— While the use of asbestos peaked about 40 years ago, the
number of cases of the rare but deadly cancer it causes has
year, doctors diagnose about 3,000 new cases of mesothelioma
after patients come in with a cough, fever, fatigue, excessive
sweating and pain in the chest. In most cases the disease
already has advanced so far that patients will die in a matter
is primarily palliative — meant to ease the suffering —
but that may be changing.
see hope as interest in the disease has grown. There are at
least 20 clinical trials underway, and the FDA recently gave a
special designation to a new drug created by AstraZeneca’s
Rockville, Md., subsidiary MedIummune.
the first time we have more companies than ever interested in
this orphan disease," said Mary Hesdorffer, a nurse
practitioner who is executive director of The Meso Foundation,
which says it is the only nonprofit organization dedicated to
ending mesothelioma and the suffering from it.
of the new drugs prove promising, it could extend the life of
those who live with the disease.
treatment since the early 2000s has not changed for
mesothelioma," said Dr. Julie Renee Brahmer, an associate
professor of oncology and interim director at the Johns
Hopkins Kimmel Cancer Center at Bayview, who is participating
in some of the clinical trials. "Mesothelioma is such a
slow-growing disease that it is insidious, and we need to find
better ways to treat people."
average mesothelioma patient will live only 7 to 17 months
after diagnosis, doctors said. Only about 9 percent of
patients diagnosed from 1975 to 2008 survived at least five
result most of the attention on mesothelioma has been on
litigation rather than developing treatments. If the disease
can’t be cured, the thinking goes, someone ought to pay.
around the country, including Baltimore’s Peter T. Angelos,
sued the companies who exposed workers and others to asbestos,
the fire-resistant and insulating material that is
mesothelioma’s primary cause. They’ve won large
settlements for the victims and huge profits for themselves.
laws and regulations limit the use of asbestos, though it’s
still found in some products such as roofing and brake pads.
An entire industry has sprung up around removing asbestos from
homes and buildings, where it was used to insulate walls and
only one drug combination treatment for the disease approved
by the FDA. The chemotherapy drug pemetrexed works by blocking
the action of a certain substance in the body that may help
cancer cells multiply. It is combined with another
chemotherapy drug called cisplatin, which can kill cancer
cells, but doctors said more effective treatments are needed.
announced in April that it received FDA orphan drug
designation for its drug tremelimumab to treat mesothelioma.
Intended to encourage the development of drugs that might not
prove too profitable, the designation is given to drugs used
to treat rare diseases and gives their makers extended
exclusitivity to sell the drugs and tax credits for developing
is part of the broad pipeline of immuno-oncology treatments
under development by AstraZeneca and its biologics research
and development arm, MedImmune, which are designed to harness
the body’s own immune system to fight cancer. It also is
being tested in combination with another drug to treat head,
neck and non-small cell lung cancers.
addition to researching this immunotherapy treatment, studies
are looking at gene therapy, which attempts to add new genes
to mesothelioma cells to make them easier to kill, according
to the American Cancer Society. Researchers also are studying
the use of specially designed viruses that could infect and
kill the cancer cells directly, or cause the immune system to
attack the cancer cells.
these treatments are still in the early phases of clinical
Brahmer is involved in a trial testing a vaccine that attacks
a protein on mesothemial cancer cells. She is also part of a
study that targets cancer stem cells.
of mesothelioma first began increasing significantly in the
1970s. Those in the medical community differ on when and if
they think the disease has peaked. Some say it hit its high in
the 1990s, while others said it may yet peak down the road.
it is so rare the interest is not quite as great, but it does
impact those people who have been exposed, as well as their
families," Brahmer said.
sometimes confuse the symptoms of mesothelioma with other
illnesses, such as asthma or pulmonary disorder. A correct
diagnosis may not come until the disease is in the most
Blair, a 43-year-old substitute teacher, said it took months
for doctors to figure out what was causing severe pain in her
abdomen in 2007. They blamed it on gynecological issues, and a
family member even accused her of being a hypochondriac and
suffering from postpartum depression. Finally, a CAT scan
determined the truth.
disease was caught early enough that it was removed with
surgery. But it reappeared and she had to have a second
surgery this past March. She worries about its return.
don’t know what my new normal feels like," she said.
"The first time it took me like two years before I wasn’t
predominantly blue-collar Baltimore, many cases of asbestos
have been connected to jobs in shipbuilding, insulation, pipe
fitting, auto mechanics and other manufacturing professions.
Microscopic asbestos fibers easily become airborne and can be
inhaled, lodging in the lungs and slowly damaging them.
people with the disease show symptoms many years after being
exposed, well after companies have shut down or cleaned up
doesn’t happen a year out and it doesn’t happen 10 years
out," said Albert Polito, medical director at the Lung
Center at Mercy Medical Center. "It’s like 30 to 40
years out in most cases."
may not know they have been exposed to asbestos until doctors,
and sometimes lawyers, start asking their medical history.
They may have been exposed at a school or an old apartment
isn’t sure where she was exposed. She has been a teacher all
her life and never worked in manufacturing.
wives of manufacturing workers exposed to asbestos also have
been known to get the disease, perhaps from cleaning clothes
covered in the microscopic fibers. Some research also has
found that people exposed to high doses of radiation to the
chest or abdomen as treatment for another cancer have
disease is different than most cancers in that it doesn’t
appear as raised tumors. The tumors are more flat along the
lining of the lungs, making them hard to remove once they have
spread. Doctors said it’s difficult if not impossible to
remove all traces surgically.
are almost certainly going to succumb to the cancer at some
point," said Dr. Joseph Friedberg, a mesothelioma expert
who is the Charles Reid Edwards professor of surgery at the
University of Maryland School of Medicine. "The goal is
to try and buy you more time."
also head of thoracic surgery at University of Maryland
Medical Center and thoracic surgeon-in-chief for the
University of Maryland Medical System, recently came from the
University of Pennsylvania, where he pioneered a lung-sparing
surgical technique for mesothelioma and, along with fellow
researchers, published some of the best results that have been
reported for the deadly cancer.
the treatment technique they employed involved the use of
photodynamic therapy, a light-based cancer treatment that
potentially stimulates the immune system against the cancer
and is under further investigation.
to do even more advanced research at the University of
Maryland, where he has created a mesothelioma program.
not where we need to be, not even close," Friedberg said.
"But there is progress being made all around."