Pleural mesothelioma is a type of an aggressive cancer that develops in the tissue that surrounds the lung cavity. It is known to be primarily caused by asbestos exposure. Asbestos was largely used as a material in products revolving construction, automobile, and insulation. It is apparently still used in the said products today in buildings and houses in the U.S. The clear disparity between its latency period, which generally takes decades, compared to its fatal ramifications and little chance of recovery, makes this illness life changing. The symptoms are recorded to range from fever, fatigue, shortness of breath, to back pain, which are commonly overlooked by some, especially in old age. Thus, it was commonly misdiagnosed for lung cancer and pneumonia. At least 30% of the reported mesothelioma claims every year come from veterans. Since the Navy was heavily dependent on asbestos in building submarines, ships, and military houses back in the 1900s, veterans and their dependents from this group have unknowingly contracted mesothelioma that spread through air particles.
Considering the nature and form of this cancer, it is recommended for patients to undergo chemotherapy. The rampant cancer cells can easily spread to nearby organs and remote parts of the body. However, there is no explicit cure for mesothelioma, as such, researchers are investigating ways to enhance the chances of survival of its victims by incorporating or enhancing procedures and chemotherapies.
Immunotherapy has proved its promise in the battle against mesothelioma. The medicines used in immunotherapy are inhibitors that block sets of proteins from linking to successfully strike tumors. A patient with peritoneal mesothelioma, which affects the tissue lining of the abdomen, was observed to take 2 immunotherapy medications and lived for an additional 12 months compared to the usual 1 year survival of victims with mesothelioma that did not go under an operation. The drugs, namely Opdivo (nivolumab) and Yervoy (ipilimumab), served an anti-tumor reaction which caused the tumors to shrink and disappear. Although this combination of drugs has been approved by the FDA, it still has its own set of side effects (rash, diarrhea, nausea, fever, and more) that are commonly temporary and can be managed. However, after 12 months, Opdivo and Yervoy stopped working, which caused the tumors to reappear and spread again.
A report from JAMA Oncology, further strengthened the connection of immunotherapy to mesothelioma. The ATOMIC-meso trial is a 3-phase clinical trial revealed to be a combination of traditional chemotherapy, and a newly introduced drug called ADI-PEG20. This pegargiminase-based approach in chemotherapy to non-epithelioid pleural mesothelioma showed extended survival to patients with advanced-stage non-epithelioid pleural mesothelioma. It relatively elevated the median survival of the study’s participants that went through the procedure by 1.6 months and reached a survival of 36 months, compared to the participants who participated in placebo-chemotherapy.
A certain participant, Mick, who reportedly got exposed to asbestos when he worked in a factory boiler room in the 1970s where cases of asbestos exposure peaked, lived to celebrate his 80th birthday 2 years and a half after taking part in the ATOMIC-meso trial despite being given four months to live by his doctor. Professor Szlosarek, the head researcher of the said clinical trial, observed malignant mesothelioma cells for 20 years and discovered its lack of ASS1, a kind of protein which allows the cancer cells to produce arginine. He then decided to pursue the path in arginine depletion using ADI-PEG20. Along with this discovery, it was also identified that this drug can be used as another form of treatment for other divisions of cancer. In recent developments, ADI-PEG20 is being used in a study which involves patients with glioblastoma and sarcoma, both cancer types who are dependent on arginine.
On the other hand, alternative types of chemotherapy have also been discovered, such as heated intrathoracic chemotherapy (HITHOC) or heated intraperitoneal chemotherapy (HIPEC), which presented a survival rate of 25%. It is inserted to the chest or abdominal cavity using a port or catheter to eliminate the visible tumors and cancer cells. HITHOC was found to have an average range of survival of 2 years and 4 months, compared to the average survival of mesothelioma patients of 24-28 months. This treatment, followed by immediate surgery, is recommended to people with early-stage pleural mesothelioma as it increases their likelihood of extended survival. These cases and discoveries prove the critical lack of wider clinical research and testing that surrounds the varied forms of mesothelioma despite its increasing cases, where 2,803 cases were recorded in the United States alone.
About Jonathan Sharp
Jonathan Sharp is from the Environmental Litigation Group P.C. situated at Birmingham, Alabama, a firm specializing in legal representation, filing claims, advising, and counseling of victims of asbestos, PFAS and other toxic exposure.