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Combination Drug Treatment Helps Beat Mesothelioma
12-Feb-2007 - People with mesothelioma - a form of cancer
associated with asbestos exposure - have a higher survival
rate when treated with a combination of two cancer drugs,
a large multicenter study finds.
Mesothelioma, a rare but aggressive form of cancer that occurs
in the lining of the lungs, heart and abdomen, is associated
with exposure to asbestos. There is no known cure.
In the study, patients receiving pemetrexed and cisplatin
- along with the vitamin supplements folic acid and B12 -
survived nearly three months longer than patients getting
Researchers led by John Green, M.D., at the Clatterbridge
Center for Oncology in England, reviewed a study of 448 patients
with advanced mesothelioma who were treated with either the
single drug or the combination.
"Pemetrexed used in combination with cisplatin significantly
increases the length of survival, when compared with cisplatin
alone," the researchers say. "Further research is
needed into the optimum treatment regimen for pleural mesothelioma."
The review appears in the current issue of The Cochrane Library,
a publication of The Cochrane Collaboration, an international
organization that evaluates medical research. Systematic reviews
draw evidence-based conclusions about medical practice after
considering both the content and quality of existing medical
trials on a topic.
The researchers examined data from a clinical trial of 20
treatment centers in Europe, the Americas, Australia and Asia.
Eighty-one percent of the patients were men, with an average
age of 61. Patients who received the combination treatment
survived an average 2.8 months longer.
Patients receiving both medications also reported improved
quality of life in terms of fatigue, loss of appetite, pain
During the early stages of the trial, patients receiving
pemetrexed had serious symptoms of toxicity, including drug-related
death. Other side effects included blood cell abnormalities,
nausea and diarrhea, which decreased in both incidence and
severity after the vitamins were added to the treatment. People
who work trades such as shipbuilding, railway engineering,
construction work and asbestos manufacture have higher rates
of mesothelioma than the general public. The cancer may take
10 to 60 years to develop, and the risk does not diminish
after exposure to asbestos has stopped. Family members of
people exposed to asbestos at work also have an increased
risk of developing mesothelioma from asbestos fibers carried
home on the clothes of the people they live with.
Daniel Baram, M.D., a pulmonologist at the Lung Cancer Evaluation
Center at the State University of New York, said, "Most
cases [of mesothelioma] are still from pre-OSHA workplace
improvements. I suspect that modern asbestos abatement precautions
will avoid most, if not all, future cases. The latency is
over 30 years, so we are still diagnosing cases with exposure
during World War II and the '40s and '50s."
Mesothelioma is difficult to diagnose, Green said, because
"there is a lag of many years between exposure and asbestosis,
which is a nonmalignant condition, and a greater lag before
the development of overt malignancy."
"There is no way of diagnosing the premalignant phase
during the latent period of 15 to 20 years," Green added.
"Many of these patients smoke and are in economically
disadvantaged communities. Many individuals have moved away
from heavy industries and may not admit or know they were
exposed to asbestos as young men, with similar issues for
According to the U.S. Environmental Protection Agency, 10
percent to 15 percent of schools and other public buildings
in the United States contain asbestos insulation.
Although safety measures for working with asbestos have been
in place since the 1970s, mesothelioma is projected to account
for 65,000 deaths between 2001 and 2050 worldwide, peaking
between 2012 and 2015, according to background information
in the review.
It is a personal matter as to whether the survival increase
for patients receiving the two drugs is worthwhile, Baram
said. "It depends in large part on the patient. A 2.8-month
mean survival increase means that some patients may get even
more than that, though some people will get less. Many, if
not most, patients when faced with a disease with a very bad
prognosis are often willing to undergo aggressive therapy,
although the toxicity is serious and potentially life-threatening."