Pleural Mesothelioma - Chemotherapy questions - 1266676

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shhs
Pleural Mesothelioma - Chemotherapy questions - 1266676

My brother has pleural mesothelioma - We live in Wellington New Zealand he explains

I haves had: thoraoscopy, biopsy, talc pleuradesys, decortication and re-inflation of my
right lung (W/C 13 10 14). .
I am currently on a 'trimodal' treatment plan.

I would however like to ensure that we are doing everything to scour the world for any emerging treatments.

I have epithelial malignant pleural mesothelioma, am fit with no
other health issues and by all accounts have a 'low disease burden'.

Does chemotherapy lose effectiveness over a number of treatments and why?

My therapy, starting 07 11 14, will be using Alimpta and Platinum for 3
rounds . I understand that this is pretty much the recognised treatment. I seems that a round was 4 weeks in Australia and 3 weeks here in NZ . What is common practice?

Is it common practice to included blood vessel blockers?

I have also seen reference to FGF and FAK inhibitors,
Can you explain what these are?

Hot' chemo drugs can be applied into chest cavity post surgery. I understand the disease tends to stay local and that direct application of the treatment to the site has the benefit of
applying concentrations that could not otherwise be achieved. Is this view shared by others?

Do mistletoe injections have any good or harmful effects (the are used in Europe)

Thanks

Mike Sparrow

Dr West
Mike,

Mike,

I'm very sorry about your brother's diagnosis. We're happy to try to help but in the interest of time, it's only feasible to cover the more central questions, not the ones that are not relevant to treatment.

The standard chemotherapy treatment is definitely cisplatin and Alimta (pemetrexed), most commonly given every 3 weeks. This chemotherapy is not commonly combined with other targeted therapies. There has been a large study that tested the role of Avastin, an angiogenesis inhibitor ("blood vessel blocker"), in mesothelioma and showed that it does not improve outcomes. It is not used in combination with chemotherapy. Nor are targeted therapies like FGF or FAK inhibitors, which are novel therapies that really haven't demonstrated any clear benefit in cancer at this time. While it would be reasonable to consider them in a clinical trial, they have no role in standard treatment.

The idea of hyperthermic chemotherapy is done in a few centers in the US -- I presume also some others in the world. The few places that do it think it helps, but this treatment is very toxic and is very far from being a standard of care.

Mesothelioma is a setting in which there is relatively little research because it's a very uncommon cancer, and much of what drives treatment is the sometimes very strong opinions of the doctors treating it and the misguided presumption by some doctors and many patients that it must be better to give the most phenomenally aggressive treatment a patient can survive. I would be very cautious about following the zealous opinions of people who are making judgments based on presumptions and faith rather than evidence. What often happens is that the healthiest patients with the lowest cancer burden with the most favorable cancer biology are selected for the most extreme treatments. If they do well, it is attributed to the treatment, even though they were exactly the patients expected to do best anyway.

(cont)

+++++++++++++++++++++++++
Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education

Dr West
With regard to mistletoe, the

With regard to mistletoe, the short answer is that there is no evidence of any quality to suggest that it should be included in the treatment plan. That treatments are done somewhere is very different from them being useful. People do all sorts of things. I would say that neither I nor any other recognized thoracic oncology expert has ever recommended mistletoe injections for their patients. It wouldn't crack my top 500 recommendations for patients.

-Dr. West

+++++++++++++++++++++++++
Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education

shhs
Dr West

Dr West

Thankyou for the speedy reply

Thankyou for confirming the standard chemotherapy treatment and the information about Avastin

Simon fits in the category of "healthiest patients with the lowest cancer burden with the most favorable cancer biology are selected for the most extreme treatments" - I ve just been walking the paddocks with him.
So you comments are most appreciated.

With regards mistletoe the research we reviewed concluded that there was no strong evidence that it did any good but conversely no evidence it did any harm. Is that your understanding of the research?

Regards

Mike Sparrow

Dr West
I think that's a fair

I think that's a fair assessment of mistletoe for cancer. There isn't enough research to say much either way. There's always a potential danger, just as there is always a potential benefit, when interventions haven't been assessed enough to say more, but otherwise I'd say the leading risk is simply false hope that it's going to have a major effect. Perhaps, but I wouldn't presume that.

Good luck.

-Dr. West

+++++++++++++++++++++++++
Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education

shhs
Thanks reply

Thanks reply

No risk of false hope vis a vie mistletoe

The real difficulty is obtaining data

- 5 and 10 year survival rates for the
- 'trimodal approach,
-verses the chemo and radiation
- verses chemo only

When betting ones life and you are 'doomed if you do- doomed if you don't - without the data
its hard to make an informed decision.

Mike

Dr West
Studies are too small to rely

Studies are too small to rely on data here. These aren't randomized trials: they are small numbers of patients, usually carefully selected, getting treated at only a few centers. I don't think it's really possible to generalize a broader experience without a randomized trial in which half of the patients get trimodality therapy and half of the patients receive a different, less aggressive approach. Another approach that is gaining traction among some experts is the so-called "Toronto approach" (developed in Toronto, also called SMART therapy, an acronym I can't remember the origin of the acronym for) in which patients receive 5 days of high dose radiation to the entire half-chest with the mesothelioma. followed immediately by an extrapleural pneumonectomy, followed by follow-up and no planned chemotherapy unless or until the cancer recurs.

I'll say that one approach that I still think is very reasonable in an an asymptomatic (no symptoms) patient with a small volume of mesothelioma is to follow it without treatment, until clear progression, if a patient can psychologically deal with that. Mesothelioma can sometimes develop over yers, sometimes over MANY years, and I'm very unconvinced that the long-term survivors of super-aggressive approaches to mesothelioma aren't just the same people who would have been alive ANYWAY 3-5 or even 10 years later if their mesothelioma had been left untreated or treated just with chemotherapy. To some surgeons, suggesting as much is sacrilege, but all of the approaches for potentially resectable mesothelioma are more based in faith and bias than actual evidence. I can assure you that I follow some patients with an indolent mesothelioma that shows barely perceptible change every 4-6 months on scans, whether I give chemo or not, and others respond well enough to chemo that I can treat them for years and years with minimal side effects.

It may not help to know of so many options, but there's much room for patient preference.

-Dr. West

+++++++++++++++++++++++++
Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education

shhs
As always thank you for your

As always thank you for your time.

In Simon's case he started getting plural effusions that had to be drained - suggesting perhaps the mesothelioma was becoming less 'indolent'. The diagnosis followed the effusions.

The book "Cancer - the emperor of all maladies" talked of how in the 'war on cancer ' the radical surgery and later radical chemotherapy approaches were ideologically driven - with the best intentions. This also being your message.

The difficulty with patient preference - is that also faith based on a lot less knowledge

Questions

1. I thought the cancer cells became desensitised to the chemotherapy hence limiting the number of time it could be used - is this not the case?

2. Are changes monitored at the cellular level (e.g taking more biopsies) or only using scans? Using scans is it easy to miss significant changes and the you miss the window for treatment options?

3. Do you know which centres are practicing the 'Toronto approach'

Regards

Mike Sparrow

catdander
Hi Mike, I've been out of www

Hi Mike, I've been out of www range for a few days and haven't had a chance to welcome you to Grace. I'm so sorry your brother is going through this. It sounds like Simon is lucky to have you in his corner.

It's true cancer mutates to grow through chemo drugs also each individual's system can only withstand so much of a drug. For both these reasons people with stage IV lung cancer are usually better off using only enough treatment to feel well as long as possible. A metaphor about living with non curable lung cancer is that of a foot race where treatment is a marathon as opposed to a sprint.

There are growing reasons today to look at current biopsies when so called targeted treatments are used such as those with an EGFR mutation have been using 1st gen drug like erlotinib then begin to progress (cancer mutates to grow through treatment). Doctors have found specific mutations that happen and have found drugs that work around the new mutation. But this is a specific only to those cases in which people have an EGFR, ALK, ROS1 mutation. For the rest/most people scanning is still the best way to watch what's happening. There's not information found in a biopsy that can alter treatment decisions. If there is reason to doubt a spot found on scan may or may not be cancer a biopsy may be in order.

I hope this is helpful. Best of luck to you and your brother. I hope he does well for a long long time to come.

Janine

catdander
While looking for info on

While looking for info on “Toronto approach” I came across this,though not any new info, http://www.mesothelioma.com/blog/authors/jack/trimodality-therapy-for-me...

JimC
Hi Mike,

Hi Mike,

I just to add some thoughts to the good information Janine provided. Although it is true that for the most part a particular chemo drug eventually becomes ineffective, there are patients who remain on a single drug (especially in the case of targeted therapies) for an extended period. Patients are monitored with scans and if progression is seen, the recent trend (as Janine pointed out) is to re-biopsy to see if there is a new mutation for which a targeting drug has been developed.

If there is no progression, usually doctors will not re-biopsy, preferring to re-scan and perform clinical examinations of the patient. One reason is that biopsies are invasive procedures which are not risk-free, so they are only done when they will directly affect the management of the cancer. If you biopsy when there is no progression, you may discover a new mutation but if it's not causing trouble it would be premature to initiate treatment. If progression later appears, you would probably still need a new biopsy to be assured that it is the same mutation which is causing the progression so that the proper treatment can be selected.

JimC
Forum moderator

<p>I began visiting GRACE in July, 2008 when my wife Liz was diagnosed with lung cancer, and became a forum moderator in January, 2010. My beloved wife of 30 years passed away Nov. 4, 2011 after battling stage IV lung cancer for 3 years and 4 months</p>

Dr West
Not much to add. Scans (and

Not much to add. Scans (and symptoms) are definitely the way we monitor the pace of the disease, which almost invariably tends to accelerate over time, though sometimes that's just from "extremely indolent" to "still pretty indolent, but less so" over many years (admittedly, the best case scenario).

I couldn't say where the Toronto approach is being done. The surgeon discussing surgery options would be in the best position to speak to this, but I don't want to imply that this is the clear standard of care right now or that I am definitely advocating it as a best opion. Rather, it's the latest development that has captured the attention of the surgeons at my center who see a significant number of patients with mesothelioma.

-Dr. West

+++++++++++++++++++++++++
Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education

shhs
Are you able to comment on

Are you able to comment on the following

"Probably one of the largest changes in the last decade has been the development of drugs addressing specific mutations. From the notion of lung cancer as a disease which takes decades to develop and involves multiple carcinogens, has come a realization that some cancers appear to have a primary mutation. For these cancers, that mutation plays a substantial role and a drug addressing it can have significant impact. For example, many non-smokers may be EGFR (epidermal growth factor receptor) and anti EGFR drugs like Tarceva can have a beneficial impact."

Thanks

Mike

JimC
Hi Mike,

Hi Mike,

Targeted therapies such as those described in your quote have been the focus of much research for several years. As a result, it has become standard practice to test the cancer cells for certain mutations for which targeted drugs have been developed. These mutations occur most often in non-smokers, but they do occur less frequently in smokers, so more oncologists are beginning to test all of their patients.

If you search this site for "targeted therapies" or "EGFR" you will find a wealth of information. You may want to begin with Dr. Pennell's very thorough overview here.

JimC
Forum moderator

<p>I began visiting GRACE in July, 2008 when my wife Liz was diagnosed with lung cancer, and became a forum moderator in January, 2010. My beloved wife of 30 years passed away Nov. 4, 2011 after battling stage IV lung cancer for 3 years and 4 months</p>

Dr West
I think the bigger point is

I think the bigger point is that while we're extremely aware of the potential importance of mutations in many cancers, though this hasn't been relevant yet in malignant pleural mesothelioma. This isn't to say that such mutations/targets couldn't be helpful for mesothelioma, but they haven't been shown to be useful yet in that setting.

-Dr. West

+++++++++++++++++++++++++
Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education

shhs
I would appreciate comments

I would appreciate comments on

1. Did anything new come out of the South African conference last week?. A Boston based? drug company was presenting information about a new drug they had been trialling

2. I have followed up on SMART therapy - the procedure involves radiation before lung removal - they doubled there 3 year survival rate ( figures of 70 were being quoted). I have asked the question why radiation before the lung removal not after as in the trimodal approach.

3. Are the any other experimental procedures/therapies currently being developed?

Thanks

Mike

Dr West
Sorry, we don't keep up with

Sorry, we don't keep up with the reports coming out of every meeting around the world. I don't think this conference in South Africa is very likely to have changed global standards. The important trials are presented at just 1 or 2 main meetings, primarily ASCO (American) and ESMO (European).

I can't answer the question of the order of SMART protocol. That's what they did. Bear in mind that the "doubling of three year survival" is not a randomized trial of patients getting one approach or another, but a comparison of results of an earlier cohort of patients compared with a later cohort of patients in a single institution. This is not the same as a definitive test of the utility of one approach compared head to head with another.

There are always new things being worked on, but we can't address every new agent or trial being looked our around the world.

-Dr. West

+++++++++++++++++++++++++
Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education

shhs
Your views on Amatuximab -

Your views on Amatuximab -

Amatuximab is a monoclonal antibody, a type of protein that has been designed to recognise and
attach to a specific structure (called an antigen) that is found on certain cells in the body. Amatuximab
has been designed to attach to mesothelin, a protein that is found in high amounts on the surface of
mesothelioma cells. By attaching to mesothelin, amatuximab is expected to activate certain cells in the
immune system (the body’s natural defences), so that they kill the cancerous cells. This is expected to
slow down the development of malignant mesothelioma.

Thanks Mike

Dr West
I haven't seen any clinical

I haven't seen any clinical research results with amatuximab, so I have no opinion of it. It's a theoretically appealing focus of research, but I don't know that I would recommend a patient get on a plane to pursue it.

-Dr. West

+++++++++++++++++++++++++
Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education

shhs
Your views on Curcumin

Your views on Curcumin

Department of Pathology, University of Vermont College of Medicine, 89 Beaumont Avenue, HSRF 216, Burlington, VT 05405-0068. arti.shukla@uvm.edu.
Abstract
Inflammation is a key mediator in the development of malignant mesothelioma, which has a dismal prognosis and poor therapeutic strategies. Curcumin, a naturally occurring polyphenol in turmeric, has been shown to possess anticarcinogenic properties through its anti-inflammatory effects. Inflammasomes, a component of inflammation, control the activation of caspase-1 leading to pyroptosis and processing of proinflammatory cytokines, interleukin (IL)-1β and IL-18. In the present study, we investigate the role of curcumin in pyroptotic cell death of malignant mesotheliomacells. Using in vitro models with mouse and human malignant mesothelioma cells, curcumin is shown to induce pyroptosis through activation of caspase-1 and increased release of high-mobility group box 1 (HMGB1) without processing of IL-1β and IL-18. Absence of IL-1β processing in response to curcumin-mediated caspase-1 activation is attributed to blockade of pro-IL-1β priming through inhibition of the NF-κB pathway. Furthermore, curcumin's cytotoxicity in malignant mesothelioma cells is demonstrated to be dependent on pyroptosis as inhibition of caspase-1 resulted in protection against curcumin-induced cell death. We also demonstrate that curcumin-mediated caspase-1 activation is oxidant dependent by using N-acetyl-L-cysteine (NAC) to inhibit pyroptosis. PCR array analysis using the human inflammasome template revealed that curcuminsignificantly downregulated levels of inflammasome-related gene expression involved in inflammation, e.g., NF-κB, toll-like receptors (TLR), and IL-1β. Our data indicate that curcumin has a double effect on malignant mesothelioma cells through induction of pyroptosis while subsequently protecting against inflammation.

Dr West
This is not clinical research

This is not clinical research. In my opinion it is of no clinical relevance. I think it is a mistake to chase down every publication on the planet about mesothelioma to try to cobble together an untested plan based on no clinical evidence.

-Dr. West

+++++++++++++++++++++++++
Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education

shhs
My brother now has 2

My brother now has 2 treatment plans
(if we had not been proactive option 2 would not have been available)

Option 1

Palliative care based - with the sub option of CT scan monitoring for progression prior to initiating treatment (the oncologist talked of this approach with one of his patients who had seen no progression for 18 months)

Option 2

Timodal treatment - the surgery planned for couple of months time

Questions

1. Are there any graphs around plotting survival times for the 2 different approaches - the graphs tail being of interest?

2. Are there any EPP survivors around who would be happy to talk with Simon about their experience?

Thanks

Mike

catdander
Mike,

Mike,

I've asked a doctor who specializes in mesothelioma to comment. I hope your brother does well with whatever path he follows.

All best,
Janine

JimC
Mike,

Mike,

I can't point you to any such graphs, but I would caution that if you find such information it is not very helpful to compare data from a trial of one treatment approach to data from another trial of a different approach. Unless the results come from the same cohort of patients randomized to one of the two approaches, the comparison can be misleading.

If you have not seen them, there are some discussions of trimodality therapy here on GRACE: http://cancergrace.org/lung/tag/mesothelioma/

JimC
Forum moderator

<p>I began visiting GRACE in July, 2008 when my wife Liz was diagnosed with lung cancer, and became a forum moderator in January, 2010. My beloved wife of 30 years passed away Nov. 4, 2011 after battling stage IV lung cancer for 3 years and 4 months</p>

Dr West
Indeed, there's so much bias

Indeed, there's so much bias from patients and docs in terms of what they are inclined to do that there are no trials that randomize very fit patients with a minimal tumor burden to close observation vs. trimodality therapy. I can assure you that both options are very reasonable, and I suspect that many patients in this setting could actually do well for years before showing evidence of significant progression. Moreover, I also suspect that many of the patients who do well after trimodality therapy do well because they were good candidates for trimodality therapy (having the most favorable characteristics associated with doing well no matter what treatment is given or not), and not necessarily because of the trimodality therapy itself. I suspect we will never have the evidence to show one approach is better or not.

The best person to offer contacts to discuss EPP would be the surgeon who has done these before, or possibly connecting with a mesothelioma discussion group online. HOWEVER, I can assure you that the experience leads to such variable outcomes that someone else's expereince may not be very generalizable for another person. It is an enormously big undertaking, and some patients do well, but others have quite significant pain and potentially shortness of breath afterward. Someone else's experience can tell how someone else has done, but there is no "average" or typical outcome after trimodality therapy and EPP.

-Dr. West

+++++++++++++++++++++++++
Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education

shhs
Combined cisplaten and

Combined cisplaten and pemetrexed for treating pleural mesothelioma

How do I find the data for for this treatment.

I have read median survival is 12 months and 40% of patients respond to the drug.

Information I would like is

a) 2, 3 ,4 ,5 year survival rates
b) survival rates for the 40% group that responds.

Thanks

Nike Sparrow

catdander
Nike, I hope your brother is

Nike, I hope your brother is feeling alright. Our faculty doctors can only recite what is known then explain the pros and cons of reading stats and I think Dr. West and Jim have done a good job at the latter. I looked around online and found the http://www.asbestos.com/mesothelioma/life-expectancy.php to have a lot of data such as life expectancy.

I imagine you have read these but just in case and for others here's a list, http://cancergrace.org/lung/tag/mesothelioma/
too and I don't recall you discussing Bevacizumab and VEGF which is discussed toward the bottom of the piece under<span style="text-decoration:underline;"> List of novel agents under investigation</span>: in this blog post, http://cancergrace.org/lung/2010/06/05/comprehensive-review-of-mesotheli...
Bevacizumab aka Avastin is sometimes paired up with other chemo agents.

I hope there's something here of some help.

All best,
Janine

Dr West
I don't think I have anything

I don't think I have anything to add to Janine's summary and recommended links. I would make a couple of cautionary points.

1) There aren't necessarily published or easily findable stats for every endpoint. You may need to go to the actual reference and look at graphs to try to find numbers at various time points. HOWEVER, follow-up for the study is not likely go out beyond 3 years, so there aren't likely to be accurate numbers for long-term survival.

2) Stats are very good for populations but poor for individuals. Though we might be able to say that there's a 50% survival with cisplatin/pemetrexed at one year, every individual patient is either a 100% survivor at 1 year or not. There are some long term survivors out 3+ years; it's worth knowing that there are outliers as a proof of principle, at least.

Good luck.

-Dr. West

+++++++++++++++++++++++++
Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education

shhs
Greetings

Greetings
I would like to update you on our research regarding EEP surgery, Radical P/D surgery and only Cisplaten- Pemetrexec chemotherapy treatment

Based on Kaplan Meier survival graphs and understanding that the survival plots should also include a plume showing +/- confidence limits and also understanding that the plume gets very large for longer survival times (because the studies are closed too early and many patients are censored)

We think we can say that even when allowing for patient selection
- Radical p/d surgery doubles the survival advantage over not surgery:

- Generally radical p/d surgery gives significantly better survival advantage of EPP (there are some exceptional surgeons in Australia and elsewhere whose results 'push' this statement).
[However radical p/d surgery has a much lower opportunity cost than EPP].

References
1. Phase III study of pemetrexed in combination with cistplaten vs cistplatin alone in patients with malignant pleural mesothelioma Vogelzang et al

2. Posters mesothelioma 2005? P435 Long term survival update from the randomized phase II study of pemetrexed in combination with cistplaten vs cistplatin alone in patients with malignant pleural mesothelioma Vogelzang et al

3. Pluerctomy/decortation is superior to extraplueral pneumonectomy in the multimodal management of patients with malignant pleural mesothelioma - loic Lang- Lazdunski et al

4 Surgery in the treatment of malignant pleuralmesothelioma: recruitment into trials should be the
default position Avijit Datta et al

4. Improving Survival Results after Surgical,Management of Malignant Pleural Mesothelioma:
An Australian Institution Experience Tristan D. Yan BSc et al

Simon will will be going to London for radical P/D surgery early in the new year.

The next challenge will be understanding tumor profiling, drug maintenance etc of what I am beginning to understand is a chronic disease. The asbestos being embedded in the body continuing to cause cell mutation

shhs
Dear Jack

Dear Jack

Your views are Keytruda

It seems to me a good idea to take the drug as maintenance therapy

Best regards

Mike

shhs
Dear Jack

Dear Jack

I thought the following might be useful information

Simons radical P/D went really well getting rid of all the post talc pleurodeses fluid in the right pleural cavity. [London is definitely a place of medical excellence and and is considerably more accessible and less expensive than the USA for those who are not residents or do not have US medical insurance]

(Note: post 2 cycles of Pemetrexed and Cistplaten a tongue tumor growth in pleurodeses 'pothole' was observed in the surgery)

The 15 cycles of radiotherapy had few side effects

The post surgery chemotherapy (Gemcitabine and Carboplaten/Cistplaten) has been quite savage on Simons white blood cells with a consequentially infection requiring hospitalisation Hence the move to Keytruda (pembrolizumab)

Best regards

Mike Sparrow

shhs
Dr West

Dr West

In case it is of use/interest I wanted to give you feed back about results to date of my brothers treatment

3 weeks ago Simon had a PET scan and there was no detectable signs of pleural mesothelioma.

He started on 3 weekly cycles of Keytuda 2 weeks ago.

He is currently also taking metformin, celecoxib and simvastatin with no apparent side effects

A summary of his treatment to date:

Presentation of pleural effusions September 2014
Biopsy and talc pleurodesis Oct 14 2014 (talc pleurodesis was unscucessful)
2 cycles of Cis/Pem prior to end of 2014
Radical P/D - right lung - Professor Loïc Lang-Lazdunski in London (involved travelling from New Zealand
(Loic observed a tongue of tumor growth into the biopsy/pleurodesis incision suggesting Cis/Pem was not working. 2 of the lymph nodes he biopsied were also found to be affected by the cancer)
12 rounds of radiotherapy also in London
Gemcitabine alternating with and then without Carboplatin (first cycle) then Cisplaten thereafter

Surgery had the positive side effect of permanently getting rid of the pleural fluid
Radiotherapy probably reduced his right lung capacity a bit and gets what has been described as radiation recall when taking chemotherapy drugs
The chemotherapy drugs definitely had the worst side effects. He was hospitalized for 2 weeks on time with an infection.

Simon can be described as being in good health for a man of nearly 59. He is thinking of buying a motorcycle (I guess just to ensure that his prognosis for a long life is not increased)

The lessons learnt to date I believe are (and Simon has self funded all treatment except for the conventional chemo in NZ - surgery and radiotherapy not being given as an option because of a lack of beneficial evidence :
Act fast and have the radical P/D surgery if you are a candidate (even I suspect if you have comorbidity)
Go to London - it is more accessible to international patients and less expensive. Have the radiotherapy and try all the drugs.

catdander
I'm glad to hear Simon is

I'm glad to hear Simon is doing well for a man of nearly 59. I say that sarcastically because my husband is 59 and I'm not far behind. My husband too bought a new, to him motorcycle a about 3 years ago. BTW he has enjoyed that mc so much. He bought it with the money he got from selling a 76 hd mc that he no longer could man handle on the road. I hope your brother enjoys life from here out.

Janine

giulia
Hi Mike,

Hi Mike,

I would love to hear an update on how your brother is doing?

My mum was recently diagnosed with Pleural Mesothelioma and has started Chemotherapy however we are also looking in to the option of Surgery.

We live in Sydney, Australia.

Thanks
Giulia

eriksondateinlima
<span style="text-align

<span style="text-align:center;">Mesothelioma Treatment Options</span>
<span style="text-align:justify;">
Mesothelioma treatment is decided by the stage of cancer and the degree to which it has spread. For early stage cancers which are contained in the thorax can be totally or partially removed by surgical procedures such as thoracotomy, lobectomy, pleurectomy and extrapulmonary pneumonectomy.

</span>

This may potentially reduce the recurrence rates although overall survival is not affected. Some surgical procedures such as pleurectomy and pleurodesis can be used as a palliative option where indicated when the patient is not fit enough to undergo major procedures when “cancer” has spread to distant sites.

Mesothelioma treatment is aggressive cancer which develops from the mesothelium found in the lungs (pleura), heart and abdomen. Currently, there is no cure for this cancer but treatment is available to improve the prognosis and quality of life. The standard treatment mainly consists of surgery, chemotherapy, and radiotherapy. Some patients may also seek alternative therapy and experimental clinical trials. In most instances, a combination of these therapies with a multimodal approach is being used.....</span>
<span style="color: blue;">
Mesothelioma Treatment Options</b> </span>