Real Response in Mesothelioma
CHICAGO, IL-Physicians presenting clinical data at the Malignant Mesothelioma Conference, hosted by the University of Chicago, echoed one and other with a recurring theme--while the past has offered little in the way of advancements in surgical, radiotherapy, and chemotherapy, new active drugs and insights into the biology of mesothelioma are demonstrating real progress, helping to replace longstanding nihilism that had been associated with the treatment of this disease.
Antifolates, such as premetrexed disodium (Alimta), offer new hope for effective treatments, as illustrated by the results of a phase II single agent trial of alimta, in which a confirmed partial response was seen in 14.5% (9/62) of advance pleural mesothelioma patients. In this study, 62 chemonaive patients were enrolled with a 5.2:1 M/F ratio, median age of 67 years (range 40-80) stage III/IV disease (31%/54%), and subhistology of epidermal (74%), mixed (14%), or sarcamatoid (9%) involvement.
The median duration of response was +10.8 months, median time to progressive disease, 5.4 months, and median survival was 10.7 months. Hematologic toxicities were observed as grade 3 and 4 neutropenia in 14% of patients, and grade 3 thrombocytopenia in 1.7% of patients. At present, the most common non-hematological toxicity observed in patients included fatigue (10.9%), anorexia (5.9%), nausea (4.8%), and febrile neutropenia (4.8%)--only 1% of patients experienced grade 4 non-hematological toxicities.
Previous to this study, investigators found that vitamin supplementation with low-dose folic acid and vitamin B12 was capable of markedly reducing toxicity previously seen with alimta therapy. Accordingly, this phase II single agent trial of alimta included vitamin supplementation to help alleviate anticipated toxicities. With regard to folic acid and B12 supplementation, partial response results were 18% (5/40) for fully vitamin supplemented patients, 60% (3/5) for partially vitamin supplemented patients (patients who started supplementation after cycle one), and 5% (1/17) for non-vitamin supplemented patients.
Axel Hanauske, MD, Medical Director, Eli Lilly & Company presented results from an overall comparison of observed toxicities before and after the addition of vitamin supplements to alimta studies, in which 246 patients from 12 studies received no vitamin supplements and 78 patients from 3 studies received folic acid and vitamin B12 supplements. After adding vitamin supplementation to alimta trials, a dramatic decrease was seen in both hematologic and non-hematologic toxicities (37% before vs. 6.4% after), as well as a complete cessation of drug-related deaths since the vitamin supplementation started (7% before vs. 0% after).
Mesothelioma
What is Mesothelioma?
This is about the disease itself and is written in a ‘question and answer’ format to answer the most common questions asked about mesothelioma. I’m sure there are many more which are beyond the scope of this small booklet, but further sources of
information and advice are listed in part
Mesothelioma (also known as ‘diffuse’ or ‘malignant’ Mesothelioma) is a form of cancer, which affects the thin membranes which line the chest (pleural mesothelioma). Less commonly it can affect the linings of the abdomen (peritoneal mesothelioma). It may also surround the organs found within these cavities for example the heart, lung and intestines.
Pleural Mesothelioma
The pleural lining has two layers - an inner (visceral) layer which lines the lung and an outer (parietal) layer which lines the chest wall. The pleura produce fluid to lubricate the space between the two layers allowing the layers to slide comfortably over each other as we breathe.Pleural Mesothelioma causes the pleura to thicken. This may make it press on the lung or attach itself to the chest wall. Fluid, sometimes several litres, can collect between the two layers and cause
breathlessness. This is known as a Pleural effusion
Peritoneal Mesothelioma
The peritoneum also has two layers, the inner (visceral) layer which is next to the abdominal organs and the outer (parietal) layer which lines the abdominal wall. Peritoneal Mesothelioma causes the peritoneum to thicken and fluid to collect in the abdomen, this collection of fluid is called ascites and causes the abdomen to swell. Peritoneal Mesothelioma is much less common than Pleural Mesothelioma.
Asbestos in Older Homes
Asbestos in Older Homes
Asbestos has been a growing concern for city governments and the owners of public buildings for some time. In recent years, concerns about asbestos have become a growing issue among the owners of single family homes. These are some of the questions most commonly asked of asbestos abatement companies by the owners of private homes, and their best answers.
- How likely is my home to contain asbestos?
If your home was built after 1980, the chances that it contains asbestos or any materials that have asbestos added to them is very small. If your home was built or underwent major renovations between World War I and 1980, there’s a very good chance that there are materials in your home that contain asbestos.
- How dangerous is asbestos in my home?
While asbestos is a known carcinogen, it is only dangerous in the form of tiny airborne fibers. Asbestos is a mineral that easily separates into tiny fibers that are light enough to float in the air. Those fibers were often mixed into things like paint, cement and wood pulp to help make them fire resistant and increase their insulating properties. As long as those materials are in good repair, the chance of them releasing asbestos fibers is very small, and there is little health risk in living with them.
- Why is asbestos dangerous?
Breathing in asbestos fibers increases your risk of developing lung cancer, causes asbestosis – scarring of the lungs – and may lead to the development of mesothelioma, a rare cancer that is only found in people who were exposed to asbestos. For additional resources please see the resources at Asbestos.com
- When is asbestos dangerous to me or my family?
Asbestos containing materials can become dangerous to your family’s health when they are damaged or disturbed enough to release fibers of asbestos into the air.
- How can I tell if something in my home contains asbestos?
The only way to know for sure that a material in your home contains asbestos is to have it examined by a professional. It’s nearly impossible to identify asbestos by visual examination alone unless you have the experience and knowledge to identify specific brands and types of materials by sight. Even then, most professionals rely on a microscopic examination to determine whether a material contains asbestos.
If you suspect that something in your home is made of asbestos, you have two choices: you can assume that it contains asbestos and take the same precautions you would if you were certain that it did, or you can have it tested by a professional asbestos surveyor. Testing is not very expensive, and it could set your mind at east.
- Where might I find asbestos in my home?
Asbestos was used in thousands of different products that were used in home construction and consumer products. Among the most common places to find asbestos are:
- roofing and siding shingles made with asbestos cement
- insulation in homes built between 1930 and 1950
- textured paints used for decorative ceiling and wall coatings (banned in 1977)
- pipe insulation and caulking
- furnace or water heater blankets may contain asbestos
- the floor and walls under and behind stoves, fireplaces and heaters may be protected with asbestos containing millboard, asbestos paper or cement sheets containing asbestos
- the door gaskets in oil or coal furnaces may contain asbestos
- joint compound used to seal wallboard may contain asbestos
- resilient floor tiles or sheet vinyl flooring may have been made with or backed with asbestos containing materials
- decorative plaster treatments on walls and ceilings may contain asbestos
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MALIGNANT MESOTHELIOMA
HARVEY I. PASS, MD
CLINICAL FEATURES
The onset of mesothelioma is usually insidious; a common pre-senting symptom is persistent localized pain.PLEURAL MESOTHELIOMA Chest pain or dyspnea is almost constant, although of varying degree.63,214 Pleural effusion is present initially inup to 95% of cases. 63 Later, tumor growth usually results in complete obliteration of the pleural space and encasement of the lung. 93,214,264Cough, weight loss, and fever are not uncommon. In contrast to benign mesothelioma, clubbing is rare and was seen only in 6% of cases. 51 Mediastinal invasion with dysphagia, phrenic nerve paralysis, pericar-dial effusion, and superior vena cava syndrome can occur. 225 Sponta- neous pneumothorax or hydropneumothorax and Horner’s syndrome have been described. 127,206 Progressive invasion of the chest wall often leads to intractable pain. Chest radiographs reveal a variable amount of fluid, with pleural thickening or pleural nodules, often several centimeters in diameter, imposing a scalloped appearance (Fig. 89.2). Predominance at the base is almost constant. In advanced cases, psilateral shift of the mediastinum and retraction of the involved hemithorax are characteristic, unless the tumor volume becomes very large.
63,93 The electro cardiogram (ECG) is abnormal in almost 90% of patients, showing various arrythmias (sinus tachycardia is the single most common change [42% of cases] but also premature atrial or ventricular contractions, atrial fibrillation, or flutter), conduction abnormalities (right-side bundle branch block, left hemiblocks), nonspecific ST-T changes, or left or right hypertrophy. 289 Computed tomography (CT) is most valuable in showing the extent of disease (including chest wall, mediastinum, pericardium, and diaphragm), relative amount of fluid and tumor, involvement of interlobar fissures, and retraction of the involved hemithorax (Fig. 89.3). In addition, signs of asbestos exposure, such as contralateral pulmonary fibrosis and/or pleural plaques, are seen in 50% of cases and pleural calcifications in 15%.202 Furtherstudies are needed to evaluate the role of magnetic resonance imaging (MRI). MRI has been better than CT in showing tumor spread into the fissures, diaphragm, and bony structures, whereas both procedures are equally effective to detect invasion into the chest wall, lung, and mediastinum.
145a Echocardiography is useful to reveal pericardial involve ment, especially if cardiac tamponade is suspected. 289 Uptake of gal lium 67GA citrate by mesothelioma tumors has been experimentally demonstrated, 273 and gallium scan was positive in 43 of 49 patients (88%) with pleural mesothelioma.265 Recently, the role of fluo rodeoxyglucose (FDG) positron emission tomography (PET) imaging has been examined in a cohort of 28 patients with suspected mesothelioma (confirmed in 22). 26b Standardized uptake values (SUVs) were determined from the most active tumor site in each patient. The mean SUV of the deceased patients was 6.6 +/- 2.9, compared with 3.2 +/- 1.6 among the combined survivors. The deceased patients had tumor SUVs that were highly correlated with duration of survival after the PET study. The survival distribution of the high-SUV group showed significantly shorter survivals, compared with the low-SUV group.
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MESOTHELIOMA IN AUSTRALIA INCIDENCE 1982 TO 2005 DEATHS 1997 TO 2006
Data on the number of new cases of mesothelioma are collected nationally by the Australian Institute of Health and Welfare (AIHW) in the National Cancer Statistics Clearing House, via the State Cancer Registries. Information on deaths from mesothelioma is also collected by the AIHW as part of the National Mortality Database. Data are available from 1982 to 2005 for the number of new cases, and from 1997 to 2006 for the number of deaths.
New cases diagnosed
> In 2005 there were 597 new cases of mesothelioma diagnosed in Australia. Although this fgure is considerably higher than the 156 reported in 1982, the earliest data available, it is a reduction from the fgure of 645 new cases reported in 2003. Over the period since 1982 the large majority of new cases involved men: typically accounting for between 80% and 90% of new cases. > In 2005, the age-standardised rate of new cases of mesothelioma was 2.8 per 100 000 population. This rate has increased over time, from 1.2 cases in 1982. In 2005, the highest age-specifc incidence rate of new cases, 47 cases per 100 000 population, occurred among men aged 80–84 years.
Deaths due to mesothelioma
> In 2006 there were 486 deaths attributed to mesothelioma. Data on the number of deaths due to mesothelioma are available for the years 1997 to 2006. Refecting the incidence of new cases diagnosed, the overall number of deaths resulting from mesothelioma generally increased over the period between 1997 and 2006: reaching a maximum of 545 in 2004. > In 2006, the age-standardised rate of death due to mesothelioma was 2.3 deaths per 100 000 population.
The overall age-standardised rate has remained relatively stable over the 10 years for which data are available. Over the period the standardised rate has ranged between a minimum of 2.1 deaths per 100 000 population in 1999 and a maximum of 2.7 in 2001.
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