With the success of recent research in the area of genetics, doctors have been looking forward to bringing personalized treatment to their mesothelioma patients. By identifying specific genetic mutations, or biomarkers, within tumors doctors can target treatment according to the patient’s unique characteristics. For example, crizotinib has been found to be an effective drug for treating non-small cell lung cancer patients with tumors that express the abnormal anaplastic lymphoma kinase (ALK) gene. However, according to researchers in Great Britain, treatment based on genetic markers could fail due to genetic diversity within each tumor.
Personalized care has been touted as offering treatment options that might not otherwise have been considered. Personalized care also optimizes the potential for success of the treatment. Mesothelioma, an asbestos-caused cancer, currently has limited treatment options, but genetic science has promised to allow physicians to tailor treatment to individual patients based on their genetic makeup.
According to an article published in the New England Journal of Medicine (NEJM), though, genetic tests can be misleading. Depending on where on a tumor a biopsy is conducted, or whether it is from the primary or secondary tumor, the results could lead a physician down an incorrect path.
The researchers from the London Research Institute report that most often only one biopsy sample is taken to drive the course of treatment. But after they mapped the “genetic changes or faults in different regions of the same tumor” they believe physicians could miss the gene they had hoped to find to guide the patient’s treatment with just a single test.
The researchers analyzed kidney cancer tumors with samples taken from different regions of the primary tumor as well as biopsies from organs where the cancer had metastasized. They found that nearly 70% of the biomarkers differed across samples. This led them to conclude that these differences “may present major challenges to personalized-medicine and biomarker development.”
“We’ve known for some time that tumors are a patchwork of faults, but this is the first time we’ve been able to use cutting-edge genome sequencing technology to map out the genetic landscape of a tumor in such exquisite detail,” said Charles Swanton of University College London’s cancer institute who led the study.
In an editorial responding to the article, Dan Longo, MD, Deputy Editor of the NEJM, suggested the findings are a stark difference to the “overoptimism” in the field. He added that the drive toward personalized medicine may be more difficult than previously thought.
The researchers do not want the study to dampen enthusiasm for using genetically targeted therapies, however, they point out the focused treatment could become more costly. Mesothelioma advocates, although disappointed in the fact that personalized medicine may be more challenging, are encouraged that the findings now suggest physicians conduct multiple tests prior to subscribing to a particular treatment.
Patients diagnosed with mesothelioma, an asbestos-caused cancer, often endure many rounds of chemotherapy while fighting the disease. Unfortunately, the side effects caused by the potent medicines can be debilitating, often leading patients to halt treatment. Within the past few months, however, researchers have found several solutions for increasing the effectiveness of chemotherapy and for lowering its toxicity in cancer patients. Now, researchers at Duke University report yet another breakthrough in reducing chemotherapy’s side effects.
Physicians rely on chemotherapy in the treatment of mesothelioma, as well as many other cancers. One issue with chemotherapy is that the medicine is highly toxic and it kills healthy cells as well as the diseased cells. But Duke researchers found the “transporter” molecules that can deliver chemotherapy directly to the diseased cells, bypassing the healthy cells and limiting the effects from toxicity.
The “transporter” molecules, or nucleoside transporters, the researchers found, work by moving nucleosides, the basic building blocks of nucleic acids or DNA and RNA, from the outside to the inside of cells. The transporter also carries the nucleoside-like chemotherapy drugs through cell membranes into the DNA, preventing tumor cells from dividing and growing.
“Knowing the structure and properties of the transporter molecule may be the key to changing the way that some chemotherapies, for example, could work in the body to prevent tumor growth,” said senior author Seok-Yong Lee, PhD, assistant professor of biochemistry at Duke.
By understanding the interaction between the transporter and the cancer drug, the researchers believe a new drug can be developed with a unique shape the transporters will recognize. A lower dosage of drug, with fewer side effects, could then be used to successfully fight the cancer.
Duke reports the next step “will be to try to understand which features of the transporter confer the ability to recognize certain chemo drugs and ultimately to design drugs that can easily enter the cells.”
This finding offers hope to mesothelioma patients who have limited treatment options. A drug that is effective, yet does not have toxic side effects can mean the difference in survival and prognosis for those that cannot tolerate current chemotherapy treatments.
More mesothelioma patients are seeking second opinions from doctors, which can lead to significant differences in how the cancer is treated.
Although mesothelioma can be detected with the right tests, some doctors can easily mistakenly diagnose the disease as lung cancer, or as something else completely. The mistake is simple to make, especially with a rare cancer such as mesothelioma.
Both cancers have some of the same symptoms. Patients can experience dry cough, chest pain, shortness of breath and difficulty breathing. Doctors have been known to misread slides and test results. Sometimes they may not be able to see all the possibilities and overlook key evidence. That’s why it’s important to share your medical and occupational history with the doctor, especially if you think that you were around asbestos.
Mesothelioma is caused by asbestos exposure. Some mesothelioma patients can pinpoint the cause of their cancer to when they worked with asbestos, or asbestos-containing products.
Asbestos products were once commonly used in thousands of products from hairdryers to home insulation. Hundreds of thousands of people who worked around these products were exposed to asbestos on a daily basis. Asbestos is still used in the U.S. today. Throughout the years it’s likely that a number of those exposed have been misdiagnosed.
There are about 3,000 people diagnosed with mesothelioma every year. About 10,000 people die from asbestos diseases annually.
Mesothelioma develops most often in the membrane that lines the lungs called the pleura. Mesothelioma can also develop around the abdomen and the heart.
Doctors can diagnose the type of cancer using several tests including CT scans, scopes and biopsies. Doctors may differ on treatment options depending on the type and stage of mesothelioma.
It’s important to know that seeking a second opinion is not an indictment of the doctor. Doctors are usually glad to recommend other physicians who can help patients get a second opinion. It’s not uncommon for some patients to seek out three or more "second" opinions. Sometimes it’s comforting for patients to hear the opinions from several physicians just to make sure they’re getting the proper treatment and diagnoses.
Of course receiving a second opinion can be expensive. There could be more tests, more travel and more medical costs. But in most cases patients won’t have to undergo the same diagnostic tests twice. Patients are entitled to view and send their medical records to other doctors who will be giving the second opinion.
It’s also important to check with healthcare providers to see if a secondary visit is covered by insurance. Some providers actually require a second opinion before approving major surgery or treatment.
Not to be overlooked during the process is the trust factor. Patients should choose doctors they are most comfortable with. Trust in the medical staff and receiving proper care can drastically improve the quality of life for a mesothelioma patient.
Mesothelioma sufferers could get a boost if lawmakers approve a plan to allow the FDA to rapidly approve innovative drugs and treatment.
Florida Rep. Cliff Stearns introduced the Faster Access to Specialized Treatments act that will fast-track medical options for patients who don’t have the time to wait. The goal is to get much needed treatment to those who have fallen ill with rare diseases, such as mesothelioma, a cancer caused by exposure to asbestos.
For example, if scientists discover that a new medication can shrink a tumor, that treatment could be approved quickly, even if the study isn’t yet complete. According to a report in the Journal of Clinical Oncology, the current state of drug approval is slow. In the fast-track process that currently exists, it took about seven years to get new drugs to market.
Many mesothelioma patients don’t have that long to wait.
The disease strikes about 3,000 people in the United States each year. Mesothelioma can occur in the lining of the lung, the abdomen or the heart. Doctors have yet to find a cure. However, scientists have found several treatments that can prolong life and make the disease less aggressive.
People suffering from other rare diseases will also benefit from this bill. A rare disease is one that affects no more than 200,000 Americans. Mesothelioma is one of the 7,000 rare diseases that fit into this category. The FDA reports that 30 million Americans are diagnosed with these rare diseases.
While rare, mesothelioma usually occurs in people who have worked in trades where they were exposed to asbestos.
The new legislation will update the 20-year-old accelerated approval process that experts say are now outdated. Under that law, Congress gave the United States Food and Drug Administration permission to approve drugs quickly for those suffering from HIV, AIDS and other rare cancers.
Several biomedical firms and advocacy groups representing those with rare diseases have praised Congress for considering the bill. Mesothelioma patients will join in giving Congress the praise it deserves.
Diseases like mesothelioma have been forgotten for years because it’s so rare. In fact, many doctors fail to accurately diagnose the disease. Mesothelioma shares many of the same symptoms as lung cancer and has similar warning signs. Common symptoms are chest pain, persistent cough, breathing difficulty and fatigue. Symptoms don’t normally occur until 10 or more years after initial exposure to asbestos.