What to expect from your Oncologist

Since we have reviewed what to expect when you meet the surgeon, many of you may also be interested in what to expect with a visit to the Oncologist. Not every patient is a surgical candidate, so most cancer patients are diagnosed and followed by an Oncologist. The largest part of my career has been spent working with one Oncologist who specializes in lung cancer and mesothelioma. Depending on where you live, the type of office setting your Oncologist practices within will vary. I work for a hospital and clinic system in which a team of Oncologists practice in a cancer center Monday- Friday. Our team of Oncologists has a schedule in which they alternate between clinic and hospital duties.


Why am I seeing an Oncologist?

I will focus on lung cancer and mesothelioma for a patient who has just been diagnosed. Many patients start out in the primary care physician’s office or pulmonology department when they are diagnosed. The focus today will not be on the diagnosis since this has been covered in my first blog.
What brings a patient to an oncologist is the staging and treatment of the lung cancer. An earlier stage lung cancer (1a or b) may never step foot in an Oncology office. Typically those patients are cared for and followed by the thoracic surgeon.
If your cancer requires the care of an oncologist, he/she will make the stage assessment, follow NCCN guidelines if treatment is recommended, prescribe the chemotherapy regimen, and will also determine if radiation oncology is needed. The oncologist is the main provider who will make a radiation referral. Not every cancer patient requires radiation, so it is determined by the Oncologist and the NCCN guidelines for treatment if radiation is medically necessary. Radiation can be given at the same time as chemotherapy for optimum results.
Surgical candidates will start with the expected number of chemotherapy treatment and then have restaging scans. The oncologist will then decide if the patient is ready for a surgical evaluation. There are cases in which patients will have surgery followed by chemotherapy. This individualized plan is devised between your Oncologist and thoracic surgeon based on the specific location and size of your cancer. This team effort is a multidisciplinary approach involving.

What will my Oncologist order for me?

This is a very general topic as each stage of lung cancer is very different. Some patients require only CT scans; other patients require PET scans or an MRI of the brain. With small cell lung cancer, only CT scans and bone scans along with an MRI of the brain is required.
Mesothelioma is often diagnosed through chest xray, ct scan, and/or a pleural fluid sample. The extent of disease is best measured through a PET scan. Some patients with mesothelioma require a few cycles of chemotherapy, repeat PET scan, then evaluate for surgery. Not every patient with mesothelioma is a surgical candidate, so they will remain in the care of the oncologist. This set of patients may still see a thoracic surgeon if they continue to develop pleural effusions and need a more permanent solution to drain the buildup of fluid. The multidisciplinary approach between the pulmonologist, oncologist, and thoracic surgeon is an ideal practice with mesothelioma.

Life with chemotherapy

One of the biggest fears and concerns of cancer patients is the treatment plan. Your oncologist will be the leader in creating an individual treatment plan for YOU. Which type of chemo, the dose of chemo, the number of cycles or rounds of chemo, the point of restaging scans, and the reassessment after scans is all up to the Oncologist. This is a HUGE task. There are so many chemotherapy agents to treat the same type of cancer; it can be very overwhelming to understand why a particular chemotherapy regimen has been chosen for you. You may hear your oncologist use the words “first line” or “second line”. This is simply referring to the “first choice” in treating your stage and type of lung cancer. These guidelines are from the NCCN (National Comprehensive Cancer Network), so your oncologist cannot “make up” or self-create a regimen. All of the science and research has created this foundation of guidelines and proven therapies. These guidelines do change; however, this is part of the challenge and ongoing education of your Oncologist.

When your oncologist tells you what type of chemotherapy you will receive, he/she will review the side effects of each drug, time duration expected to receive each drug, and they will also provide you with medications to counteract nausea/vomiting. The temporary use of steroids is also used before and after certain chemotherapy agents to decrease side effects. Not every patient will be prescribed steroids – this is simply based on the type of regimen chosen for you.

Questions to ask your Oncologist

  • “Is my cancer treatable or curable?”
  • “When do I need to call your office?”
  • “What exactly is a fever and why may I have fever?”
  • “When should I start taking my nausea medication?”
  • “Can you write down when I need to start and stop my steroid medication?”
  • “After how many cycles of chemotherapy are you going to re-scan to see if this chemo is working?”
  • “What about pain? Am I going to have pain, if so, what do I take?”
  • “Am I going to lose my hair? May I have a prescription for a wig?” 

Finding the right Oncologist

After reviewing how essential an Oncologist is in your care, it is very important to find the right Oncologist for you. Going online and researching which Oncology team has lung cancer and mesothelioma specialists is a very good way to start. Most large practices with an Oncology group have some Oncologists who take a special interest in lung cancer. In a smaller city with fewer options, a general Oncologist treats more of a broad spectrum of cancer patients.  Asking your current physicians for an opinion or recommendation may also help in making a decision. Today, many patients are guided to the appropriate Oncologist via nurse navigator who is familiar with the various specialties of each Oncologist. It is important for you to feel comfortable with your choice and have the ability to ask questions

By: Alaina Mokhtarnejad – Thoracic Oncology Nurse Navigator at Ochsner Medical Center in New Orleans, LA

What Is A Mesothelioma Nurse Navigator?

My name is Alaina Mokhtarnejad and I work as a Thoracic Oncology Nurse Navigator at Ochsner Medical Center in New Orleans, LA. I’m sure the question of “what is a nurse navigator?” comes to mind. I will simplify this complicated terminology and also discuss the impact of nurse navigators in the field of lung cancer and mesothelioma.

My role as a thoracic oncology nurse navigator simply means that I “navigate” or guide patients with a new diagnosis of lung cancer or mesothelioma from the time of diagnosis through the end of their care or treatment. There are multiple other thoracic diseases or abnormalities that I also work with, but I will focus on lung cancer and mesothelioma.

Nurse navigators play a huge role in coordinating patient care with a new diagnosis of lung cancer. Here are a couple of examples of the way nurse navigators work in the field of oncology.

Example A: The patient has a cough that just wouldn’t go away for months and months, so they finally see their primary care doctor and he/she orders a chest xray. Some patients go through multiple tests before they receive a diagnosis; others have abnormalities found right away with a simple chest xray or chest CT scan. This is when the physician makes the referral to a thoracic surgeon, Oncologist, or pulmonologist based on the size of the concerning area.

The size and location of the nodule/mass noted on a scan is what determines the extent of the possible disease and to whom will take over the next phase of care for the patient. This is the hardest part… waiting…. and waiting… and waiting. Thoughts are consumed with the inevitable “Am I going to die?” “What did I do to deserve this?” “How will I afford treatment?” and the list goes on.

The nurse navigator is the next key player after an abnormality has been noted and discussed with the patient. Often times, the PCP calls the local cancer center or pulmonology department to continue the work up for the abnormality. The nurse navigator then “navigates” the patient to the next phase of care.

The pulmonologist will typically perform a CT chest if it has not been done at this point and possibly explore deeper by performing a bronchoscopy or an endobronchial ultrasound  (EBUS) to gather a sample. Other times, patients are sent directly to the thoracic surgeon to have a nodule or mass of a certain size surgically removed. Other times, a sample may be obtained through a needle biopsy by the Interventional Radiology department.

Upon removal of the mass or nodule, pathology is performed to determine if this is a cancer and the specifics of the cancer. There are also instances in which the cancer is advanced in stage and surgical intervention is not medically possible, so the patients are directed to the Oncologist and/or Radiation Oncologist to begin immediate treatment. Other times, treatment is required before any surgical intervention may be considered.

Example B:  A patient goes to their primary care doctor with similar symptoms, a cough or shortness of breath. A chest xray is performed and the xray shows a chest wall thickening or an accumulation of fluid (pleural effusion) which is concerning for mesotheolioma. Patients are sometimes able to pinpoint direct asbestos exposure, other times the exposure is unknown. The next step is likely a CT scan and a referral for a pulmonologist to obtain a sample of the pleural fluid to confirm this diagnosis. Other times, a patient may be referred to the thoracic surgeon to obtain a pleural biopsy to confirm a diagnosis of mesothelioma.

The nurse navigator is now entered into the picture once a patient has a positive pathology for mesothelioma. The ideal situation for the patient at this point is to proceed with both oncology and thoracic surgery to discuss a plan for chemotherapy and possibility for surgery. Not every patient with mesothelioma is a surgical candidate; this will be determined by the oncologist and thoracic surgeon as a multidisciplinary/team approach. The multidisciplinary approach is of utmost importance for a patient with mesothelioma as it involves the services of the pulmonologist, thoracic surgeon, and oncologist. This approach is spreading to just about every area of oncology and enhances the patient experience with a new diagnosis of any cancer type.

Another important role of the nurse navigator is guiding the patient to legal assistance for the known or unknown asbestos exposure. By this point, the patient is so overwhelmed with the diagnosis, costs, and quality of life issues; they often feel too bombarded to address the culprit of this disease.  Navigators must hold the patient’s hand through this entire experience, so seeking legal assistance is a big part of the patient’s acceptance of mesothelioma.

As a nurse navigator, it is important to be at the patient’s side through the entire process of diagnosis and treatment. It has been most rewarding for me to be the first phone call about a patient with a new diagnosis and see them through surgery, chemotherapy, and radiation. The way patients and families grow through such a terrifying experience is truly magnificent. Not every outcome is positive, however, it is up to the nurse navigator to make the experience and journey worthwhile.

My First Visit With The Surgeon

Now that everyone knows a little about my role as a thoracic oncology nurse navigator, let’s discuss what to expect with your first visit to a thoracic surgeon. I work directly with the thoracic surgeon at my cancer center, but not all nurse navigators have this direct relationship. Most navigators work alone or with a group of navigators and service a team of oncologists. The new trend in Oncology is having a disease-specific nurse navigator. In a sense, each type of cancer has its own knowledgeable navigator to direct patients specifically for that one type of cancer.


As previously mentioned, the referral to the surgeon can happen many different ways. A patient may start in their primary care or pulmonologist’s office based on the symptoms that brought them to the doctor. The reason for referral will determine the work up that is necessary for the individual. If a patient has a newly noted lung lesion/mass/nodule, the surgeon will be most interested in imaging. Chest xrays do not provide enough of a visual for the specifics on size and location, so a CT of the chest is the next step. Some physicians obtain a chest xray, then a CT chest to confirm the abnormal findings. Occasionally you will have a doctor who prefers to obtain a PET CT after viewing the CT findings.  The CT chest and chest xray are the two most commonly performed scans that patients have when visiting a thoracic surgeon. If a patient is diagnosed with mesothelioma, a PET is expected to be ordered once a CT scan and pathology have confirmed the diagnosis. In order for a PET scan to be approved, positive pathology is typically needed.


If you are seeing a surgeon that may not have access to the imaging, make sure to obtain a CD with images as well as the radiology reports so your surgeon is prepared for your visit. I would recommend obtaining 2 CD’s of your imaging – one for your own record/ future use and the second for your consultation with the surgeon. If you want to take this a step further, be sure to put the CD into your own computer to make sure this disc loads. Unfortunately, there are times that the imaging does not transfer to the CD. Part of my work as a navigator is to ensure the surgeon has adequate records before meeting the patient. A surgeon’s work is very specific and visual, so it is especially important to have updated imaging – 30-60 days would be ideal.


If your doctor has also scheduled a biopsy before seeing the surgeon, make sure to have a copy of the pathology report for the surgeon. This is very important for the surgeon and oncology team to make important decisions about your individual treatment and care. In many cases, patients are sent directly to interventional radiology for a needle biopsy once the mass or lesion is noted on a CT scan. With a suspicion of mesothelioma, most patients have a thoracentesis to sample the pleural fluid for malignancy.  A pulmonologist may perform the thoracentesis in their office or in Interventional Radiology. A thoracentesis is when a sample of fluid is taken as opposed to a sample of tumor.  Another type of biopsy for diagnosing mesothelioma is called a pleural biopsy. This is surgical procedure in which the thoracic surgeon takes a sample of this pleural tissue.


Every surgeon’s preference for a workup when seeing a new patient is very different. The surgeon I work with also prefers a full set of pulmonary function studies (PFT’s) performed prior to consultation. Our two main criteria for seeing a new patient with a lung mass, lung cancer, or mesothelioma are recent scans (chest xray, chest CT, PET/CT) and PFT’s.  Having a positive pathology does provide additional insight for the surgical oncology team, however, patients are often sent to the surgical team to obtain the pathologic staging. Some surgeons order blood work, cardiac testing and clearance, and updated scans once they meet the patient to decide on further workup. This is a terrifying experience that is new and overwhelming, so I hope that this guide will help you to understand the basic entrance into a visit with a thoracic surgeon.

Verastem Mesothelioma Treatment

Will Mesothelioma Finally Meet Its Match?

Malignant pleural mesothelioma, which affects the tissue surrounding the lungs, is a highly aggressive, asbestos-related cancer with limited treatment options.  Buta new clinical trial hopes to prove that researchers have found the key to halting progression and recurrence of this relatively rare cancer.

Currently, treatment of malignant pleural mesothelioma, the most common type of mesothelioma, includes surgery, chemotherapy and radiation – often a combination of the three therapies.  Even with treatment, recurrence of mesothelioma is likely.

Resilient Stem Cells Appear to Promote Cancer Recurrence

While tumors are made up of many types of cells, research has shown that the presence of mesothelioma stem cells are a major factor in tumor resistance to chemotherapy, recurrence and disease progression.So, although the tumor may shrink with a “first line” treatment such as chemotherapy, stem cells appear to be resistant to the treatment and remain in the body prompting the tumor to regrow.  No standard second line treatment targeting reoccurrence exists today.

A new clinical trial called COMMANDis testing what Professor Dean Fennell, Chair of Thoracic Medical Oncology at University of Leicester calls a novel “two-hit strategy.”The study will be evaluatingdefactinib (VS-6063), an oral therapy designed to target production of cancer stem cells.  Following chemotherapy treatment, patients will be given defactinib, which is designed to target the remaining stem cells.

Targeted Therapies are the Present & Future for Many Types of Cancer 

Defactinibis an example of a biological “targeted therapy.”  Targeted therapies are a focal point ofcurrent cancer treatment and drug development.  Targeted therapies focus on a cancer’s specific molecular profile to help the body fight the disease.  For example, some targeted therapies inhibit the activity of certain enzymes, proteins or other molecules involved in the development and spread of cancer cells.

Many types of cancers including lymphoma, melanoma, leukemia and others are being treated with FDA approved targeted therapies.  Additional therapies are under investigation to treat other types of cancer.  Although some drugs effectively treat more than one type of cancer, most targeted drugs are developed to treat a specific type.

Targeted therapies can work in different ways, but the idea behind them is that they attack the cancer cells more effectively and with less damage to healthy cellsas compared to traditional treatment methods.  Unlike chemotherapy, which indiscriminately kills both cancer cellsand healthy cells, targeted therapies are designed to utilize the body’s own immune system to stop cancer cells from multiplying or kill cancer cells only (not healthy cells).  Hence, the idea that they act on specific targets associated with the cancer.

Defactinib, the oral therapy being studied in the Phase II COMMAND clinical trial,targets cancer stem cells by inhibiting the process of focal adhesion kinase (FAK). FAK is critical for cancer stem cell survival. For a tumor to start growing, stem cells go through a process that is mediated by FAK.

Presently, there are no targeted therapies being used to treat malignant pleural mesothelioma, though many are being studied.  Two other companies are in active clinical trials that focus on FAK:Boehringer Ingelheim (Phase I) and GlaxoSmithKline (Phase 1b).

What Can Merlin Teach Us About Cancer Tumor Development? 

Targeting specific biological processes to kill cancer cells may sound relatively straightforward, but there are so many different interactionsoccurring inside the body at a molecular level that it makes it extremely difficult to isolate specific causes and effects.

To figure out what to target, researchers mustidentify and understand the interactions between specific cancer genes and proteins and the tissue environment that is promoting the cancer cell growth and survival.

In the case of malignant pleural mesothelioma, research has identified mutations in particular genes that help regulate the normal cycle of cell growth and cell death.  The mutations prevent those genes from doing their job of suppressing tumors.  As a result, the normal cell cycle is interrupted and cancer cells are free to grow.

Inactivation of one of the suppressor genes mentioned above called NF2 has been linked to low merlin levels.  Merlin is a protein that serves as a tumor suppressor.  Recent research published in Cancer Research (February 15, 2014) and Science Translational Medicine (May 21, 2014) has found that low merlin levels paired with the inactivation of the tumor suppressor genes cause tumors to grow more aggressively. Approximately half of mesothelioma tumors have been found to have low merlin levels.

So, the bull’s-eye for a targeted mesothelioma therapy appears to be the signaling pathway (FAK).  That is precisely what defactinib has been developed to target and what the COMMAND trial is designed to test.The study also seeks to understand the role that merlin plays in tumor regrowth.  Trial patients will be subdivided into low and high merlin groups then randomized to receive the drug or placebo in order to learn more about the role of merlin loss in tumor development.

COMMAND Study Enrolling Malignant Pleural Mesothelioma Patients 

The COMMAND study is a Phase II clinical trial seeking to enroll approximately 400 patients with malignant pleural mesothelioma at 32 clinical sites in 12 countries including the US, UK, Japan, Australia, Canada, South Africa, New Zealand and Europe.Verastem expects the study to be fully enrolled by the second half of 2015.

Eligible patients, previously treated with chemotherapy, will be categorized by high or low merlin levels and randomized to receive either placebo or defactinib.

Defactinib is a stem cell inhibitor currently being studied in other clinical trials for the treatment of ovarian and small cell lung cancerwith promising outcomes to date.  The drug was designed to stop signals that give certain cancer cells the go-ahead to divide and grow.  This is the first time that a drug will be tested to inhibit a particular protein in the mesothelioma cancer stem cells.The goals of the study (“primary endpoints”)are to halt progression of the cancer and increase patients’ lifespans and quality of life.

Mesothelioma Patients Must Meet Criteria to Participate in Clinical Trial

To be eligible for the study, patients must meet certain criteria including but not limited to:

  • Histologically confirmed (microscopic examination of tissue) malignant pleural mesothelioma that is not metastatic or unresectable.
  • Eligible to undergo excisional surgery.
  • Localized disease confined to one affected hemithorax.
  • Normal pulmonary, cardiac function, renal, hepatic hematologic and performance functions.
  • Male or non-pregnant female
  • Eighteen years of age or older

In addition to these inclusion criteria, there are also a number of exclusion criteria, which are detailed on the study website.

COMMAND is sponsored by Verastem, Inc. of Cambridge, MA.  Verastem is a biopharmaceutical company that develops drugs that target and kill cancer stem cells.

Raphael Bueno, M.D. Chief of Thoracic Surgery at Brigham and Women’s Hospital in Massachusetts is the Principal Investigator. Dr. Bueno’s clinical and research interests include finding new ways to diagnose and treat all forms of thoracic (heart, lungs, esophagus, and other organs in the chest) cancers including mesothelioma.


Could a Simple Blood Test Help Diagnose Mesothelioma…Earlier?

Despite advances in treatment options for malignant pleural mesothelioma, the median survival for patients remains 12 months.  Promising new treatments, such as targeted biologic therapies that can be taken orally, are currently being studied in clinical trials.  The hope is that targeted therapies will work more efficiently and effectively to eradicate the cancer and help prevent recurrence.  Researchers are also focusing on improving early disease detection and supporting individualized treatment strategies through the discovery of new biomarkers.

Dr. Harvey I. Pass, Chief of Thoracic Oncology at NYU Cancer Center and Chief of Thoracic Surgery ay NYU Langone Medical Center, sees the vast potential of blood tests to diagnose mesothelioma, particularly in earlier stages of the disease.  The blood tests could also be used to determine the best treatment options for particular patients based on specific characteristics of each individual’s disease state.

As a principal investigator for The North American Mesothelioma Consortium, one of the Biomarker Developmental Laboratories funded by the National Cancer Institute (NCI), Dr. Pass has devoted much of his research to identifying biomarkers in the blood that could lead to earlier mesothelioma diagnosis, as well as more personalized treatment protocols.  He and his team hope to identify blood-based biomarkers that can improve ease-of-use and predictive accuracy for diagnosing and treating mesothelioma and other lung cancers.

But before we discuss the role of biomarkers in mesothelioma diagnosis and treatment, let’s first understand what makes mesothelioma such a challenging disease to diagnose and treat.

Mesothelioma Symptoms Typically Manifest Later in Disease Progression

Seventy-five percent of mesothelioma cases are linked to asbestos exposure.

The time between first exposure and diagnosis is typically 20 to 50 years.  At the point when most mesotheliomas are discovered, patients are already in the later stages of the disease and manifesting symptoms such as chest pain, coughing and shortness of breath.

When malignant plural mesothelioma patients start to show symptoms such as difficulty breathing, the disease is typically already in Stage III or IV. At that point, the disease has likely spread to other areas of the body such as the lymph nodes, diaphragm muscle, heart tissue and other areas.  Patients may show mild symptoms at Stage II, but they are usually difficult to link to mesothelioma and may even be mistaken for the flu.  Unfortunately, the typical prognosis for patients – especially over the age of 45 – is relatively low.

Not surprisingly, the earlier mesothelioma can be detected, the better the outlook for patients.  Unfortunately, less than ten percent of mesotheliomas are found in Phase I of the disease.

Early Mesothelioma Diagnosis Remains a Challenge

Early diagnosis of malignant plural mesothelioma remains challenging particularly because patients do not typically show specific symptoms in the early stages of the disease.

For people who have knowingly been exposed to asbestos, some doctors recommend regular x-rays or CT scans to look for changes in the lungs that could be indicative of mesothelioma or lung cancer.  However, it is not clear how effective imaging is at detecting of these diseases, nor is ongoing imaging a cost-effective, long-term solution.

Doctors also use biopsies for diagnosing malignant plural mesothelioma; however, biopsies are invasive and usually performed in the later stages of the disease after the patient has already begun to show symptoms.

Researchers believe they can find less invasive, more personalized and more cost-effective methods for diagnosing mesothelioma earlier and more precisely.  Some current research is seeking to identify diagnosticbiomarkers in blood or fluid that can provide information about whether someone who has been exposed to asbestos has developed mesothelioma.

What is a Biomarker?

Generally speaking, in medical practice, a biomarker is something in the body or related to the body that can be objectively measured and evaluated to provide information about a patient’s biological processes.  Some of the most widely used biomarkers include pulse and blood pressure measurements, as well as blood tests.

As they relate to mesothelioma, biomarkers typically refer to levels of particular proteins in tissue, fluid or blood that are expressed by specific genes.  Elevated or low levels of certain biomarkers could indicate the presence of mesothelioma.

Current Mesothelioma Biomarkers Lack Sensitivity and Specificity

Biomarkersare currently used in the diagnosis and treatment of mesothelioma but, presently, they are inadequate at consistently and accurately identifying mesothelioma cancer.For example, a protein called mesothelin is a highly-studied biomarker used in the diagnosis of mesothelioma and other cancers.  Elevated levels of mesothelin indicate the presence of cancer. But the test for mesothelin has low sensitivity, which means that it is unable to detect mesothelioma in some people who have the disease.

Similarly, other biomarkers lack specificity, which means that they are unable to consistently distinguish between people who do have mesothelioma and those who do not, resulting in false-positives.

Research Reveals Promising Biomarkers for Mesothelioma

In the search for more sensitive and specific biomarkers that can help diagnose mesothelioma earlier and contribute tomore personalized treatment options, promising biomarkers continue to emerge.

Fibulin-3, which has been studied by Dr. Harvey Pass and his colleagues at New York University Langone Medical Center, is a biomarker found in blood plasma and lung fluid.  Their research conclusions, published in TheNew England Journal of Medicine,indicated a high predictive correlation between high fibulin-3 levels and the presence of malignant pleural mesothelioma.

Although further study is needed before definitive and actionable conclusions may be drawn, these findings hint at an early detection method that could distinguish between healthy people who have been exposed to asbestos and those who have developed mesothelioma.  An added benefit of this type of biomarker is that the information can be gleaned from a simple blood test.

Researchers in Japan have published positive findings in Journal of Clinical Gastroenterologyabout HMGB1, another diagnostic biomarker that can be measured by a blood test.  The team found that patients with diffuse malignant peritoneal mesothelioma had significantly higher levels of HMGB1 than those who had also been exposed to asbestos but did not develop the disease.

Not only are these promising new mesothelioma biomarkers potentially more sensitive and specific, they can also be measured through a simple blood test rather than an invasive tissue or fluid biopsy or expensive and unreliable imaging.

BiomarkersCan Help Identify Optimal Treatment Protocols for Specific Patients

Even if doctors are able to use blood-borne biomarkers to diagnose mesothelioma earlier, they still face the challenge of treating the disease.  Typically, radiation, chemotherapy and/or surgery are used to treat malignant plural mesothelioma. But the cancer is highly resistant to both radiation and chemotherapy.  In addition, surgery is highly-invasive and physically taxing and may not be appropriate for patients who are elderly or whose cancer has spread.

Currently, it is difficult to know in advance which patients will respond best to particular treatments or drugs.  Researchers hope that they will be able to identify biomarkers that will not only help with early diagnosis but will provide insight into which treatment options will be most effective for individual patients.

As researchers, such as those involved with the NCI’s Biomarker Developmental Laboratories, continue to identify cancer biomarkers, we can expect to see an increasing number of studies seeking to validate the specificity and sensitivity of promising biomarkers.  The studies will take time, but the promise of robust blood-borne biomarkers that will help doctors diagnose and treat mesothelioma appear to the on the horizon.

Good Nutrition with Mesothelioma

Good nutrition with mesothelioma is an important part of fighting mesothelioma. There is a lot of conflicting advice on what foods are best to eat, so our nursing liaisons have developed a few key guidelines to use when choosing foods to.

  1. Focus on whole foods — Eat meat, vegetables, nuts, seeds, and some fruit. It’s best to eat fresh foods: avoid processed foods and sugar. If all you can do is avoid sugar, please try it: you will notice a difference! If you really want chocolate, eat chocolate with a higher percentage of cacao. Read the label: chocolate should have a high percentage of cacao and a short ingredient list. That way you will get some nutritional benefit from the chocolate.
  2. Avoid pesticides on vegetables and fruits — If you can, buy organic produce because it has not been sprayed with pesticides. If you cannot afford to buy all of your produce organic, at least make sure to buy these foods organic:
    • Peaches
    • Apples
    • Bell peppers
    • Celery
    • Nectarines
    • Strawberries
    • Cherries
    • Pears
    • Grapes
    • Spinach
    • Lettuce
    • Potatoes

    These foods are the “dirty dozen” most contaminated types of produce because of the way they are farmed. If money is an issue, buy the “clean fifteen” foods from the non-organic section:

    • Onions
    • Sweet corn
    • Pineapples
    • Avocados
    • Cabbage
    • Sweet peas
    • Asparagus
    • Mango
    • Eggplant
    • Kiwi
    • Cantaloupe
    • Sweet potatoes
    • Grapefruit
    • Watermelon
    • Mushrooms

    Any fresh produce is better than none, so if money is an issue buy the “clean fifteen” from the non-organic section.

  3. Choose grass fed beef over grain fed beef — If you can, buy grass fed beef. It is more expensive, but the nutritional content is different. Grass fed beef is higher in omega-3 and omega-6, which help fight cancer and grow hair, respectively. Grass fed beef is also lower in fat than grain fed beef. EatWild.com and the USDA website are good resources for finding grass-fed beef near you.

Remember that when it comes to good nutrition, there are no shortcuts. There is no one food that will make you suddenly healthy: the key to a nutritious diet is eating a variety of fresh, nutritious foods and building good habits. Eating well will not cure your cancer alone, but a good diet will help you have a higher quality of life and a better chance of fighting cancer successfully.

Cancer Nutrition Clinical Trials

If you are interested in helping scientists and doctors better understand cancer & nutrition, there are several on Cancer.gov dealing with cancer nutrition clinical trials and symptom control in advanced cancer.

  • Ketogenic Diet in Advanced Cancer
    The purpose of the study is to determine the safety and tolerability of a modified low carbohydrate diet, determine if quality of life is improved and to determine if there is any effect on progression free survival (PFS) and overall survival (OS) of subjects enrolled in the study.

Dr. Jocelyn Tan
Veterans Affairs Medical Center
Pittsburgh, PA

  • Ginseng on Cancer-Related Fatigue
    The goal of this clinical research study is to learn if panax ginseng (commonly called ginseng) can help to control fatigue and other symptoms such as depression, anxiety, and mood changes in patients with cancer. The safety of ginseng will also be studied.


Dr. Sriram Yennurajalingam, M.D.
M.D. Anderson Cancer Center
University of Texas

  • Megestrol Acetate with or without Mirtazapine in Treating Cancer Patients with Weight Loss or Loss of AppetiteThis randomized phase II trial studies the efficacy of megestrol acetate given with or without mirtazapine in treating cancer patients with weight loss and loss of appetite. To date, no pharmacologic interventions have been approved by FDA to treat cancer anorexia- cachexia syndrome (CACS). Megestrol acetate has been shown to increase appetite in cancer patients. Adding mirtazapine may provide a much more effective treatment and help improve quality of life.Dr. Saiama Waqar M.D.
    Siteman Cancer Center at Barnes — Jewish Hospital
    Saint Louis, MO

Asbestos & Lung Cancer

Most people associate asbestos exposure only to mesothelioma. However, asbestos exposure in conjunction with smoking is much more likely to cause lung cancer than mesothelioma. In other words, individuals who have been exposed to asbestos are statistically more likely to develop a lung cancer rather than mesothelioma.

Overall, lung cancer is much more common than mesothelioma. In fact, lung cancer is the leading cause of cancer deaths in the United States. Lung cancer kills more men in this country than any other cancer. Lung cancer kills more women than breast, ovarian and cervical cancers combined.

Read more

February 2013 Mesothelioma Conference Schedule Update

It is important that we continue education and support for those affected by mesothelioma and because of our goals feel it is extremely important that we continue our presence within the mesothelioma community. The following is a list of mesothelioma conferences that MesoCare will be taking part in.

MAR 7-8 Las Vegas, Nevada “All In” for a Cure! Aria Resort
Meso Foundation 2013 Symposium: Mesothelioma Applied Research Foundation
MAR 22-24 Arlington, Virginia “The Asbestos Crisis: New Trends in Prevention and Treatment.” Crystal Gateway Marriott
Asbestos Disease Awareness Conference (ADAO)
APR 6-10 Washington, DC “Personalized Cancer Care Through Discovery Science” Walter E Washington Convention Center
American Association for Cancer Research


Mesothelioma Research Updates

An important key factor in the treatment and prevention of mesothelioma is the continued research about this deadly disease. Here are some highlights in ongoing research studies being conducted by external sources within the mesothelioma community.

The Ambler Asbestos Factory

Dr. Fran Berg and his team from the University of Pennsylvania School of Medicine have received a grant from the National Institute of Health to study the people that live in the area around an old asbestos factory in Ambler, Pennsylvania. The Ambler Boiler House operated for nearly a century before closing in the 1970′s. The study will document the impact of asbestos on the community and the future of the site, which has been decontaminated, renovated, and turned into office space. The project will also educate Ambler residents about the potential health effects of asbestos and use their findings on the Ambler community’s experiences to create educational materials for the residents of other communities near toxic industrial sites.

Mesothelioma Diagnosis: PET Scans

PET scans have been a controversial topic in the workup of mesothelioma patients. A recent study from Japan suggests that Positive Emission Tomography using a radioactive tracer may be the most effective imaging technique for determining mesothelioma prognosis and diagnosis. Along with the radioactive tracer molecule 18-fluorodeoxyglucose (FDG) the PET scan detects changes in metabolic activity. The PET scan is used in conjunction with CT scans, clinical picture, and history of asbestos exposure to diagnose mesothelioma.

Mesothelioma Diagnosis: Fibulin-3

Dr. Harvey Pass of New York University’s Langone Medical Center reported in an article in the New England Journal of Medicine that detection of Fibulin-3 levels in pleural fluids could help to detect mesothelioma earlier. Fibulin 3 is an extracellular glycoprotein frequently associated with vascular and elastic tissues that is overexpressed in people with mesothelioma. Dr. Pass and team hope to benefit mesothelioma patients by discovering the disease earlier when treatment can be more effective.

Mesothelioma Discoveries: GSK2256098 and FAK

Professor Jean-Charles Soria M.D., professor of Medicine and Medical Oncology at South Paris University is conducting a trial of a new drug named GSK2256098. GSK2256098 helps limit the activity of an enzyme in cancer cells called focal adhesion kinase (FAK). When FAK level is increased mesothelioma cells become invasive and spread. GSK2256098 suppresses the activity of FAK and decreases cell invasion. The drug was effective in patients lacking the suppressor gene NF2. This gene produces a protein called merlin. When both NF2 and merlin activity are restored, FAK activity goes down and cancer cells stop spreading.

Drug Trials: EPH-B4

Dr. Parkash Gill, from the University of Southern California Comprehensive Cancer Center announced that the cancer fighting drug EPH-B4 is available to patients who meet criteria for treatment. EphB4- specific antibodies have interfered with blood vessel formation and reduced the size of tumors in animal experiments. Hopes are high that this will be effective in human mesothelioma victims and EPH-B4 has been submitted for a phase 1 clinical trial.