Mesothelioma Treatment Becoming More Individualized

A respected team of mesothelioma experts predicts that treatment for this aggressive cancer will become increasingly personalized in the next five to ten years.

A malignancy in the lining around the lungs and other organs, mesothelioma is caused almost exclusively by asbestos exposure. Although its occurrence in the U.S. is believed to have leveled out at about 3,000 cases per year, the number of cases around the world is continuing to increase. Because the disease is so difficult to treat, many patients succumb within a year of diagnosis, even with the best therapies now available. For this reason, researches continue to look for ways to predict which treatments are most likely to work for which patients.

In a recent article in the journal Clinical Lung Cancer, Drs. Linda Garland of the Arizona Cancer Center, Raja Flores of the Mount Sinai School of Medicine in New York, and Anne Tsao of M.D. Anderson Cancer Center discuss how the ability to analyze individual characteristics of mesothelioma tumors can help doctors tailor their treatments for greater effectiveness. To illustrate, they point to recent research which linked the prevalence of a blood protein called microRNA-29c to longer patient survival after surgery. Because cytoreductive surgery for pleural tumors carries its own risks, the ability to use such biomarkers to predict which patients are most likely to respond well could be invaluable for treatment planning.

“Molecular/genetic tumor profiling has identified, through retrospective analysis, biomarkers that have prognostic value for cytoreductive surgeries,” they write. “If validated in prospective trials, these and other tumor profiles and biomarkers may be utilized to refine selection of (mesothelioma) patients for local therapies.”

Likewise, a number of recent studies have pointed to the value of biomarker analysis for choosing the best chemotherapeutic agent. Chemotherapy is often used in combination with cytoreductive surgery to combat mesothelioma. In patients who are too sick for surgery, chemotherapy may be used alone as a primary treatment or as a palliative measure for advanced or metastatic disease.

The article’s authors point to two new studies that have reported on predictive biomarkers specifically for pemetrexed-based therapy (the most common type of chemotherapy for mesothelioma). Both studies demonstrated that analyzing mesothelioma cells for the presence of thymidylate synthase protein could help predict not only which patients would respond best to pemetrexed-based chemotherapy but how quickly their disease would progress.

The authors caution that it will be important for future mesothelioma trials to take into account all avenues for gathering individualized tumor information. They write, “Advancing the field of biomarker research and targeted therapy in mesothelioma will require modifications in standard trial designs to ensure prospective tumor tissue collection, as well as blood and pleural effusion sampling to enable identification of surrogate peripheral biomarkers.”

Sources:

Garland, Linda et al. “Individualizing mesothelioma treatment: Small Steps into a Brighter Future”, Clinical Lung Cancer, Vol. 11, No. 6, 371-373.