Questions Arise Concerning the Use of Radiotherapy after Chemo and Surgery for Mesothelioma
A recent study will likely change the approach in some mesothelioma cancer cases, based on the results published in the journal The Lancet Oncology. The study shows the routine use of hemithoracic radiotherapy after neoadjuvant chemotherapy and extrapleural pneumonectomy is not advisable for patients with malignant pleural mesothelioma. According to current protocol, post-operative hemithoracic radiotherapy is used for treating malignant mesothelioma, but until now had not been evaluated in a randomized trial, although there are many publications describing its use as an integral part of therapy, including seven phase II studies. The recent international phase 2 trial included 151 mesothelioma patients. Of them, 113 underwent extrapleural pneumonectomy. About one-third were then assigned to complete macroscopic resection and to receive either high-dose radiotherapy or no radiotherapy treatment. The survival rate of the no radiotherapy group was an average of 7.6 months, while the radiotherapy group averaged 9.4 months. One subject died as a result of radiotherapy-associated pneumonitis. Some speculate radiotherapy could play a role in the palliative care of pain in patients with end-stage disease who have developed a resistance to opiates, steroids, anticonvulsants, anesthetic agents, and nonsteroidal anti-inflammatory agents. Further studies that show improved pain control and tolerable side effects are required.
What is Radiotherapy?
Radiotherapy, also known as radiation therapy, treats cancer by using high energy waves to kill tumor cells, the goal being to destroy or damage unhealthy cells without damaging healthy ones. Side effects are common, but vary based on the patient and his or her overall health, the location of the cancer and where treatment is targeted, and now much radiation is given. Side effects are also short- and long-term. Most people experience fatigue and skin problems during and shortly after they receive treatment. In most cases, these side effects clear up once treatment is complete. Long-term side effects can be permanent and vary based on where treatment was targeted. For instance, someone who receives radiotherapy near the abdomen could develop long-term bowel issues. Radiotherapy can also trigger cancer to develop in the future, so it is important to speak with your doctor about your specific benefits and risks, in addition to the medical data.
Mesothelioma cancer occurs in the mesothelium, the protective membrane lining most of the body's internal organs. Three out of every four cases begin in the chest cavity, but it is also common for it to occur in the abdomen or heart. For many, by the time mesothelioma is diagnosed, the disease has advanced and affected other parts of the body, and the prognosis rate is rarely good, with a five year survival rate of 10% or less. It is a relatively rare form of cancer and only about 3000 new cases in the United States are diagnosed each year. The majority of people who develop mesothelioma worked with asbestos at some point in their lives (about 75% of cases). On the job, the risk for inhaling or swallowing asbestos fibers is much higher than normal and long-term exposure increases the risk cancer will eventually develop. There is also a suspected increased risk for those who live with people who work around asbestos. Radiotherapy has long been thought an effective part of treatment for mesothelioma patients, especially when used in conjunction with first-line defense treatments like surgery and chemotherapy, but the recent information in The Lancet Oncology shows this may not be the case. Sources:
Health Department Employees Claim Unsafe Working Conditions
Allegheny County Health Department employees continue to complain about their working conditions, claiming they are unsafe and that they are being exposed to asbestos and mold. Recent photos submitted to a local Pittsburgh news channel by the workers show mold, exposed ceilings, dust residue where vents were cleaned, and buckets set up to catch water from roof leaks. One exam room was closed off due to a leak.
Asbestos and Mold Exposure Likely
One worker claims she was told there was asbestos in the building, in the fiberglass in the tiles. She says she’s been told since 1999, when she began working for the health department that the problems would be taken care of and the building repaired and upgraded. The most recent information concerning improvements is that the health department will determine in December whether it will make improvements or sell the building and move elsewhere. The local branch of the SEIU, Local 668, held a news conference recently stating that if it were a private business in such a state of disrepair the Occupational Safety and Health Administration would have already shut them down.
Health Department Clinic Open to Patients
This particular campus of the Allegheny County Health Department includes both administrative offices and a patient clinic. State representative Patrick Harkins points out the conditions in the building are neither suitable for workers or patients coming in from the public to receive health care. Health department employees are taking action, demanding something be done now instead of waiting a month or more. They point out they are working in dangerous conditions and took time recently to hand out informational fliers to the public that included details about their working conditions and what patients would be exposed to if they came to the clinic for medical care. Patients at the clinic report they haven’t noticed specific issues related to asbestos, but they do acknowledge the space has always been rundown and dirty.
Officials Respond to Claims
The health department denied the photos that have been made public are current, so workers submitted additional photos to the local news station that included the day’s newspaper to prove they were indeed up to date. Many people, including union representatives, are trying to arrange a meeting with health department officials. In response to the complaints and the calls for a meeting, the health department’s Acting Director released a statement saying the agency is addressing decades of deferred maintenance on several facilities, including the clinic, and stating they have met several times with employees and the union over the last few months. He points out it is important for the clinic to remain open because of the services it provides to patients, and explains decisions are forthcoming concerning the long-term fate of the building. Source:
FDA Approves Cancer-Killing Virus
Imlygic, the most recent treatment approved for melanoma patients, is not expected to have any immediate dramatic effects on cancer treatment, but could have a significant impact on the long-term approach to cancer research. What is so significant about the drug is how it works. Imlygic is an alive and infectious virus, and is the first of its kind to receive the FDA’s approval for treating cancer. It is expected to open a door in cancer research and could overcome many of the obstacles created by cancer recurrence following the three most common courses of treatment. There are more than a dozen clinical trials expected on other anti-cancer viruses. Many in the cancer research industry acknowledge the idea of using a virus against cancer cells makes sense and has actually been explored for decades. When normal cells become cancerous, they replicate out of control and are no longer able to fight viruses, making them very vulnerable. A virus released into the system in a controlled way would target cancer cells and easily overpower them since they are weaker when it comes to virus fighting. Until now, no oncolytic viruses proved effective, but now Imlygic proves the theory that a virus could be a useful tool against cancer is with warrant. Imlygic is a re-engineered version of the herpesvirus. Oncologists inject a massive dose of the virus directly into the skin cancer tumor where it bursts the cancer cells into bits. This action causes the immune system to take notice, creating a two-pronged effect. Not only is the virus attacking cancer cells directly, it is triggering the immune system to join into the fight against cancer in the body. During the testing phase of Imlygic, researchers needed to prevent the virus from infecting healthy cells and causing cold sorts, while still getting viral and tumor proteins to alert the immune system. The task proved challenging, especially since researchers are not 100% clear on the role the immune system plays in the process, and have not yet determined if it will only attack virus-infected cells or if it also recognized cancer cells not affected by the virus injection. There is speculation it is the latter, but that theory has yet to be proven.
Imlygic Shows Pros and Cons
When it comes specifically to Imlygic and not just the general idea that viruses can kill cancer cells, researchers are a little less optimistic. The drug shows it is possible to make a theory work, but so far the results are less than stellar with survival time only increasing by a few months. However, the side effects, which are flu-like symptoms, are mild compared to what patients experience during chemotherapy. When paired with other drugs called checkpoint inhibitors, used to stimulate the immune system, Imlygic appears more promising. In one small clinical trial, Imlygic used with checkpoint inhibitors produced a positive response in about half the subjects, leading researchers to speculate it will be the combination approach that will work best in the future. Further studies are currently underway testing the effect various viruses, including smallpox, polio, and reovirus, have on cancer cells.
Central Michigan University Closes Building After Asbestos Discovery
As the school year draws to an end, numerous Central Michigan University employees are working from a different location on campus, and some from home, after Warriner Hall was forced to evacuate due to an asbestos issue. The problem was discovered May 29th
, when staff at the University’s Office of Risk Management and Environmental Health and Safety were told there were elevated levels of asbestos in the first and second floors of Warriner. All employees and visitors were asked to immediately leave the building. Samples were taken May 28th
from the building when people working on the water lines found insulation and old pipes in a crawl space inside of a large air duct. The building has been in use since 1928. The relocation of employees is temporary until the college is able to properly deal with the asbestos. Provost Mike Gealt acknowledges the relocation of 169 employees is merely precautionary. The school is waiting for environmental consultants to provide an all-clear announcement once further testing is complete.
Cleanup and Testing is Underway
The most recent round of testing, conducted by environmental consulting firm Fibertec, showed the air to be clear with the exception of the air duct under the Plachta Auditorium, where asbestos had been disturbed. Further testing of dust also came back clear, except for the first floor lobby near the auditorium and a portion of the tunnel system. Also working with the college is asbestos abatement contractor HBC. The company was called on to remove the damaged asbestos from the duct system and clean the auditorium and lobby. Once the cleanup is complete new tests will be conducted to ensure safety.
Asbestos Increases Risk for Developing Deadly Diseases
Asbestos is a natural mineral fiber that was once used in insulation and to protect against fire. Over the years it was discovered that asbestos, when its small particles are inhaled, can be dangerous. When undisturbed, asbestos rarely poses a problem, but when cleaning, demolition, renovations, or other issues jostle the fibers they become air born and are easily inhaled. Breathing in the particles can cause them to become lodged in the lungs, leading to the eventual development of lung disease and mesothelioma cancer. Mesothelioma is a rare and extremely dangerous form of cancer. It is extremely aggressive and rarely caught early enough to treat effectively. Exposure to asbestos is the primary risk factor for mesothelioma. Smoking further increases that risk. Using asbestos has been banned for most purposes, but many older buildings, like Warriner Hall, still contain asbestos. Source: http://www.mayoclinic.org/diseases-conditions/mesothelioma/basics/risk-factors/con-20026157
Families Continue to Recover from the Mr Fluffy Buyback Program
Australian families are struggling with the aftermath of their long-term exposure to loose-fill asbestos fibers in their home. Asbestosfluf, now labeled a class 1 carcinogen of which there is no safe level of exposure was manufactured by the Mr. Fluffy company and used 40 years ago to insulate ceilings in homes in Canberra and throughout the area. To “solve” the problem, the homes are scheduled to be demolished as part of a $1 billion ACT buyback plan. The Grant family, one of many affected by the exposure and buyback, is not only troubled by the family’s exposure to the deadly agent, but also the loss of their home. Ms. Grant describes feelings of guilt and anger, and claims to have experienced many sleepless nights since she found out her home of 13 years was contaminated.
Mr. Fluffy Homes Put Homeowners at Risk for Developing Asbestos Related Diseases
Ms. Grant’s concern is that her children will develop asbestos related diseases, such as mesothelioma, a type of cancer that affects the mesothelium of the lungs. Mesothelioma is aggressive and deadly, and though there are treatments, prognosis is negative. The material in question was manufactured during the 1960s and 1970s. There were efforts by the Federal and ACT government during the 1980s and early 1990s to clean up the loose-fill asbestos from the Canberra homes, but contamination remained at dangerous levels. It wasn’t until recent years that tests showed many of the homes still had a disturbing level of Mr. Fluffy particles and there was no way to make the homes safe. The problem was so bad some families were ordered to evacuate immediately, taking with them nothing but the clothing on their backs. The government decided to buy back the 1021 homes affected and plans to begin demolition in early summer 2015. There is also debate whether the government will also buy back 60 NSW homes in the coming months.
Homeowners Face Multiple Losses and Mounting Costs
In addition to health concerns, homeowners must also face the loss of their family homes. Living in a home for 13 years and having to give it up with no warning is an extremely difficult loss. Despite the risk, the Grants still mourn their beloved home. They had worked over the years to make it their own, including installing an art mosaic dedicated to the family patriarch on one of the outer walls of the home. That mosaic, along with the rest of the home, must now be destroyed. Ms. Grant explains the difficult decision she faced to leave her home and claims she felt pressured to participate in the government buyback program. She does not feel she was properly informed and believes other homeowners face the same challenges. It was the government that allowed the problem to happen and it is now the government that is leading Mr. Fluffy homeowners hanging. Ms. Grant has been forced to close down her home-based business and purchase all new clothing and shoes for her family. The new life she has been forced to begin has only partially been funded by the government and she is at least $100,000 in the hole. Though there is little she can do to make the situation better, she is calling for a joint ACT, NSW, and Federal Government inquiry, stating she wants answers and wants people held responsible for what has happened. Sources: http://www.news.com.au/lifestyle/health/mr-fluffy-buyback-scheme-life-has-been-ripped-from-us/story-fneuzlbd-1227275844549 http://www.mayoclinic.org/diseases-conditions/mesothelioma/basics/definition/con-20026157
Pembrolizumab Brings Hope for Mesothelioma Victims
Until recently there was very little hope for those diagnosed with mesothelioma. Mesothelioma is primarily caused by long-term exposure to asbestos. It can affect the lungs (pleural) and abdomen (peritoneal). It is a rare form of cancer often considered a death sentence and while treatment is available to help patients live more comfortably, no cure exists and life expectancy is rarely more than one year. A recent development in the pharmaceutical industry could change that. Pembrolizumab has been shown to halt tumor growth in more than one-third of patients suffering from pleural mesothelioma in a recent medical study. The drug is a PD-1 inhibitor cancer immunotherapy drug and is so far impressing researchers at the Perelman School of Medicine at the University of Pennsylvania. The findings from the study were presented at the American Association for Cancer Research Annual Meeting in Philadelphia in April 2015.
Pembrolizumab Shows Promising Results in Study
The study was led by an international team that included scientists from the United States, United Kingdom, and throughout Europe. Of the 25 participants in the study, seven experienced shrinkage of their tumor and 12 patients experienced an all-out halt of tumor growth. In four of the patients tumor growth progressed and two remained unassessed. None of the patients had to stop treatment because of side effects caused by the drug. All 25 study participants had already received standard and first-line therapy or were unable to receive any treatment before participating in the trial. Standard and first-line treatment for mesothelioma include surgery, chemotherapy, and radiation. The FDA has yet to approve any treatment for malignant mesothelioma that has progressed following standard treatment and in previous attempts, responses to second-line treatments show a less than 10% effect rate.
Hope on the Horizon
The FDA approved pembrolizumab in September 2014 for treating metastatic melanoma. The drug targets programmed cell death protein 1 (PD-1), which helps regulate immunity and prevent the activation of T-cells. Cancer patients often experience autoimmune disorders that produce antibodies that attack the body’s own tissue, but preventing these diseases means providing an opportunity for cancer cells to grow. These new PD-1 inhibitors activate the immune system to attack cancer tumors without putting a person at risk for other health problems. Additional research and clinical trials are necessary to determine if pembrolizumab will be approved for treating mesothelioma, but hopes are high. In addition to immunotherapy like pembrolizumab, gene therapy and photodynamic therapies, as well as the drugs Endostatin and Lovastatin, and Intrapleural interferon gamma are also being investigated to determine their success in treating mesothelioma. References:
Michigan Asbestos Mishandling Leads to Convictions
Three Michigan residents are facing up to five years in federal prison following their role in the state’s largest mishandled asbestos incident in at last four decades. The woman and two men pled guilty to violating the federal Clean Air Act, according to information released by the US Attorney’s Office in Grand Rapids. LuAnne LaBrie and Robert “Mike” White of Kalamazoo and Cory Hammond of Hastings failed to notify federal or state authorities that asbestos material was being stripped and removed from the former Consumers Energy power generation facility. Hammond and White also pled guilty to charges they failed to wet asbestos during the removal process. The facility is located in Comstock Township. The three embarked on the project in 2011 and agreed they would salvage material from the facility and split the proceeds. Other laborers participated in the removal project, but it is believed they were not aware of the danger.
LaBrie Acted as the Ring Leader
LaBrie had control over the facility and managed the project, regularly visiting the site and communicating with Hammond and White. Despite her knowledge of the presence of asbestos, laborers, including Hammond and White, removed asbestos insulation without notifying the US Environmental Protection Agency (EPA) or the State of Michigan. The case was investigated by the EPA's Criminal Investigation Division, the Michigan Department of Natural Resources Environmental Investigation Section, and the Internal Revenue Service. The mishandled asbestos removal led to $1 million in cleanup by the EPA’s Superfund Division. LaBrie, White, and Hammond will pay restitution to the EPA for the cleanup.
Dangers of Asbestos Exposure
Asbestos is supposed to be wetted during the stripping process and collected and sealed in a leak-tight container to prevent the release of particulates. According to WebMD.com, exposure to asbestos, which increases when the material is mishandled, can cause asbestosis, an inflammatory condition of lungs that leads to shortness of breath, coughing, and eventually lung scarring of the lungs that impede breathing. Long-term exposure is believed to cause mesothelioma, a rare cancer that affects the lining of the lungs, chest cavity, or abdomen. It is also thought to trigger other lung problems, including pleural plaques (changes to the membranes surrounding the lungs) and pleural effusions (abnormal collections of fluid between the lungs and the inside wall of the chest. In response to the case, US Attorney Patrick Miles issued the following warning: "Those who attempt to evade the law by cutting corners to maximize profits and harm our environment will be held accountable for their actions.” LaBrie is due to be sentenced April 23, 2014, and Hammond’s and White’s sentence hearings are scheduled for July 6, 2014. References: http://www.mlive.com/news/kalamazoo/index.ssf/2015/02/trio_pleads_guilty_to_violatin.html
Michigan Taking Action Against Asbestos Abatement Companies
Government at the federal and state level in Michigan are taking action against companies assigned to remove asbestos from abandoned buildings after it was discovered the work they performed was shoddy and not up to code. The effort comes in response to numerous botched removal jobs, one of which occurred at the Utica Trim Automotive Plant in Shelby Township, MI in 2010. The investigation at the plant showed site conditions were abysmal and workers were unnecessarily put at risk. In addition to working with faulty equipment and wearing thin disposable suits, they were subjected to daily quotas and their jobs were threatened if those quotas were not met. The owner of the property, Indiana LLC, located in Chicago, recently agreed to pay nearly $70,000 in penalties. Additionally, Northern Boiler and Mechanical Contractors of Muskegon will be paying $30,000 to the state and four men have been charged criminally in the case. It's too soon to tell whether those working at the Utica plant will suffer any long-term health effects because lung disease from asbestos exposure typically take a decade or more to develop. Shelby Township One of Many Instances of Shoddy Asbestos Removal
In addition to the Shelby Township case, the Michigan Department of Environmental Quality (DEQ), working in conjunction with the federal government, are punishing contractors and property owners for violating the Clean Air Act with improper asbestos removal from buildings scheduled to be demolished. Since 2011, heavy fines have been levied and 11 men have been convicted or pleaded guilty to criminal charges related to improper asbestos removal. Five received prison sentences. Other asbestos removal cases include:
- Terry Williams sentenced to 27 months in prison after pleading guilty to removing asbestos-containing materials from a former Chrysler plant in Detroit without wetting it in order "…to avoid the more costly cleanup and demolition required under federal law."
- Anthony Michael Davis sentenced to a year in prison and ordered to pay more than $168,000 after scrapping metal from a former paper mill in Allegan County in west Michigan without wetting the asbestos, exposing his employees and the public to the dangerous dust and leaving taxpayers holding the bill for cleanup.
- Roy Bradley convicted of failing to wet asbestos during demolition work at a former church. The case also included a carpenter charged with lying about the asbestos removal to a federal grand jury.
- Michigan State University and its contractors Qualified Abatement Services fined more than $13,000 for violations involving an underground steam tunnel insulated with asbestos.
- The Ingham County Land Bank and its contractors fined more than $22,000 for improper asbestos removal at the former Michigan School for the Blind in Lansing.
Worldwide Mesothelioma Epidemic Could Be in the Future According to Data
Mesothelioma is a rare, aggressive, and deadly form of cancer that occurs in the thin layer of tissue covering the majority of a person’s internal organs. Though there is no definitive known cause of mesothelioma, many researchers firmly believe asbestos exposure greatly increases a person’s risk for developing the disease. A recent study sought to evaluate worldwide asbestos exposure and how it corresponds with mesothelioma rates. Diagnosis rates have soared globally in recent years and medical experts are unsure of the cause. Their goal is to collect and analyze as much data as is available and determine if there is a mesothelioma epidemic underway. A recent study analyzed data from Cancer and Mesothelioma Registries from around the world, while also personally speaking to and collecting information from local researchers in certain regions. Results of the data collection showed the highest incidence of mesothelioma occurred in Europe, specifically the UK, Netherlands, Malta, and Belgium, and in Australia and New Zealand. Notably lower rates were present in Central Europe and Japan. Many of the moderate regions still showed a steady increase, despite not ranking at the highest levels. The study concluded that a mesothelioma epidemic is not definitive, but could be in the future. Asbestos is still used in much of the world, having been banned in only 55 countries. Unfortunately, there is limited data available from countries in which asbestos is still in use – data both pertaining to its extent of use and the incidence of mesothelioma.
Highest Rates of Mesothelioma
Of the countries with the highest rates of mesothelioma:
- The UK reported steadily increasing rates since monitoring began in 1968 and reported 2360 in 2010 and 2291 in 2011.
- Australia reported 666 cases in 2009, with a 2011 report of 3.2 cases for men and 0.7 cases for women per 100,000.
- The Netherlands reported a mean number of 526 cases per year from 2008 to 2001.
- New Zealand reported between 60 and 102 cases per year between 2000 and 2010.
- Belgium report 273 cases in 2011.
Data also shows the rates of mesothelioma within each country vary from region to region, so in a way, these national rates are misleading. In most cases, when clusters of higher rates are found, an asbestos mine is nearby or asbestos was widely used in the area. What researchers are still trying to determine is why areas like Japan, Poland, and Spain, in which there were high instances of asbestos use in shipbuilding, show some of the world’s lowest rates for mesothelioma. Researchers also predict a coming wave of mesothelioma diagnoses that will encompass a greater number of regions through the world. Though a link between asbestos exposure and mesothelioma is assumed, additional accurate global data is needed to form a definitive conclusion concerning the link. References: http://www.ijoem.com/article.asp?issn=0019-5278;year=2014;volume=18;issue=2;spage=82;epage=88;aulast=Bianchi
Mr. Fluffy Asbestos In Australia Causing Problems for Hundreds of Families
December 3, 2014 - The Commonwealth of Australia recently offered a concessional loan of $1 billion to the Australian Capital Territory (ACT) to enact a plan to end problems related to Mr. Fluffy insulation products and asbestos. The Mr. Fluffy Company, makers of Asbestosfluf, used loose-filled asbestos in roofing spaces in more than 1000 homes throughout ACT. The practice began in the 1970s and continued for several years. A cleanup was attempted during the 1980s, but recent discoveries have shown there are still traces of asbestos in the homes, which are now considered uninhabitable. The loan money will be used by ACT to purchase the homes from current owners and demolish them, beginning in January 2015. The intention is to later sell the land once the homes are gone. The total project will take at least five years, with 200 homes due to be demolished each year.
Residents Unhappy and Scared
Despite the uninhabitable status of the homes, many are still occupied by residents who received letters in early 2014 warning them of the danger. Each was told their home likely contained toxic traces of Mr. Fluffy product to which they were exposed to during their residency. Asbestos can be harmless when left alone, but renovations tend to stir up particles and make them air born, and therefore more likely to be inhaled. In some homes, asbestos levels were so dangerous homeowners evacuated immediately. The goal of the loan and demolition project is to ensure there is not a single “Mr. Fluffy house” left standing. Unfortunately, experts have determined there is no practical or affordable way to make the homes safe for residents without demolition. Homeowners have been given six months to agree to the deal. Since some are unhappy with the demolition plan, there will likely be some backlash. Already, homeowners are claiming there was an opportunity to shut down Mr. Fluffy, but the government failed to do so.
Dangers of Asbestos Exposure
Asbestos is a mineral found naturally in the environment. Its fibers are strong and resistant to heat, making it useful in construction. Mesothelioma is a type cancer with a high fatality rate, caused almost exclusively by exposure to asbestos. When asbestos is broken up it creates dust, which when inhaled or swallowed settles in the lungs and stomach causing long-term irritation. It is assumed that other factors play a role in determining whether or not asbestos exposure will lead to a mesothelioma diagnosis, as not everyone exposed develops cancer and other exposed only for a short time fall ill.
It can take decades for cancer to develop. Symptoms of mesothelioma include:
- Chest pain under the rib cage
- Painful coughing
- Shortness of breath
- Unusual lumps of tissue under the skin on your chest
- Unexplained weight loss
- Abdominal pain
- Abdominal swelling
- Lumps of tissue in the abdomen
- Unexplained weight loss
Mesothelioma is an ongoing health problem in Australia
due to the country's extensive use of asbestos. References: