Mesothelioma

Cancer (Oncology)

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NewYork-Presbyterian Hospital recently established a Mesothelioma Center, unique in this area, to provide comprehensive diagnosis and treatment for this uncommon cancer. Mesothelioma originates in the membrane lining the abdominal cavity or the chest cavity, and is often seen in older patients who have been exposed to asbestos. Other causes, such as radiation and certain viruses, have sometimes been implicated.

Diagnostic Innovation

NewYork-Presbyterian Hospital offers patients the latest tools for the assessment of mesothelioma. This condition is diagnosed from biopsies of affected tissues (pleura or peritoneum) obtained surgically by thoracoscopy, thoracotomy, laparoscopy, or laparotomy. The tumor is imaged and staged by CAT scan or MRI and its metabolism assessed by newer methods of radioisotope or PET scanning. Using the latest "bench-to-beside" laboratory techniques, tumor tissue from a newly diagnosed mesothelioma patient is examined for its ability to grow outside the body, for patterns of gene expression, for tumor antigens potentially useful in constructing mesothelioma vaccines, and for sensitivity to selected chemotherapy drugs. These tests, many of which are not obtainable elsewhere, help to estimate the likelihood of effective curative or palliative therapy, and are often directly linked to treatment.

Therapeutic Excellence

Under the aegis of the Mesothelioma Center, more than 100 newly diagnosed patients with mesothelioma are cared for and followed each year from all over the country. (The total number of new cases in the U.S. is less than 3,000 per year). Most patients are seen or treated by a surgeon, medical oncologist, and radiotherapist during their course, as well as a highly specialized nursing staff and psychiatry liaison.

Experimental Therapies

Because mesotheliomas represent less than 1 percent of cancers and are infrequently seen in the practice of most community oncologists, finding the correct treatment can be very difficult. NewYork-Presbyterian Hospital's Mesothelioma Center offers patients access to the newest experimental treatments.

Peritoneal Mesothelioma
Over 50 patients with this rare disease have participated in our nationally recognized intensive multimodality treatment program, which involves debulking surgery, repeated intraperitoneal chemotherapy, second-look surgery, and whole abdominal radiation. This is a disease whose survival is traditionally 18 months or less from diagnosis. In our first clinical trial, the median survival has not yet been achieved (now over 68 months), and 37% of our patients are disease-free.

Pleural Mesothelioma
Our Center is among the leading US institutions that are evaluating new chemotherapy drugs, such as pemetrexed plus cisplatin, (currently the most effective, just recently FDA-approved drug combination), for advanced, inoperable mesothelioma; the combination of gemcitabine + cisplatin or oxaliplatin; and the amino acid analogue l-alanosine. For patients who are candidates for surgical treatment, we have implemented multimodal protocols for pre- and postoperative adjuvant chemotherapy in conjunction with surgical treatment and radiation therapy.

Whether the most up-to-date conventional or experimental plan of care is chosen, the goal of treatment is always the expeditious improvement of patient survival, symptoms, and quality of life.

Research

The Mesothelioma Center is very active in laboratory-based research in order to ensure that the newest concepts of cancer biology are used to design the most advanced investigative treatments.

Translational Studies

Our colleagues in Pulmonary Medicine and Pathology have accumulated genetic profiles from microdissected specimens of peritoneal mesothelioma tissue removed from our patients at surgery. These data will aid in diagnosis of difficult cases, and allow development of rational therapies. For example, they have discovered that 15% of mesothelioma patients who show a sarcomatoid pattern of growth and with an extremely poor prognosis (average survival 6 months or less) have a unique genetic profile that distinguishes them from the other 85% of patients; these patients also demonstrate unique biochemical features that can be used as targets for experimental drugs.

PreClinical Studies

Other preclinical studies include:

Microarray gene studies of primary and long-term cultured mesothelioma cells exposed to conventional chemotherapy drugs, hypomethylating agents, and tyrosine- kinase inhibitors
Genetic profiles of mesenchymal tumors sensitive or resistant to gemcitabine, cisplatin, and bortezomib chemotherapy
In collaboration with the Ludwig Institute for Cancer Research, discovery and definition of tumor-related peptide antigens detected in our patient material using Serex and related techniques, and the development of peptide and protein vaccines for immunotherapy.