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New Tumor Treatment for Malignant Pleural Mesothelioma Approved by FDA

In May 2019, the Food and Drug Administration approved a device for the treatment of malignant pleural mesothelioma under the Humanitarian Use device section of their policy on rare diseases. 

 

What is the new treatment?

This new therapy is Novacures’s Tumor Treating Fields delivery system, or NovoTTF-100L.  Tumor treating fields are mild electric fields that pulse through the skin or scalp and interrupt cancer cells’ ability to divide. Electrodes are attached to the skin and attached to a portable device. The person keeps the portable device with them as they go about their activities of daily living. The treatment is portable and does not need to be done in a hospital or clinic setting. The therapy is continuous but can be interrupted for short time everyday. It is advised to be attached 18-20 hours a day to the person. 

This treatment is non invasive and does not cause side effects that other treatments might,  such as nausea, vomiting, diarrhea, or fatigue. The tumor treating fields work by acting upon rapidly dividing cells of cancerous tumors without affecting normal cells. It targets highly charged proteins in the cells. The proteins are essential to the process of cell division which is how the tumor grows and spreads. With the tumor treating fields device the tumor is then prevented from dividing and growing.

Why was it approved?

Malignant mesothelioma is a rare disease and thus fits the description for approval under the Humanitarian Use Device clause. In order to qualify for this category the FDA must determine that the medical device is intended to benefit patients in the treatment of a disease that affects or is manifested in not more than 8,000 individuals in the United States per year.

The last relevant treatment approved by the FDA was chemotherapy with Pemextred and Altima in 2004.

How was it approved?

The Tumor Treating Fields device was first approved in 2011 for treatment of aggressive brain tumors called glioblastomas. For malignant pleural mesothelioma a clinical trial called STELLAR was conducted in Europe using this technology with patients that have the disease. The results were positive with an increase of overall survival in patients who took part in the trial, all of whom were not surgical candidates. It was used in conjunction with the approved chemotherapy for malignant mesothelioma, Pemextred and cisplatin.

What does it all mean?

This is progress for some patients with malignant pleural mesothelioma. It gives them another option. This is not a cure, but an additional treatment to help overall survival used in conjunction with the first line chemotherapy, pemetrexed plus cisplatin.

When meeting with your mesothelioma expert and team ask if this treatment option would be beneficial for you or your loved one. If you have been diagnosed and are seeking information or justice, please reach out to Belluck & Fox for a free consultation.

Can you screen for malignant mesothelioma?

One of the difficulties in diagnosing malignant pleural mesothelioma is the long time between exposure to asbestos and the beginning of symptoms. The average incubation period for malignant pleural mesothelioma is 20-50 years. Are there any tests that can screen for malignant mesothelioma?

Screening is testing for a disease when there are no symptoms. The reason to screen people is that early detection usually results in better treatment options and improved success in treatment. Screening can help detect cancers earlier and start treatment when the disease is in an earlier stage. These screenings can take the form of blood tests, procedures, or x-rays, depending on the disease. Examples of different screening tests for cancers are a mammogram for breast cancer, colonoscopy for colon cancer, or a blood test for prostate cancer. Malignant mesothelioma – whether it is pleural or peritoneal – is usually diagnosed after other diseases have been ruled out.

In the past few years there has been the development of screening for lung cancer with a low dose CT scan. People that have high risk factors for lung cancer are screened using a cat scan. The yearly screening CT scan is recommended for patients that have a history of heavy smoking, who have smoked now or quit within the past 15 years and are between the ages of 55 and 80 years old.

Researchers in Toronto have conducted a clinical trial screening both people exposed to asbestos 20 years prior and people with known high risks for lung cancer, with a low dose CT scan. These are the same scans that have been used for detecting early lung cancer. Unfortunately, the researchers did not find the low dose scans to be a benefit in screening for malignant pleural mesothelioma. 

Screening for cancer is important. Although this study did not prove successful, there are researchers continuing with this important work. Helping to develop a screening tool to detect malignant pleural mesothelioma will hopefully allow people to start treatment earlier.

If you have a diagnosis and need information of assistance, please reach out for a free consultation.

Patients Can Use Technology to Learn and Share Information

The average age of the person diagnosed with malignant mesothelioma is 60 years or older. With advances in technology, many are users of smartphones, technology, and the internet. There was a time when these technologies were mostly for the younger generation, but today we are all using these devices to some capacity. Technology has changed the way we obtain information, including some options for treatment for a serious rare cancer.

From my personal experience, patients use these devices to ask questions or seek further understanding. People have apps on their phones that help them monitor vital signs or schedule medications. This concept has become very beneficial to the mesothelioma community. Often these texts, pictures, and graph, or any information that can be shared with a healthcare professional can be a game changer. We as mesothelioma team members stay in tune with patients, but information that is in real time  sometimes can state the facts and make the picture of what is going on clearer. 

This avenue has allowed patients to feel more confident asking questions. Having a serious illness like mesothelioma forces you to contemplate the possibilities of treatment. As nurses, technology can help educate the patient about their disease treatment and recovery. When one understands this disease and its many complex characteristics it empowers patients. Technology has also empowered the patient making them feel in control.

Another reason to take advantage of technology is if you have traveled to a Mesothelioma Center of Excellence and you don’t live nearby. Sending pictures or texts can paint a clearer picture of what is going on. If you are staying nearby your treatment center and are away from home, FaceTiming with family can help this road be less lonesome or stressful. One of the keys to success on your journey with mesothelioma is keeping in control and giving factual information to the healthcare team. 

At the end of the day a person needs to be able to participate in his own care and feel good about him or herself. If using technology to advance your understanding of this disease, or using devices to help maintain or improve your health is an option than this is what you should do. There are many devices on our smartphones that can track, monitor, and log information which helps give a picture as to what is going on. Communication with your mesothelioma team, with your family and friends, updating your progress, and becoming involved in support groups are now all accessible through technology. These services may not be for all and that is fine too. Whether you use the latest apps or not to obtain information, the bottom line is to do what makes you feel comfortable.

Belluck & Fox works tirelessly to help mesothelioma patients get access to information and justice they deserve. If you are diagnosed, reach out for a free consultation today.

Pleural Effusions & Mesothelioma

“My husband had a large amount of fluid drained from his chest a couple of times before he was diagnosed with malignant pleural mesothelioma. The other man we were talking to at the meeting never had any fluid drained. What does that mean for the future? Is that bad?”

This question in one form or another is asked frequently. The pleural fluid is located around the lung between the pleural and visceral layers – thin cell layers that line the lung. Usually in a healthy person there is about a tablespoon of fluid that lubricates the cell layers and allows the lungs to expand. Pleural effusions become significant when there is more than 200cc, just less than a cup. When draining a pleural effusion most practitioners stop draining at 1,000cc, around a quart.

There are many diseases that can cause pleural effusions. Some of the common reasons are congestive heart failure, liver or kidney failure, pneumonia, infection, and lung cancer. Malignant pleural mesothelioma is usually diagnosed after other more common reasons are ruled out.

In a research study published from the Academic Respiratory Unit at the University of Bristol, a team led by Anna C. Bibby looked at a center in England at patients diagnosed with malignant pleural mesothelioma between 2008 and 2017. They looked back at the symptoms that the patient presented with, the presence and size of pleural effusions, and then followed the patients through their journey with mesothelioma.

They found that 82.8 percent of all 229 patients diagnosed during this time had pleural effusions. Of the 192 patients, 41 percent had fluid that occupied more than 50 percent of the hemithorax. They also confirmed that right sided tumors and early stage disease were more common in patients that have pleural effusions and those that don’t. In addition, they found that patients with pleural effusions were more likely to be short of breath as the presenting symptom. Those without pleural effusions presented with chest pain as the most common symptom.

This study looked at the size of pleural effusions, and whether or not you had a pleural effusion did not contribute to overall survival. The study also found that effusions are associated with lower disease stage. The reason may be that when someone is short of breath they may go to the doctors earlier and disease possibly diagnosed sooner leading to more treatment options.

The study supports once again the importance of seeking treatment at a Mesothelioma Center of Excellence with an expert team experienced in malignant pleural mesothelioma. Research is constantly behind the answers to questions and constantly evolving.

If you or a family member has been diagnosed with mesothelioma and has questions about this or any legal issues, Belluck & Fox is here to help you get justice. Call today for a free consultation.

Living Life with Mesothelioma

With mesothelioma in the headlines, and important recognitions like Mesothelioma Awareness Day, we have witnessed many tributes to mesothelioma warriors who have fought, and continue to fight, this terrible disease. As tributes poured in via social media it encourages us, as healthcare providers, to evaluate how well we are doing.

The one true payoff is when you meet someone with mesothelioma and watch them recover from the treatment and continue to live. The greatest reward is watching someone go out and do the things they enjoy. It made me reflect about a patient I had met who was forty years old and was recovering in a hotel waiting for the “OK” to get back to his southern state. He appeared stable, his wound looked well, his vital signs were stable, and his mood was in good spirits. 

When I asked him how he was going to spend his time in Boston, he told me he was taking a bus to a casino. He was showered, clean shaven, happy, and ready for his day out. The story does not end there. I am not sure whether he won or not. When I reported in with his surgeon about his progress and spoke about how he was going to head to the casino, the surgeon’s face lit up like a Christmas tree. 

The goal of being the best in the business is great, as you are the person people travel to from far and wide to get the best chance of survival. The truth of the matter though is that while it is great to be offering the latest treatment options, it is even better to see how you have been able to provide the opportunity for people with this rare cancer to live their lives. 

As my conversation progressed with the surgeon, it made me think about how while the mesothelioma centers offer the best of the best, what is the patient doing with it? Cleary, living is the greatest thank you that you can give your medical team. A couple of days ago I called a patient to visit and check in on her and her recovery.

Be brave, seek out your best options for treatment, but go live your life to the best of your ability. Don’t let your disease define you, because you can take control.

Talc pleurodesis could help treat pleural mesothelioma

One of the common findings that people present with before being diagnosed with malignant pleural mesothelioma is a pleural effusion. It is estimated that 90 percent of patients diagnosed with malignant pleural mesothelioma present with pleural effusions. Pleural effusions can be present in greater than 50 different pleural, pulmonary, or systemic disorders. It is often the case that only after the common reasons for pleural effusions are ruled out, the diagnosis of malignant pleural mesothelioma made.

What is a pleural effusion ?

A pleural effusion is fluid buildup in the lining of the lung. There are two layers that line the lung – the visceral layer closest to the lung and the parietal layer lining the chest wall. These linings are very thin sheet like structures. The fluid that lubricates the two layers is the pleural fluid.  Without disease there is usually 10-20cc of pleural fluid lubricating the visceral and parietal layers allowing the lungs to expand or contract. With a pleural effusion, the fluid builds up compressing the lung making it harder to breathe. Patients with malignant pleural mesothelioma often present with a gradual onset of pulmonary related symptoms: shortness of breath, cough, chest pain, and just not feeling well.

Successful management of pleural effusions can improve patients quality of life with malignant pleural mesothelioma. Treatment for pleural effusions can be a thoracentesis. During thoracentesis, fluid is drained out of the pleural space usually with ultrasound guidance. 

What is talc pleurodesis?

Depending on the patients treatment options management of pleural effusions can also involve a procedure called talc pleurodesis. Talc pleurodesis involves inserting sterile talc or another irritant into the pleural space. The irritating substance helps the parietal and visceral layers adhere to the chest wall. The talc is an irritant that effectively eliminates the space. This procedure is used for some patients post surgery for mesothelioma to treat prolonged air leaks.

Recently, researchers have been looking at this procedure a possible front line treatment for patients. For some patients who are not candidates for surgery or choose not to have surgery, talc pleurodesis may be a way to stop the pleural effusion issue. Researchers found that patients who did not have pleural fluid issues live longer, as do patients that do not have fluid reculimating in the pleural space.

If you or your loved one has been diagnosed with malignant mesothelioma, go to a mesothelioma center of excellence for your best options. Research is constantly looking at the options available and hopefully progressing to a cure. It may be a new look at a procedure that is commonly done, or a new treatment for symptom management. Improving quality and survival it is best to be evaluated where this is their expertise in this rare cancer.

Balancing Mesothelioma with Everyday Life

Balancing living with mesothelioma over time and living day to day with mesothelioma is a challenge. Living with Mesothelioma at times can be frustrating. Many people question and critique their progress daily or even sometimes hourly. It is important that you pay strict attention to your overall health and stamina, but when is it too much or not enough? The patients that we see after initial treatment are often in their homes or local hotels, rehabs, or staying locally near a mesothelioma center.  There is a wide variety of expectations after this initial hospitalization. For some they keep logs of weights, medication, and lists of fluids and food that they have consumed. This can be helpful with accuracy and to stay ahead of changes to a situation. For others they are more accepting of symptoms that can be improved on. It is a balance that every person has to find.

Two examples that come to mind are a patient that had logs for his weights, charts for his meds, diaries for his food intake – all was going well in those areas. Sleep was an issue, and became something that he focused on. He realized the one area that he had not put enough emphasis on was walking. Ambulating is very important and could help improve his sleeping, and so balancing these activities helped him recover.  

Another patient had no energy, was dizzy, and blood pressure was low. He expected that he should feel bad and thought this was just how it should be. He did not reach out to his mesothelioma team. Adjusting his blood pressure meds improved his energy, appetite, and outlook.

When is there too much focus on something? There is no easy answer to that. Many times, we see patients and families who are hyper focused on one thing. Sometimes it can be weight, pain, shortness of breath and they constantly talk about it. How do we refocus on life and not so much the disease? Professionally speaking we try to focus on something else, preferably something positive. Maybe if someone is focused on lack of sleep or shortness of breath, we try to engage the patient about mobility. We concentrate on the value of ambulation, how it builds endurance, strength, promotes confidence, and overall is good for you. We encourage them to measure their distance and how they felt after each outing. This can sometimes work in a favorable way and it can encourage people to push themselves and not focus on the other stuff.

As you enter the world of mesothelioma you may hear that this disease can also affect you mentally. Many patients previously have chosen to focus on being a warrior and not a victim of asbestos. This is not an easy task to do day to day. It takes practice to incorporate this mindset into your daily life. 

Physically we all know when something feels different out of our norm. We are quick to pick up if we are coming down with a cold, or we have bruised a bone. If something does not feel right you should let your team know about it.  

Seeking and undergoing treatment for mesothelioma is a challenge. This is about taking the disease by the hand and taking charge of how your recovery will go. Controlling what you can and letting go of what you can’t control will allow you to work with your team for the best possible results.

World Lung Cancer Day

August marks the beginning of a new summer month, and with it, World Lung Cancer Day. Lung Cancer continues to be one of the most common cancers worldwide, claiming more lives than breast, colon, and prostate cancers combined. In the early twentieth century, lung cancer was rare. Today it is one of the most common cancers in the world, affecting nearly one in five cancer deaths globally. Factors that attribute to lung cancer are smoking, asbestos, and air pollution, to name a few. If you are a smoker you are 24-36 times more likely to get lung cancer than a nonsmoker.  

Those who are part of the American College of Chest Physicians (CHEST) and the Forum of International Respiratory Societies (FIRS) use this day to communicate, celebrate, and support those impacted by lung cancer throughout the world.

The International Association for the Study of Lung Cancer (IASLC) holds a World Conference on Lung Cancer – the largest meeting dedicated to lung cancer and other chest malignancies. Last month the IASLC group hosted a dedicated Mesothelioma Forum of medical professionals sharing the latest clinical trials. Although the research is hopeful, there is much work to be done. Collaboration throughout the world leads to more treatment options. More research could help end this disease. The other factor is education, and reaching as many people as possible with knowledge of the risk factors that can lead to a diagnosis of lung cancer.

The goal of World Lung Cancer Day is to bring education and attention to a disease that still remains a global threat to health. Therapies are still being developed and education is still needed. People throughout the world  continue to smoke cigarettes, and now the latest fad of vaping whose long term effects are unknown.       

According to the World Health Organization, 34,000 Americans die from preventable asbestos-caused lung cancer each year. Asbestos causes lung cancer and causes Mesothelioma. Despite how you have contracted your disease, please early treatment and detection are you best fight against these diseases.  

Collaboration, awareness, support, and education are all factors in making the first day of August World Lung Cancer Day annually.

Breaking Down New York Asbestos Deaths by County

A new analysis from the Environmental Working Group (EWG) indicates that during the period 1999 to 2013 more than 12,000 New Yorkers lost their lives to the carcinogenic mineral fiber asbestos—one of the highest totals in the country.

Asbestos deaths varied significantly from county to county, with Nassau County experiencing the most and Schuyler County the fewest.

Not surprising is that the populous southern counties of Nassau (1,135 deaths), Suffolk (1,130), Queens (843), Kings (604), and Westchester (529), as well as the populous northern counties of Erie (1,133) and Monroe (657), are near the top of the list in terms of total asbestos deaths. But when asbestos deaths are viewed in terms of deaths per 100,000 people, many of New York’s less-populous counties top the list.

Niagara County, with a population of around 215,000, leads New York with an asbestos death rate of 14.5 per 100,000 people. Second and third are Cattaraugus and Wayne counties, each with a population of less than 100,000. Greene and Chenango counties have roughly 50,000 people apiece but have asbestos death rates of 8.8 and 9.0, respectively.

One explanation for the high asbestos death rates in these New York counties is the presence of major local employers that utilized asbestos-containing materials in their products and manufacturing processes.

The Occidental Chemical Corporation, for example, did business in Niagara Falls and exposed workers to raw asbestos used in the manufacture of chlorine as well as to asbestos-containing equipment used to manufacture chemicals at Occidental.

niagara asbestosOther prominent Niagara Falls companies that used asbestos and exposed workers to the carcinogen include the Carborundum Company, Dunlop Tire and Rubber, Union Carbide, and Niagara Electro Chemical Company.

Niagara Fall residents also commuted to the industrial city of Buffalo, New York, where a number of prominent companies—including Chevrolet, American Standard, and Georgia Pacific—exposed workers to asbestos.

The small town of Olean, New York in Cattaraugus County is home to Dresser-Rand and a significant contingent of its manufacturing workforce. American Cyanamid Company and a number of other businesses that used asbestos in its products also had operations in Olean.

Similar instances of New York companies exposing workers to asbestos are found throughout the state, from the powerhouses that light up New York City to the upstate paper mills and steel plants to the shipyards that dot the state’s coastal region.

Millions of tons of asbestos were used by U.S. industry and the military during the 20th century, resulting in millions of people being exposed to asbestos and many thousands of deaths.

And as EWG points out in its latest report, asbestos is “still legal and still everywhere.” While the asbestos deaths that EWG reports occurred from asbestos exposure decades ago, the continued use of asbestos in this country ensures that this entirely preventable epidemic will continue.

If you or a loved one was diagnosed with mesothelioma, lung cancer, or asbestosis, contact our top rated mesothelioma lawyers at Belluck & Fox, LLP for a free legal review. We’ve represented hundreds of New Yorkers in asbestos lawsuits against companies throughout the state. Visit our offices located at Woodstock, The Capital District, New York and Rochester.

 

Learn why we are uniquely qualified to handle your claim during a free case review.

MA Public School System Amiss in Addressing Asbestos Issues

Eliminating exposure to asbestos is the only sure way to prevent mesothelioma from developing. The terminal cancer is triggered when microscopic asbestos fibers are inhaled or ingested where they burrow in for decades, eventually leading to cancer.

Unfortunately, authorities fear the aging of the Massachusetts’ public school system may contribute to an increased number of asbestos-related illnesses down the road.

Although asbestos is no longer used in construction, asbestos-containing materials were used throughout schools built prior to the 1980s. Asbestos is a human carcinogen, but if it is intact the material does not pose a risk. However, the U.S. Environmental Protection Agency reports that there is no safe level of asbestos exposure, and “the risk of school children being exposed to even low levels of asbestos is a concern.”

According to a Dec. 6 article in the Boston Globe, authorities are concerned that hundreds of Massachusetts public schools could still contain asbestos. But lack of funding has led to non-compliance of state and federal regulations designed to protect students and employees from asbestos exposure.

Under requirements set forth by the Asbestos Hazard Emergency Response Act (AHERA) these asbestos-containing materials in schools must be managed in an undamaged and non-friable condition.

The spotlight was put on the Mass. school system after U.S. Senators Edward J. Markey (D-Mass.) and Barbara Boxer (D-Calif.) sent a letter to all U.S. governors this year in an effort to assess the conformance of school systems to AHERA and to determine the extent of the presence of asbestos within the U.S. school system.

See “Government Raises Concerns Over State of Asbestos in U.S. Schools” to find out more about the initiative.

The Boston Globe reports the responses back from the school system was spotty, at best. Per the senator’s request, state officials surveyed Massachusetts’ 2,500 public, private, and charter schools. 1,054 responded, and of those, 30 percent reported still having asbestos-containing materials.

1,446 of the schools never responded, leaving the officials in the dark about the status of asbestos in those schools. Not only do they not know if asbestos is present, but the officials do not know whether school officials are monitoring or inspecting the schools for potential asbestos hazards.

“This is concerning,” said Brian T. Wong, chief of investigations and enforcement at the state Department of Labor Standards, which oversees compliance with asbestos laws in Massachusetts, according to the Boston Globe. “From what we see, the schools certainly aren’t doing all that they should.”

The EPA notes that inspecting the condition of asbestos materials in schools is extremely important so that changes in the material’s condition, such as damage or deterioration, can be detected and corrected before the condition worsens.

Wong reports the state no longer reimburses schools for the costs of conducting inspections and developing management plans leading the schools to put asbestos issues on the back burner.

“When faced with declining school budgets, teacher layoffs, and program cuts, compliance with [the asbestos law] was not their priority,” said Wong.

But in a statement from the Department of Elementary and Secondary Education, a spokeswoman said, “Maintenance issues, such as the presence of asbestos, are the responsibility of local officials,” placing the onus on the schools.

Mesothelioma is a terminal cancer caused by past asbestos exposure. 3,000 Americans are diagnosed with the cancer each year. Unlike many environmental toxins, asbestos has a long latency period taking between 15 and 60 years before an asbestos-related disease is diagnosed. Students exposed to the mineral face a life-long risk of developing mesothelioma.

If you or a family member has been diagnosed with mesothelioma, lung cancer, or other asbestos-related disease, you need to speak with our trusted asbestos lawyers at Belluck & Fox, LLP today. Visit our law office in New York City now.