Esophageal Stents As a Palliative Care Measure for Mesothelioma

Mesothelioma, a cancer that invades the wall lining of the lungs and other internal organs, is a particularly difficult type of cancer to treat. Almost universally related to the inhalation of asbestos particles, treatment of advanced stages of the disease is largely palliative. Palliative health care refers to the focus of relieving symptoms and pain as opposed to taking steps to eliminate the illness.

In many advanced cases of mesothelioma, patients experience a difficulty swallowing. The medical term for such a symptom is dysphagia. As the mesothelioma tumor spreads from the lungs to the esophagus, the tumor can reduce the diameter of the air pathway. In some cases, this reduced ability to breath and swallow is the direct cause of death.

In an effort to assuage dysphagia, prolong survival and reduce discomfort, a recent study performed at the Department of Cardiothoracic Surgery in Derriford Hospital points to esophageal stents as a potential treatment.

A case report published in the January 25, 2008 Journal of Cardiothoracic Surgery details the success of self-expanding esophageal stents on patience with mesothelioma. In the three patient cases discussed in the report, all three patients achieved immediate satisfactory reduction in dysphagia. However, progressive dysphagia resurfaced 1 to 6 months later. In such cases further stenting is required to open up a larger portion of the esophagus.

As dysphagia is usually an end-case symptom, patients are not expected to survive a considerable length of time as a result of the stents. However, the primary goal of the procedure is to relieve pain and improve quality of life for the patient.


Mesothelioma Patterns in the United States

A recent study sheds some insight into the background rates of mesothelioma over the past several decades in the United States. The study looked at patterns for males and females in five age groups.

According to the study performed by Exponent Inc., a health sciences practice in New York City, mesothelioma rates remained relatively constant for young individuals. Rates of older age groups declined overtime and male rates were about five times greater than female rates for individuals 60 years of age and older. Overall rates of mesothelioma were higher among large shipyard areas located on the West Coast. In total, the background rate of the deadly cancer was found to be around one individual per million for the American citizens below the age of 50. Estimations for older ages will require additional studies.

The data for the study was collected via the National Cancer Institute’s Surveillance Epidemiology and End Results (SEER) registry and pertains to data collected between 1973 and 2002. SEER is a program dedicated to collecting and publishing cancer cases and survival data. The data they collect is exhaustive, and encompasses 26 percent of the United States population. The program has also taken considerable measures to unify the network of cancer registry systems so that population-based data may be more easily accessible. It is this accessibility that allowed the researchers to investigate these mesothelioma trends.


Data Supports Further Investigation of Mesothelioma Virotherapy

Oncolytics Biotech presented data that indicates malignant mesothelioma cells are sensitive to certain viruses. Their presentation titled “Combination Immunotherapy and Oncolytics Virotherapy for the Treatment of Malignant Mesothelioma” discussed in vitro data showing mesothelioma cells could be suitable targets for reoviruses which could then attack and compromise them.

The company currently has 7 ongoing phase I and phase II trials though none are currently for mesothelioma patients. Reoviruses, which the company is investigating, are generally gastrointestinal infections with the most common form being the rotavirus.

The goal of virotherapy is to isolate and reprogram viruses to only attack cancerous cells. It is still a relatively undeveloped field within cancer research but progress is being made.

Piroxicam and Cisplatin Show Promise Against Mesothelioma Cells

Piroxicam, a nonsteroidal anti-inflammatory drug (NSAID), has shown anti-tumoral activity which is amplified when combined with Cisplatin.

Researchers used two mesothelioma cell lines and treated cells with piroxicam and cisplatin alone then combined the two treatments.

Cell growth was significantly limited in both lines and treatment with either agent appeared to disrupt cell cycle phase distribution and expression of some regulatory proteins.

Their effects were significantly increased when used as a combination therapy. In one of the cell lines they appeared to create a synergistic effect on apoptosis (likely through the activation of caspase 8,9).

The data suggests that a combination of piroxicam and cisplatin should warrant further investigation because of their effects on apoptosis and cell cycles.

Animal models of mesothelioma

This month’s Journal of Inhalation Technology has a review article on how animals have been invaluable in research on mesothelioma treatment. Scientists have induced pleural mesothelioma and peritoneal mesothelioma in rodents and then running a variety of mechanistic studies. They’ve looked at development of the disease from the time the fibers enter the body and they’ve looked genetric tendencies and their effects on the pathology.

Tour de Force presentation of evidence against asbestos companies

Stunning article (opinion piece) out of The Herald (Scotland). Writer Joan McAlpine lays out the case for mesothelioma patients: the fact that asbestos companies knew of the hazards and continued to produce this hazardous material.

Mesothelioma sufferers already know what is killing them: exposure to asbestos dust. So they know who is to blame: irresponsible employers. The direct link between the insulating material and disease was established in 1960, according to the British Lung Foundation. Yet asbestos remained popular in the UK for two more decades. Its use increased considerably between 1960 and 1975. Workmen bored holes in it, lagged pipes with it and lined walls with it. Later, they demolished buildings full of the stuff, breathing in clouds of deadly dust in the process.”