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Treating Mesothelioma with Durvalumab and Tremelimumab A recent clinical trial sponsored by the Dana-Farber Cancer Institute is providing hope to pleural mesothelioma patients. The goal of the study is to test the efficacy and safety of treating patients with two different immunotherapy drugs, tremelimumab and durvalumab. IV Icon Durvalumab – is an anti-PD-L1 monoclonal antibody. It is typically used to treat patients whose cancer hasn’t spread to nearby tissues or can’t be treated surgically, but didn’t get worse when treated with chemotherapy or radiation. Durvalumab works by helping the immune system to slow or prevent cancer cells from growing. Medicine Bottle Icon Tremelimumab – is an anti-CTLA4 monoclonal antibody. It works by blocking a receptor on immune cells that are normally suppressed. Both of these drugs have been used in previous clinical trials to treat mesothelioma, but they’ve never been used together. This clinical trial will further investigate the effect that tremelimumab and durvalumab have on patients when paired together to combat mesothelioma. Drug Combination Piques Interest in European Trial Previously, this clinical trial occurred in Europe. European researchers studied the drug combination in 40 inoperable pleural or peritoneal mesothelioma patients. All of the participants in the trial were able to complete at least one dose of the tremelimumab and durvalumab combination as first or second line therapy. The drug combination was given every four weeks for four cycles and then followed by nine cycles of maintenance durvalumab. Highlights of the study included: 55% of patients were free from progression at 6 months and 28% at 12 months 63% of patients had disease control with a median overall survival of 16.6 months The treatment drugs appeared safe, and patients seemed to have a positive response. Treatment-related toxicities were controllable in all but 3 participants. “The availability of new checkpoint inhibitors and the interest of pharmaceutical companies in testing drugs for malignant pleural mesothelioma means that the future of these patients looks brighter than ever before,” the researchers from the Netherlands Cancer Institute in Amsterdam commented at the end of the study. The hopeful researchers concluded that more testing needs to be conducted using the drug combination as a treatment option for mesothelioma patients. U.S. Clinical Trial Recruits Pleural Mesothelioma Patients Researchers at the Dana-Farber Cancer Institute hope to see positive results just like the European clinical trial. Currently, the institution is openly-recruiting participants for their location in Boston, MA. This phase II trial anticipates being completed by 2024. The study plans to enroll 40 patients. Enrollees must have unresectable or inoperable malignant pleural mesothelioma. They must have also had disease progression after receiving chemotherapy. Individuals enrolled in the trial will receive durvalumab and tremelimumab by IV. They will receive both drugs once a day for 28-day cycles. Patients will receive tremelimumab for potentially up to 4 doses. On day one of cycle 5, they will continue taking durvalumab on its own until dismissed from the study.

Analyzing Pleural Mesothelioma Patients Postoperatively The National Cancer Database recently evaluated newly diagnosed non-metastatic pleural mesothelioma patients. During the study, the database analyzed the overall survival of patients by cancer facility volume. The investigation also took into perspective the well-being of patients after surgery. Evaluated pleural mesothelioma patients had either undergone an extrapleural pneumonectomy (EPP) or a pleurectomy/decortication (P/D). 1,307 patients were treated. 621 patients were treated in lower-volume facilities, and 686 patients were treated in high-volume facilities (HVFs). 75% of P/D operations and 25% of EPP procedures occurred at HVFs. Whereas, 84% of P/D operations and 16% of EPP procedures happened at lower-volume facilities. While the overall survival added on 3 months, outcomes of individuals who received treatment at a high-volume facility experienced: Shorter hospital stays Lower hospital readmission rates Lower mortality rates Top 3 High-Volume Pleural Mesothelioma Treatment Centers Receiving a mesothelioma diagnosis alters the lives of families across the globe. Every year in the United States 2,000 to 3,000 cases of this rare cancer occurs. Approximately 75% of these cases are pleural mesothelioma. Research suggests that patients treated at high-volume facilities have a better outcome. At high-volume centers, physicians of all specialties weigh in on creating a patient’s treatment plan. The medical experts at high-volume treatment centers not only see more mesothelioma patients than other facilities, but they also have more experience in performing complex surgeries like the P/D and EPP. The following 3 centers are known for being high-volume cancer centers specializing in successfully performing P/D and EPP to help improve a patient’s prognosis. 1 Brigham & Women’s Hospital Image of Brigham and Women's HospitalBrigham and Women’s Hospital is home to the International Mesothelioma Program (IMP). IMP is composed of departments from the Dana-Farber Cancer Institute and Harvard School of Public Health. The extrapleural pneumonectomy procedure was created and has been perfected by Brigham and Women’s mesothelioma surgeons. In addition to performing EPP surgeries, this hospital conducts a number of P/D procedures. Brigham and Women’s also provides hope to patients through an abundance of clinical trial opportunities. Every day the Brigham & Women’s Hospital makes great strides towards improving treatment options not only to pleural mesothelioma patients but to peritoneal mesothelioma patients as well. The facility is a place of residence to experts Dr. Bueno, Dr. Lebenthal, and Dr. DaSilva. 2 UCLA Medical Center UCLA Medical CenterDr. Robert Cameron is changing the lives of pleural mesothelioma patients at the University of California Los Angeles Medical Center. He is widely recognized for developing the pleurectomy with decortication surgery. Treatment at UCLA is focused on techniques that target only the patient’s tumor(s). The facility has perfected methods that keep a patient’s lungs, pericardium and diaphragm healthy. Aside from surgery, specialists at UCLA are dedicated to researching and improving treatment options for mesothelioma using targeted and immunotherapies. The medical center has an area of expertise in treating all mesothelioma cells types. 3 Baylor College of Medicine Baylor Mesothelioma Treatment Center NightMesothelioma specialist Dr. David Sugarbaker leads the Mesothelioma Treatment Center (MTC) at Baylor. He is known for creating the EPP for pleural mesothelioma. Patients at MTC experience an aggressive treatment and recovery plan. The crew at Baylor believe that multimodal treatment plans prevent a patient’s cancer from returning. Individuals may experience an EPP or the P/D, depending on the extent of their cancer. Dr. Sugarbaker and his team also favor quick and safe recovery for their patients. In many circumstances, a patient will be walking not too long after they’ve had surgery. Connecting Patients with Our Doctor Match Program Since very few doctors know how to treat this rare cancer, it is important that an individual finds a mesothelioma specialist. An expert not only has an understanding of the cancer, but they have experience in treating it. In this above study, researchers found that patients who received care at high-volume facilities experienced less complications. It may be necessary to travel to a cancer center to receive treatment. Our Doctor Match Program will provide you with resources for decreased lodging and other travel expenses. It is important that patients know that they are not alone and that many survivors are rewriting statistics. At Mesothelioma Guide we can help you get connected to top specialists and cancer centers through our free Doctor Match Program.

Meet Peritoneal Specialist Dr. Bhagwandin Dr. Shanel Bhagwandin is changing the lives of patients with peritoneal malignancies, including mesothelioma. Dr. Bhagwandin is affiliated with the Mount Sinai Hospital Health System in New York. Recently, he has brought his experience in treating rare diseases to the Jupiter Medical Center located in Jupiter, Florida. This not-for-profit medical center is recognized for its outstanding physicians and innovative techniques for treating patients. “I came to Jupiter Medical Center because the hospital is committed to going above and beyond the scope of patient care,” Dr. Bhagwandin said. Treating Peritoneal Mesothelioma with HIPEC Sometimes patients have to travel to receive treatment. Dr. Bhagwandin understands that this can be difficult. With this thought in mind, he has helped initiate a program at Jupiter Medical Center to treat peritoneal malignancies with hyperthermic intraperitoneal chemotherapy (HIPEC). During HIPEC, a patient has heated chemotherapy washed around in their abdominal cavity. This procedure typically follows after the surgical removal of a patient’s tumors. HIPEC allows mesothelioma specialists to treat a patient’s disease more aggressively. By applying a high dose of chemotherapy directly to the site of a patient’s cancer, experts believe that it helps reduce the risk of it recurring. “I am the only board certified surgical oncologist in the Palm Beach County as well as other neighboring counties able to provide care for peritoneal mesothelioma and other peritoneal malignancies,” Dr. Bhagwandin stated. The Power of a Second Opinion Receiving a mesothelioma diagnosis can be hard to process for both patients and their loved ones. “I firmly believe it’s important to take a step back, recognize there is a person in front of you, and address any obvious misconceptions before proceeding,” Dr. Bhagwandin explained. Second opinions can change everything. Getting an opinion from a mesothelioma expert can open doors to treatment options patients may have been denied before. Dr. Bhagwandin is a firm believer in second opinions. He consults with a number of medical experts to optimize treatment plans for his patients. “I routinely provide my patients here in Florida with a ‘second opinion’ from other Mount Sinai- New York surgical oncologists, medical oncologists, and gastroenterologists without them having to leave the area,” Bhagwandin claimed. In many circumstances, mesothelioma patients are misdiagnosed. Since this type of cancer is both rare and hard to diagnose, it is vital that patients seek a second opinion from a doctor that has experience treating the disease. Training and Experience Dr. Bhagwandin is a native of South Florida. He is beyond thankful to return to Palm Beach County and make a positive impact on the cancer community. “I’m grateful to return home and not only provide care to patients who haven’t had access to it but to make an impact in the area where I grew up,” Bhagwandin commented. Dr. Shanel Bhagwandin completed a fellowship in Complex General Cancer Surgical Oncology at Mount Sinai Hospital. After his fellowship, he joined Mount Sinai’s Division of Surgical Oncology. At Mount Sinai, he received training from Dr. Umut Sarpel and Dr. Daniel Labow. Dr. Labow is known for establishing the HIPEC program at Mount Sinai. Additionally, Dr. Bhagwandin has been mentored by Dr. George Salti at the Edward Cancer Center. “I’ve been able to participate in a number of cases for primary peritoneal malignancies as well as metastatic cases since 2013,” Dr. Bhagwandin said. s it important to psychologically evaluate a mesothelioma patient and their caregiver? A recent study believes so. The study focused on how both patients and their caregivers cope with a malignant mesothelioma diagnosis and prognosis. It encompassed some of the psychological factors, such as anxieties and fears that can have an impact on them. Interviewing Mesothelioma Warriors and Caregivers During the study, 10 patients with malignant mesothelioma and 9 of their caregivers were recruited for interviews. Both patients and their caregivers were interviewed together by clinical psychologists. “Patients and caregivers were interviewed together in order to promote communication between family members on MM diagnosis and its impact,” stated the study. Interviews for all of the participants lasted approximately 45 minutes. To avoid getting insufficient data and only yes/no answers, the trained psychologists asked a series of open-ended questions. Interviews covered a patient’s Asbestos exposure Work history History of treatments Impact of their disease to them personally Impact of their disease on relationships with family and loved ones The study also covered strategies on how a patient and their caregiver can handle the sensitive subjects of end of life, death, and survival. “When participants did not talk about the prognosis of the illness, no explicit questions were made about dying, but plans for the future were alike explored,” the study said. “Nothing Is Like It Was” The interviews revealed that both patients and their caregivers mourn and grieve in different ways. In some scenarios, the phycologists noted changes in their attitudes and points of mood deflection. “The problem is that you become too terrified,” a patient remarked about their diagnosis. “You try not to think about it. The less I think about it, the better I feel,” replied a caregiver when asked about her loved one’s fate. Receiving a mesothelioma diagnosis can be life-altering. During the study, caregivers and patients were asked how the disease impacted their daily lives. Researchers discovered that all of their answers tried to make the best of the situation. “Well, nothing is like it was. You have to think about your situation and make it go on in another way,” explained a patient. “What Will Become of Us?” Researchers also asked questions that covered areas of worry and concern for both the patient and their caregiver. Data suggested that patients are concerned about how their diagnosis impacts the lives of their caregiver. It also revealed that a patient’s caregiver witnessed a change in their loved one after receiving their prognosis. “They have always told him that he can live a normal life. He is the one who refuses to do so. He could live a very normal life, but he doesn’t because he knows he is sick. It makes me even madder that I cannot convince him to have a normal life,” answered a caregiver. On contrary to what caregivers encountered, many patients expressed that they are doing their best to stay positive. “You have to take life as it is. Work up the courage and go on,” responded a patient. Improving Communication Between Patients and Caregivers Researchers determined that it is easy for patients and caregivers to talk about the facts about mesothelioma, treatment, and their medical journey. On the other hand, emotions were harder to manage when talking about how this type of cancer has affected them personally. “…We can trace in patients’ and caregivers’ narratives the need to find new ways to talk to each other and maybe a more adaptive way to face and put into words separation and death anxieties,” concluded the study. Presently, researchers believe that health care services and interventions can help strengthen communication and the overall well-being of patients and caregivers. However, more research will need to be conducted. You’re Not Alone – Help Is Available A mesothelioma diagnosis can be hard to accept. It is important that patients and their caregivers stay strong and know that they are not alone. There is help available in the form of support groups. Patients and caregivers can attend meetings in their community or even online. These groups provide an opportunity for individuals to share their experience and to surround themselves with others that can relate to them. Hope resonates in the stories of survivors. Many mesothelioma warriors are rising above statistics. By taking their prognosis into their own hands, patients are even reaching a state of remission. You can learn more about defying the odds in our free Mesothelioma Survivors Guide.

Conference Urges Asbestos to Be Banned The Asbestos Disease Awareness Organization (ADAO) wrapped up its 14th Annual Asbestos Disease Awareness Conference earlier this month. Members of the community affected by asbestos-related diseases like mesothelioma, banded together to share their stories and efforts made towards officially banning asbestos. During ADAO’s conference, new findings and stories were shared by researchers and speakers. For those that couldn’t make it to the conference, ADAO invited them to watch via live streaming. “Our conference this year brought together asbestos researchers and ban advocates from across the globe all asking for the same thing: that we stop considering asbestos exposure acceptable,” stated ADAO’s President Linda Reinstein. Asbestos-Related Deaths Are Rising According to ADAO, there has been an increase in asbestos-related diseases. This evidence was revealed by Dr. Jukka Takala. Dr. Takala serves as the President of the International Commission on Occupational Health. Dr. Takala’s research uncovered that “asbestos-related diseases cause 39,275 deaths in the United States annually—more than double the previous estimates of 15,000 per year. Specifically, asbestos leads to 34,270 lung cancer deaths, 3,161 mesothelioma deaths, 787 ovarian cancer deaths, 443 larynx cancer deaths, and 613 chronic asbestosis deaths.” These morality numbers are appalling. Dr. Takala’s discoveries not only support that asbestos needs to be banned, but they suggest that asbestos-related diseases are extremely under reported. In fact, Dr. Takala’s data insists that every year in the United States approximately 39,275 asbestos-related deaths occur. Unfortunately, this number is double the amount that is published by agencies of the U.S. Government. “These new findings make the call for a ban in the United States even more critical, and we are hopeful the EPA specifically will take note and make the appropriate response,” Reinstein commented. Putting an End to Mesothelioma Dr FloresDr. Raja Flores is a well-respected name in the mesothelioma community. He is known for changing the lives of many patients by treating them with either extrapleural pneumonectomy (EPP) or pleurectomy with decortication (P/D). At ADAO’s conference, Dr. Flores spoke about the connection that asbestos has to both patients and manufacturing industries. He even floored the conference attendees by informing them that it still isn’t banned in the United States. “No asbestos – No Mesothelioma. It’s simple,” Dr. Flores announced. Dr. Flores shared briefly about his experience of working in an office that contained asbestos. He also revealed that even though treatment for mesothelioma and other asbestos-related diseases are improving, that legislation can save more lives. “With mesothelioma and asbestos-related cancers, the pen is more powerful than the knife. And I hope that after this meeting, we just don’t go about our days, but we continue to push for legislation that can actually save lives,” Dr. Flores concluded. Dr. Flores is considered to be one of the top mesothelioma specialists in the United States. Patients travel near and far for his expertise in treating asbestos-related diseases at the Mount Sinai Medical Center in New York. Tribute of Hope Award ADAO awarded the “Tribute of Hope Award” to both U.S. Senator Jeff Merkley and U.S. Congresswoman Suzanne Bonamici. Both Merkley and Bonamici are sponsors of bills that have one mission: ban asbestos. Senator Merkley helped introduce the Alan Reinstein Ban Asbestos Now Act. Bonamici recently introduced a companion bill with the same name. “We have known about the dangers of asbestos for decades, and many countries have banned it for good reason. It’s past time for Congress to take action and save lives,” said Bonamici. Asbestos is still legal in the United States. In the last decade, over 8 million pounds of this carcinogen went through U.S. ports. Some products that still contain asbestos are: Clothing Vinyl floor tile Roof coatings Cement pipe Automatic transmission components Disk brake pads “The chemical industry continues shamefully to seek a way to profit from a known carcinogen, putting the lives of miners from other countries at risk, as well as those exposed during and after production,” declared Reinstein. Every day ADAO and mesothelioma warriors from across the U.S. and around the world continue to fight. With each battle, they become one step closer to ending preventable diseases and officially banning asbestos.