While recent studies have concluded that the neutrophils to lymphocytes ratio or NLR may be a poor indicator of cancer, new research suggests that NLR may be a helpful prognostic tool with respect to developing mesothelioma treatment protocols.
The study published in Oncotarget conducted an analysis of 10 other studies which covered the cases of 1,500 mesothelioma patients.
NLR is a marker for inflammation in the body and therefore NLR provides a snapshot of the overall health of the immune system, a function vital to fight malignant cancer cells and to fight against new tumors. Improved treatment strategies could be key in extending survival times or quality of life during those survival times. NLR has also shown promise in helping approving mesothelioma patients for clinical trials.
Myth #1 Mesothelioma Only Affects Senior Citizens
Because mesothelioma typically takes 10 to 50 years to manifest the largest demographic of those suffering from mesothelioma are over the age of 65 but it’s a misconception to say that they’re the only ones. There are a growing number of individuals much younger who have been devastated by the disease. Unfortunately, we have come across cases in our practice where young girls who helped their fathers with clothing contaminated with asbestos from the job site be subsequently diagnosed with mesothelioma. The worrying trend is also a product of asbestos in schools that are failing to properly contain the mineral and preventing disturbances which can lead to deadly exposure.
Myth #2 It’s Caused by Smoking
Smoking does not cause mesothelioma, nor does smoking make you more likely to be diagnosed with mesothelioma. This misconception may exist because smokers who are also exposed to asbestos have a greater chance of being diagnosed with lung cancer
Myth #3 Only Long Term Exposure Causes Mesothelioma
While long term exposure does increase the chances of a mesothelioma diagnosis, it is not required. Modern medical surveys and the Environmental Protection Agency have said in no uncertain terms that there is no safe level of exposure.
Myth #4 Mesothelioma Only Impacts the Lungs
Approximately 75% of all cases are pleural or based in the lungs but there are several other forms. The next most common type is peritoneal which impacts the lining of the abdomen. Pericardial mesothelioma which effects the lining of the heart is a rarer form which impacts approximately 1% of those diagnosed. Even rarer than pericardial is the testicular form (men) as well as the papillary form (women).
Myth #5 Asbestos is Banned in the United States
Although over 55 countries have banned the deadly mineral, the United States still actively imports asbestos into the country. While many new uses have been banned by the US Government there are still certain permitted applications.
A French study published in Oncotarget revealed that curcumin, the active ingredient in turmeric, both slowed tumor growth and reduced tumor mass.
The study focuses on sarcomatoid mesothelioma - one of the rarest and deadliest forms.
The plant based drug has been the subject of much research in the mesothelioma field due to its natural anti-inflammatory properties. While curcumin has shown promising results, it’s still in the animal test phase. One of the author’s of the study, Dr. Pouliquen stated that, ““The treatment of tumor-bearing rats with 1.5 mg/kg curcumin on days 7, 9, 11 and 14 after tumor challenge dramatically reduced the mean total tumor mass at day 16.” Dr. Pouliquen went on to say that, ““These data open up interesting new prospects for the therapy of sarcomatoid mesothelioma with curcumin and its derivatives.”
A new report out of Belgium, published in the Acta Chirugica Belgica studied 101 pleural mesothelioma cases from 2001 to 2015.
The study found that the median survival time of 18.3 months. Of the cases studied the survival rates were as follows:
Understanding the TNH system
The staging system is designed for predict outcomes and select treatment protocols based on three factors:
Surgery Versus The Staging System
The results of the study points to the idea that the stage alone may have negligible impact on survival rates. The author of the study reported that “A significant difference in survival was observed in patients undergoing surgery versus no surgery…and treatment with chemotherapy alone versus chemotherapy with surgery.” One of the other significant factors for survival times was whether the patient was a smoker. Smoker tended to have worse treatment outcomes.
A new report published in the European Journal of Cardio-Thoracic Surgery studied the cases of 314 pleural mesothelioma patients from 2011 to 2014 who had P/D surgery to remove the pleural membrane from their diseased lung.
The study concludes that not all P/D methods are created equal. Of the three P/D methods, the researchers concluded that only two had positive impacts on survival rates.
The three P/D surgical protocols examined were Extended P/D, P/D, and Partial P/D.
Marulli, the author of the study concluded that, “Whether the P/D is extended or not, it shows similarly good outcomes in terms of early results and survival rate. In contrast, a partial pleurectomy, which leaves gross tumour behind, has no impact on survival.”
The fear of the unknown and confusion that accompanies a mesothelioma diagnosis is something that no one can truly understand unless they have been through the experience. To help combat this confusion physicians from Australia developed an app that helps patients to organize their medical records, treatment schedule, appointments, and the point of contact information for all of their healthcare providers.
The app even allows healthcare providers to who use the application to provide patient specific treatment plans and advice.
The information that the patient inputs into the device provides healthcare providers with an efficient way to get vital patient information. While the app is designed to help patients with all types of cancers, it is likely that it will be an invaluable resource for mesothelioma patients.
Currently CancerAid is the leading cancer app in the apple store for the United States, Australia, and the United Kingdom. There have been over 30,000 downloads and the numbers continue to rise. To learn more about the application click here.
In a study published just last week in the American Journal of Industrial Medicine it was revealed that dental technicians may be subject to an elevated risk of mesothelioma, an often overlooked piece of information in the dental field.
The Italian study observed 5,344 pleural mesothelioma cases in Italy ranging from year 2000 to 2014. Of the sample there were four individuals who where subkected to 100% of all of their exposure from the dental field. These individual included three males and one female who helped her husband make dental implants for over 30 years. Total exposure between the technicians ranged from 4 to 34 years.
Asbestos was previously used as a binder in periodontal dressings as well as the heat resistant tape in implants. The dental field was one of those industries that many thought wouldn’t be effected by asbestos exposure however according to the author of the journal article, Caroline Mensi, “We confirm the association of malignant mesothelioma with dental technician work.”
Medical researchers at the University Hospital of Saint Etienne published a study in the international journal, Virchows Archiv which involved 116 pleural mesothelioma patients. The French doctors came up with six sets of cellular characteristics which may have a bearing on survival rates.
The lead author of the study Cyril Habougit, stated that, "Our work shows that mitotic count <3/10 HPF, the lack of necrosis, mild nuclear atypia, the lack of atypical mitoses, a nucleoli size <3 um and a nucleoli absent or visible at 200x or higher magnification are significantly associated with a better median overall survival in epithelioid mesothelioma."
Currently, the less precise subtype is the only generally accepted way to predict survival rates using pathology. If these cellular factors could enable doctors to better target therapies leading to better treatment outcomes.
The Department of Defense has provided research grants of $550,000 Pietro Bertino and his team at the University of Hawaii to develop a vaccine aimed at preventing mesothelioma before it ever forms.
Dr. Bertino, the head of the research team, is optimistic at the progress they’ve already seen in the animal trials. Bertino’s approach is novel in the sense that it doesn’t seek to treat the malignant mesothelial cells but rather prevent them from ever forming in the first place.
The vaccine works by targeting specific proteins requisite for mesothelioma tumor growth. Early results show the vaccine successfully eradicated mesothelioma tumor cells in mice which ultimately lead to a tumor free life in 40% of the animal subjects. If successful, the vaccine could be administered to people who have bio-markers for a predisposition to mesothelioma as well as those who have a particularly risky occupational exposure history.
Pietro Bertino has a long history in the mesothelioma research and well regarded as an expert in his field. He grew up in Italy right next to a large asbestos plant and saw firsthand the devastating health effects of the dangerous mineral. Bertino stated, “This is a different kind of intervention, my final goal is to make a preventative vaccine and help perfect it. And if it works for mesothelioma, it could be effective in preventing other kinds of cancers, too.”
To read the full article from the University of Hawaii click here
While there currently is no cure for mesothelioma there are treatment options.
Unfortunately, diagnoses typically come far too late for those treatments to be very effective. The stress of the diagnoses as well as the physical and mental toll treatment takes requires the mesothelioma patients to seek both physical and mental reinforcement. Mental wellbeing is critical to maximizing and increasing the quality of the precious time that the patient has remaining. Meditation and massage are both classified as Complimentary Alternative Medicine (CAM). According to the National Cancer Institute approximately 4 out of 10 adults take advantage of CAM therapies with the most common being deep breathing exercises.
In a study published in The American Journal of Hospice & Palliative Care the researchers concluded that “massage, as well as other coveted CAM therapies, available as regularly offered options to enrollees in hospice and palliative care programs may offer significant benefit, particularly if provided over an extended period.”
Research continually shows positive and meaningful improvements in the quality of life of those even with terminal cancers. Because scheduling a massage is a little more intuitive than practicing meditation, we’ve provided some techniques below which were compiled by Cancer Forward.
Sitting Meditation Tips:
The Indian Journal of Occupational and Environmental Medicine reports that asbestos has been banned in 65 countries which have a total population of over billion people or approximately 16% of the global population.
Countries with the greatest number of mesothelioma deaths per 100,000 include
Countries with the fewest numbers of Mesothelioma diagnoses per 100,000 include
To view the full journal article click here.
Last week concluded the annual Washington D.C. conference of the American Association for Cancer Researchers (AACR).
At the conference, scientists and researchers from around the world reported their most recent breakthroughs and innovations for various forms of cancer.
One of the stand out presentations for the week included Bristol-Myers Squib drug in first phase clinical trials called Opdivo (MDX-1106). The drug increased the five year survival for some patients with non-small cell lung cancer to 16% from the National Cancer’s Institute’s rate of 4.9%. To read the whole study click here.
Opvido operates by blocking the PD-L1 protein and leading the immune system to fight the cancerous cells. This type of treatment protocol also is a signature of fighting pleural mesothelioma. The results are very promising for other types of cancers including asbestos related ones.
Dr. Brahmer stated that, “We are performing further studies to learn why these patients did so well for so long and better understand which patients can stop treatment at two years and which of them need to continue treatment beyond two years.”
Mesothelioma researchers from the University of Hawaii Cancer Center have seen promising results from the application of a treatment protocol for multiple sclerosis (MS).
The researchers are investigating the use of an immune system modulator called FTY720which comes from a fungus called Iscaria Sinclairi. The results were published in The Journey of Translational Medicine.
Scientists believe that FTY720 has potential therapeutic applications for other cancers as well but the University of Hawaii’s tests represent the first time that the treatment has been used for pleural mesothelioma. Currently the test has just been performed on mice but the results are promising.
Agata Szymiczek, author of the published study, stated that, “FTY720 administration in vivo [in a live subject] effectively reduced tumor burden in mice without apparent toxicity.” While there is still much work to be done, we remain hopeful that there may be positive results in the near future.
Dear Cancer Research Supporter:
Hi! I'm Dr. Parkash Gill, professor of Medicine and Pathology at the Keck School of Medicine of USC; head of the tumor and vascular biology laboratory at the University of Southern California; the Leader of the Translational and Clinical Sciences Program at the USC Norris Comprehensive Cancer Center, and the Ezalow Family Chair in Cancer Therapeutics.
My focus, and that of the research team with me, is on the future of mesothelioma cancer care -- and I'm fortunate enough to benefit from funds provided by the Mesothelioma Research Foundation of America. Their funds help me, and the young scientists working with me, to explore promising new approaches and technologies to treat mesothelioma cancer.
My work is in the emerging field called: Targeted Cancer Therapy (TCT). Targeted therapy is a cancer treatment that uses drugs, however, it is different from traditional chemotherapy. The drugs known as targeted therapy help stop cancer from growing and spreading. They work by targeting specific genes or proteins. These genes and proteins are found in cancer cells or in cells related to cancer growth, like blood vessel cells.
My hope is that Trials for TCT research will be a standard part of the options offered on every mesothelioma cancer patient's treatment plan. Certified clinicians will use TCT models to plan the best care, and select the most effective drug treatment for each person's individual disease, translating to fewer side-effects upon the patient; the patient spends less time in treatment; and more patients have better results.
My research team and I are looking forward to where our studies take us, thanks to the extraordinary funding and support from Mesothelioma Research Foundation of America. If you would like to discover more about Targeted Cancer Therapy and the hope it holds for the future of mesothelioma cancer care, please use the following form to contact us!
Dr. Parkash Gill, Oncologist
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