Chemotherapy Does Not Improve Treatment For Mesothelioma
Editor's ChoiceMain Category: Asbestos / Mesothelioma
Also Included In: Clinical Trials / Drug Trials; Lung Cancer
Article Date: 15 May 2008 - 16:00 PDT
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For mesothelioma patients, the addition of chemotherapy to the usual active symptom control (ASC) does not appear to improve survival or quality of life, according to an article released on May 16, 2008 in The Lancet.
Malignant pleural mesothelioma (MPM) is cancer of the mesothelium, the protective layer that covers the lungs. Generally associated with exposure to asbestos, it is almost always fatal.
Worldwide, this cancer has been rising. For example, in the UK, the mortality rate increased by a factor of 12 between 1968 and 2001, and nearly 2000 deaths were recorded in 2005. By 2013, the yearly death rate due to mesothelioma is expected to increase to 2200. Similar death rates are found in the United States and in Western Europe. Due to the risks of asbestos exposure, however, the epidemic will shift towards countries that produce or use large quantities of asbestos, such as Russia, China, Canada, Kazakhstan, Brazil, Zimbabew, India, and Thailand.
To investigate various treatment options for MPM patients, Richard Stephens and Professor Mahesh Parmar, Medical Research Council (MRC) Clinical Trials Unit, London, UK, and colleagues performed the MS01 study, funded by Cancer Research UK. This randomized trial examined 409 patients with MPM from 76 centers in the UK and two in Australia. OF these, 136 were randomly assigned to be administered ASC alone; 137 were given ASC plus MVP chemotherapy, which involved four cycles of mitomycin, vinblastine, and cisplatin every three weeks; the remaining 136 patients received ASC plus vinorelbine chemotherapy, which was one injection of vinorelbine every week for twelve weeks. Follow up was performed every three weeks up to 21 weeks after the treatment. Due to an insufficient number of recruited subjects, an assessment of the individual chemotherapy treatments was not possible, so the groups were combined and compared with the baseline ASC only group for the primary outcome of overall survival.
When the analysis was performed, 393 (96%) of the patients had died. 132 of these came from the ASC only group, 132 came from the ASC/MVP group, and 129 came from the ASC/vinorelbine group. A small benefit to the combination therapy was present but not statistically significant. Patients in the ASC/vinorelbine group also showed improved survival, with a larger number alive after one year, but this was also not statistically significant. Analysis of the quality of life in each of the groups, including physical functioning, pain, shortness of breath, and overall health status, were similar.
The authors conclude that this particular therapy method does not improve the fate of the mesothelioma patient: "The addition of chemotherapy to ASC offers no significant benefits in terms of overall survival or quality of life. However, exploratory analyses suggested that vinorelbine merits further investigation."
Dr Nicholas J Vogelzang, Nevada Cancer Institute, Las Vegas, NV, USA, contributed an accompanying comment in which he discusses evidence regarding various chemotherapy regimens for this disease. "Patients with MPM who wish to be treated should be informed that strong medical evidence establishes the standard of care for MPM as cisplatin and pretrexed. Although cisplatin plus gemcitabine might be equally effective, there have as yet been no randomised comparisons of the two doublet regimens."
Active symptom control with or without chemotherapy in the treatment of patients with malignant pleural mesothelioma (MS01): a multicentre randomised trial
Martin F Muers, Richard J Stephens, Patricia Fisher, Liz Darlison, Christopher M B Higgs, Erica Lowry, Andrew G Nicholson, Mary O'Brien, Michael Peake, Robin Rudd, Michael Snee, Jeremy Steele, David J Girling, Matthew Nankivell, Cheryl Pugh, Mahesh K B Parmar, on behalf of the MS01 Trial Management Group
Lancet 2008; 371: 1685-94
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Chemotherapy for malignant pleural mesothelioma
Nicholas J Vogelzang
Lancet 2008; 371: 1640-2
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Written by Anna Sophia McKenney
Copyright: Medical News Today
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13 Feb. 2012. <http://www.medicalnewstoday.com/articles/107633.php>
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Could Talc Improve Treatment For Mesothelioma?
posted by Gregory D. Pawelski on 16 May 2008 at 11:07 pmA study published in the European Respiratory Journal last April, revealed that talc stimulates healthy cells to produce endostatin, a hormone considered the magic bullet for treating metastatic lung cancer. The University of Florida researchers say talc is an exciting new therapeutic agent for cancers largely considered incurable.
They found that talc causes tumor growth to slow down and actually decreases the tumor bulk. Talc is able to prevent the formation of blood vessels, thereby killing the tumor and choking off its growth. The tumors appeared to grow much slower and in some cases completely disappeared.
Scientists have only recently discovered that talcum powder stunts tumor growth, though the mineral has been used for almost 70 years to treat the respiratory problems that accompany metastatic lung cancer. About half of all patients accumulate fluid around the surface of the lungs, a condition known as malignant pleural effusion. That fluid can press down upon the lung, impair the breathing of the patient and cause the patient to feel very short of breath.
Pleural effusions indicate that the cancer, which might have started in the breast, lung or gastrointestinal tract, has spread throughout the body. The prognosis for the roughly 200,000 patients afflicted with this condition is poor: Many die within six months.
To make life more bearable for these patients, doctors close the extra space between the lung and the chest wall, where the troublesome fluid collects. The trick is gluing the two surfaces together. Talc is blown into the patients' chest cavity to irritate the tissue and create tiny abrasions. When the lung tissue heals, it becomes permanently adhered to the chest wall without impairing the patients' breathing. The effects of the procedure, called medical thoracoscopy with talc pleurodesis, are immediate and last a lifetime.
The Food and Drug Administration approved talc for use in medical thoracoscopy in 2003. Doctors have noticed that patients who undergo medical thoracoscopy with talcum powder live up to 18 months longer than expected.
Talc has added benefits besides causing scarring and taking away the fluid that surrounds the lung. The cells that cover the lining of the lung are stimulated by the presence of talc to produce a factor that inhibits the growth of blood vessels and kills the tumor cells themselves.
Less than one day after treatment with talc, patients began producing 10-fold higher levels of endostatin, a hormone released by healthy lung cells. Endostatin prevents new blood vessels from forming, slows cell growth and movement, and even induces nearby tumor cells to commit suicide. All of these make it hard for tumors to grow and spread into healthy lung tissue.
What is being done is the normal pleural mesothelial cells continue to produce endostatin. Talc doesn't go away. Talc stays in the chest cavity, constantly causing the normal cells to produce this factor that inhibits the growth of the tumor. And the antitumor effects of talc appear to be long-lasting.
This work will undoubtedly have a significant influence on future clinical trials dealing with the treatment of pleural malignancies, including lung cancer, mesothelioma and metastatic adenocarcinoma involving the pleural surfaces.
Source: University of Florida
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