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Howard (Jack) West, M.D.

Howard (Jack) West, M.D.

Thoracic Oncologist, Swedish Cancer Institute in Seattle, WA

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MesoMark: Progress in the Diagnosis and Monitoring of Mesothelioma

Mesomark test

Among the many challenges of managing mesothelioma are the difficulties in diagnosing and then following the disease for progression or response to treatments administered. One of the potential tools to help in this regard is an assay of soluble mesothelin related peptides, now a commercially available test called Mesomark. Mesothelin is a glycoprotein (a protein with sugar molecules attached to it) that is expressed on normal mesothelial cells but also over-expressed in patients with malignant pleural mesothelioma (MPM) as well as potentially in patients with peritoneal mesothelioma or ovarian cancer. Soluble mesothelin-related peptides (SMRPs) are believed to be either peptide fragments of mesothelin (peptides being pieces of larger proteins) or variant versions of mesothelin that don’t remain bound to the cell surface. These SMRPs can then end up in serum or pleural fluid.

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The Chemo Question: An Alternative to the Potentially Challenging Standard

The Chemo Question

This morning in our thoracic oncology tumor board discussion, we reviewed a case of a 72 year-old man who is now diagnosed with malignant pleural mesothelioma (MPM) that is too advanced to consider surgery, and who is rather debilitated from emphysema and other longstanding medical problems. The best studied treatment for MPM is the chemotherapy combination of cisplatin and Alimta (pemetrexed), which has a proven survival benefit compared with cisplatin alone1. But cisplatin is an older chemotherapy agent that is notoriously challenging for even many fit patients to tolerate. This raises the question of whether there might be an alternative approach for patients who are unlikely or unwilling to tolerate the anticipated side effects of a cisplatin/Alimta combination, which often include nausea/vomiting, possible kidney damage, hearing loss, peripheral neuropathy (numbness and tingling from nerve damage), and sometimes other issues not typically seen with carboplatin. The data from a large European registry2 provide reassurance that the generally better tolerated combination of carboplatin/Alimta can provide comparable benefit for patients who are not candidates for the standard cisplatin-based regimen.

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The Treatment Dilemma: Assessing Response in Malignant Pleural Mesothelioma

Stethoscope

Among the many challenges of managing malignant pleural mesothelioma (MPM) is reliably assessing the response of the disease to our treatment. We don’t want to discard a treatment that is effective, nor do we want to have patients continue on a treatment that isn’t helpful but is causing significant side effects. In oncology, we typically grade our work by comparing an imaging study like a computerized tomography (CT) scan of the chest done after 2-3 cycles of systemic therapy (usually covering a 6-9 week interval) to a baseline scan performed prior to the start of treatment. As you’d suspect, significant tumor shrinkage is good, while growth is bad, and stable disease is somewhere in between. Typically, we want to continue our treatment in the absence of significant progression or prohibitive side effects.

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