being needlessly exposed to high levels of hazardous coal dust.

In an effort to urge the MSHA to lower acceptable coal dust levels, the Appalachian Citizens’ Law Center (ACLC) recently submitted a petition calling for improved miner safety. In support of the petition, numerous health professionals sent a letter to the MSHA. A key point of the letter states that:

“According to a 2008 report by NIOSH, the prevalence of CWP has more than doubled since 1995 among coal miners with more than 20 years of exposure. NIOSH has also identified advanced cases of respiratory disease in working U.S. miners as young as 39 years of age.”

The ACLC petition is just the most recent attempt to sway MSHA to reduce miner exposure to coal dust. Other petitions and lawsuits have been filed in the past. Despite these efforts, the MSHA does not plan to propose new rules on airborne coal dust and silica until April of 2011.

Resources:
 http://thepumphandle.wordpress.com/2009/…

One of the earliest chemotherapy drugs is showing positive results in bowel cancer patients that could signal a resurgence in its use. The drug, known as methotrexate, was first used during the 1940s World War II era.

According to UK researchers at the Institute of Cancer Research (ICR), the drug may find a new use as a tailored treatment for bowel cancer patients who have a specific genetic fault. In studies, it was shown that methotrexate effectively killed cells that carried the faulty gene, dubbed MSH2.

The MSH2 gene has been linked to a genetic condition known as HNPCC. For men who carry this gene, 90 percent will be diagnosed with bowel cancer by the time they are 70. For women, the probability is 70 percent.

In total, the gene is linked to approximately 5 percent of all cases of bowel cancer. 40 percent of all patients with HNPCC have a faulty MSH2 gene.

Though use of methotrexate has dropped significantly since the 1940s (newer chemo drugs are typically preferred), the drug is still frequently used as a leukemia treatment. Now, researchers are hopeful that it can also be used as a tailored treatment for bowel cancer.

As Dr. Alan Ashworth, leader of the ICR study, explains: “What’s exciting about methotrexate is that it selectively destroys the cells lacking the MSH2 function. This indicates that it may make an excellent treatment for patients with the genetic alteration.”

Clinical trials to confirm the safety and effectiveness of methotrexate as a treatment for bowel cancer have already begun. While the potential for the customized drug will only affect a small proportion of bowel cancer patients, the new findings are promising indeed. Methrotrexate is one of the antifolate class of chemotherapy agents.

Customized cancer treatment based on specific genetic mutations or cancer subtypes continues to be a promising field. Methotrexate is just one of many drugs currently being investigated for the use as a tailored cancer medication.

Resources:
 http://news.bbc.co.uk/2/hi/health/822344…
 http://www.hc2d.co.uk/content.php?conten…

The first major case study of workers contracting lung and heart illnesses as a result of nanoparticles was released in the September issue of the European Respiratory Journal. The case involves seven workers of a Chinese printing plant, who fed a chemical paste that contained nanoparticles into an auto-spray machine that coated polystyrene boards.

All seven workers developed serious lung and heart conditions, and two ultimately died from their illnesses. In the aftermath of the case study, questions continue to be raised about whether or not nanoparticles are to blame.

Certainly, the symptoms exhibited by the workers are remarkably similar to those exhibited by lab mice during earlier research efforts performed by NIOSH and others. In these studies, nanoparticles such as carbon nanotubes and metal oxides were deemed toxic to both the hearts and lungs of lab mice.

Unfortunately, the case study of the Chinese workers cannot adequately determine whether or not nanoparticles played a part in manifesting the illnesses. The results are inconclusive due to a lack of exposure data. Additionally, experts point to several alternative explanations that may have resulted in the development of these heart and lung conditions.

Beyond nanoparticles, the workers were exposed to a number of other hazardous chemicals, including butanoic acid, butyl ester, N-butyl ether, acetic acid, toluene, di-tert-butyl peroxide, 1-butanol, acetic acid ethenyl ester, isopropyl alcohol and ethylene dioxide. Thermodegradation fume products absent of nanoparticles have already been proven to cause illness in occupational settings. Additionally, traditional paint spraying has also been known to be hazardous.

While the case study is not conclusive, it does raise additional concern into the safety of nanoparticles. Regardless of whether or not nanoparticles contributed to the illnesses of the seven Chinese workers, NIOSH strongly recommends that safety precautions be enforced in occupational environments in which nanoparticles are present.

Resource: http://www.cdc.gov/niosh/blog/

Like any other industry, pharmaceutical companies are continually chasing profits. In recent years, companies like Pfizer have grown fat off of cardiovascular drugs such as Lipitor (used for lowering cholesterol).

However, it seems there’s a shift in Big Pharma’s business model. It seems nearly all the major players are jumping on the cancer bandwagon, and ramping efforts in the realm of cancer research.

The reason for this renewed interest in cancer is twofold. For one, recent cancer research has identified a number of new biomarkers and targets. These new targets help point pharmaceutical manufacturers in the right direction when it comes to developing effective drugs.

For two, annual earnings from cash cows such as Lipitor are beginning decline. The potential for high profits that is possible through cancer medications can help fill this gap in profitability.

For some experts, the shift to cancer is a bit surprising. In the past, Big Pharma largely eschewed cancer research because of the small population segments that are diagnosed with any one particular type of the disease. This results in a much smaller target consumer when compared to the millions of individuals who suffer from more widespread diseases.

Additionally, very few cancer drugs make it to market each year. For 2008, only two new cancer drugs were approved by the FDA.

Despite this, Pfizer plans to increase annual sales of cancer medications from $2.5 billion in 2008 to $11 billion by 2018. The reasoning comes in the exorbitant prices that often come along with cancer drugs. Despite small target audiences, cancer drugs accounted for three of the top ten medications in terms of annual sales for 2008. Cancer drugs as a whole also combine to be the largest category in terms of worldwide sales.

As Robert L. Erwin, a biotechnology industry executive at Marti Nelson Cancer Foundation, explains: ” As long as the health care system will pay the price, the money will flow in that direction.”

Resource:
 http://www.nytimes.com/2009/09/02/health…

Costs related to health care remain a strong topic of debate in the United States. As new medications and treatment technologies continue to become available, the costs associated with health care are expected to rise.

The American Society of Clinical Oncologists (ASCO) estimates that cancer care costs are growing at a rate of 15 percent each year. Given that 33 percent of families faced with paying for cancer care have difficulty making payments, ASCO has become increasingly concerned about these rising cancer care costs.

In an effort to minimize cost-related hurdles facing cancer patients, ASCO has established a Cost of Care Task Force. The goals of the Force will be to identify challenges concerning cost of cancer care, and subsequently develop solutions to overcome these challenges.

ASCO’s tactics for tackling costs of cancer care begin at the patient-physician level. The four main components of the Guidance Statement for the Task Force are as follows:

Promote patient-physician discussions of cost when discussing potential treatment options (presently, only 37 percent of oncologists “always” discuss costs with patients, according to a recent ASCO survey)
Promote the availability of educational and support tools for oncologists to aid in cost discussions with patients
Provide educational materials directly to patients, through such documents as ASCO’s Managing the Cost of Cancer Care Booklet
Address underlying factors related to rising costs of cancer care

In addition to working within the current system, ASCO is also a vocal organization in Washington D.C. Representatives of the organization are continually working with others in the cancer community to change legislation to improve insurance coverage and other key components related to cancer costs.

Resources:
 http://www.asco.org/ASCOv2/Public+Policy…
 http://www.asco.org/ASCOv2/Practice+%26+…

A couple months ago, the FDA approved Avastin for use in treating brain cancer. The new approval is just the latest in a growing number of applications for the drug. First approved in 2004 to fight colorectal cancer, Avastin is now considered an avenue of treatment for lung, breast and other forms of cancer.

However, the effectiveness of Avastin is highly variable on a case-by-case basis. While some patients experience a considerable increase in survival time thanks to the drug, Avastin only delivers a 2-month increase in expected overall survival when compared to other drug treatments.

Initially heralded as a breakthrough drug, doctors are now coming to realize a vast set of complexities behind the effectiveness of Avastin.

Avastin works by blocking a cancer’s ability to feed a growing tumor with new blood vessels. This is accomplished by inhibiting the function of a vascular endothelial growth factor (VEGF) protein that is responsible for stimulating formation of new blood vessels.

When successful, Avastin deprives a tumor of oxygen, limiting or reversing growth. However, for too many patients, the drug has no effect at all.

The variability of success is based on genetic variations present in a patient. Unfortunately, the responsible DNA has yet to be identified.

In absence of more targeted answers, doctors continue to dole out Avastin to a high number of cancer patients in the hopes that they will respond positively. However, a relatively low number of patients are favorably affected by the treatment. Add in the high cost of the drug (up to $55,000 for a single treatment), and doctors are clamoring to create a more focused means of identifying viable patients for the drug.

To achieve this, researchers at Genentech (Avastin’s manufacturer) have already sifted through 150 genetic markers in the hopes of identifying pertinent genes. The Susan G. Koman for the Cure advocacy group has also set aside $6 million to research the subject over the next five years. Hopefully, these considerable efforts will lead to genetic discoveries that doctors can use to predict the effectiveness of Avastin in future patients.

Resource:
 http://www.technologyreview.com/biomedic…

A number of substances used during historical war times have been known to be hazardous to veterans’ health, according to the U.S. Department of Veterans Affairs (VA). Oftentimes, veterans exposed to these substances develop cancer later in their lifetimes. Two such substances linked to cancer include ionizing radiation and Agent Orange.

Ionizing Radiation

Presently, ionizing radiation is used in a number of medical treatments and tests, including CT scans, x-rays and mammograms. However, high levels of ionizing radiation have been known to cause cancer. For some veterans, unhealthy exposure to ionizing radiation may have resulted from contact with nuclear weapons or fallout from such weapons.

Those who served in Japan during World War II or were present for nuclear weapons testing between 1945 and 1962 are at the highest risk for exposure to ionizing radiation.

A number of types of cancers have been linked to ionizing radiation, including, breast, thyroid, stomach, bladder, lung, colon and brain. For a full list of cancers linked to ionizing radiation, please view the VA’s Diseases Associated with Ionizing Radiation Exposure.

Agent Orange

Agent Orange is an herbicide that was used extensively during the Vietnam War. Approximately 20 million gallons of the substance was sprayed throughout the Vietnam jungle to kill plants and expose enemy hiding places. Among the many chemicals present in Agent Orange is dioxin, a substance recently linked to numerous long-term health conditions.

Several studies conducted by the VA, Centers for Disease Control and other agencies have linked Agent Orange to such cancers as lymphoma, lung cancer, prostate cancer, multiple myeloma, soft-tissue sarcoma and chronic lymphocytic leukemia. For a full list of illnesses related to Agent Orange, please see the VA’s Diseases Associated with Agent Orange Exposure.

Veteran Affairs Benefits

The VA offers health care benefits for those veterans exposed to either ionizing radiation or Agent Orange. If a veteran has been diagnosed with one of the cancers linked to these substances and documentation can be provided that indicates wartime exposure, then the individual is eligible for such benefits. Both medical and financial treatment may be available.

Additionally, veterans exposed to ionizing radiation or Agent Orange are eligible for free health examinations. These health examinations may help identify and diagnose any potential cancers so that proper treatment can be initiated.

Resources:
 http://www.cancer.net/patient/Library/Ca…
 http://www.cancer.net/patient/Library/Ca…