Transarterial chemoperfusion shows promise for mesothelioma patients

A novel treatment for advanced mesothelioma is safe and effective and may improve the quality of life for patients who have few treatment options, according to a research abstract presented during a virtual session of the Society of Interventional Radiology's 2020 Annual Scientific Meeting on June 14. Transarterial chemoperfusion treatment for malignant pleural mesothelioma (MPM) comes with minimal side effects and shows promise for extending the lives of patients who have limited or no remaining treatment options.

"MPM is a devastating cancer of the pleura, the membranes surrounding the lungs, that is very difficult to treat," said Bela Kis, MD, PhD, the principal investigator on the study and an interventional radiologist at the Moffitt Cancer Center in Tampa. "The typical survival rate of patients with stage 3 and 4 MPM is around 12 months from diagnosis; but with this new treatment, we are hoping we might be able to extend patients' lives beyond that--giving them more time with friends and family."

Twenty-seven patients with MPM were enrolled in the Phase II clinical trial and underwent chemoperfusion treatment. All patients had received prior chemotherapy, many of whom received multiple lines of chemotherapy. Four of the patients had prior radiation therapy and three patients had pleurectomy. All continued to have disease progression before enrollment. 

Transarterial chemoperfusion delivers a relatively high concentration of drugs to diseased tissue in the lining of the lungs to maximize the treatment effect with limited side effects. Unlike other chemotherapy that is delivered intravenously and circulates through the entire body, interventional radiologists inject one-third of the chemotherapy cocktail of cisplatin, methotrexate, and gemcitabine directly into the internal mammary artery that supplies the pleura. The other two-thirds of the drugs are injected into the descending aorta, which reaches the intercostal vessels that also supply the pleura. The treatment is an outpatient procedure and typically lasts an hour, followed by a one-hour recovery.

The interim results of the study show 70.3 percent disease control rate and median overall survival rate of 8.5 months from the start of the chemoperfusion treatment. The treatment was well-tolerated by patients with a major complication rate of 1.4 percent. Most side effects were relatively minor, including mild nausea and chest pain.

"We were pleasantly surprised to find that this treatment doesn't come with the same side effects of traditional intravenous chemotherapy," said Kis. "To see these promising results with so few side effects means we are able to make a positive impact on quality of life for these patients."

Currently, surgery is the only truly effective treatment for MPM, but the disease must be diagnosed early. Unfortunately, only 10 to 20 percent of patients are candidates for surgery and often experience surgical complications. The researchers are looking to expand their study to other cancer centers with larger MPM patient populations, since the cancer is so rare. They also hope to add flexibility to the study to allow for increasing the dosage and changing the combination of medications for individual patients to determine whether either approach could further improve outcomes.

Additional information about the clinical trial is available at ClinicalTrials.gov, using the identifier NCT02611037

The research was originally scheduled to be presented in person at SIR's Annual Scientific Meeting, March 28-April 2, in Seattle before the meeting was canceled due to COVID-19 concerns. Visit sirmeeting.org for the latest information.

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Scientists discover new technique that shows how cancer cells grow

Researchers have observed how stem cell mutations quietly arise and spread throughout a widening field of the colon until they eventually predominate and become malignant. Using an innovative modelling system in mice, the researchers visually tagged  colon cancer mutations by causing stem cells to glow. Mutations found in colon cancer were then visualised in the animals, illuminating a sort of tournament-to-the-death underway in the intestine in which one or another mutation prevailed over the others to become the driving force of a malignancy.

Joshua Snyder, PhD, assistant professor in the Departments of Surgery and Cell Biology at Duke University, said: “This study provides new insight into the previously invisible process in which mutant precancerous stem cells spread throughout the colon and seed cancer.” The study was published in the journal of Nature Communications.

“Our technique sets a firm foundation for testing new therapies that interrupt this early, pre-malignant process. We hope to one day target and eliminate these stealth precancerous cells to prevent cancer,” Snyder said.

In this way, the researchers found key differences in how the intestinal habitats common to babies and adults grow pre-cancerous fields of mutant cells. At a critical period, new born babies are sensitive to the effects of mutations within intestinal stem cells.

This insidiously seeds large fields of premalignant mutated cells throughout the intestine — a process called field cancerization — that dramatically increases cancer risk. These fields of mutated cells can grow and spread for years without being detected by current screening technologies; often, they remain harmless, but under proper conditions, these can rapidly become cancerous later in adults.

The researchers also observed that some colon cancer mutations found in patients can lead to a striking increase in the fertility of the environment surrounding precancerous fields. Ultimately, this leads to the rapid spread of fields throughout the intestine, with lethal consequences. Certain common mutations that arise from external sources, such as an injury or an environmental exposure, could also disrupt the environment surrounding the stem cell and lead to the rapid growth and spread of precancerous fields.

These occurrences can be especially lethal in adults and occur much more rapidly than previously expected — as if dropping a match on a drought-stricken forest. “Field cancerisation has been suggested to be the defining event that initiates the process of cancer growth, including cancers of the breast, skin, and lung,” said Snyder.

“Our technique allows us to model how premalignant cells compete and expand within a field by simple fluorescent imaging, potentially leading to earlier diagnosis and treatment.”

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Foetus shows left-handed movements when mom is stressed

Foetuses are more likely to show left-handed movements in the womb when their mothers are stressed, according to a new research.

Researchers at Durham University and Lancaster University in the UK said their findings are an indicator that maternal stress could have a temporary effect on unborn babies.

However, the researchers emphasised that the study was not evidence that maternal stress led to fixed left-handedness in infants after birth.

Using 4D ultrasound scans, researchers observed 57 scans of 15 healthy foetuses, recording 342 facial touches.

The foetuses were scanned at four different stages between 24 and 36 weeks of pregnancy. Researchers also asked the mothers of these babies how much stress they had experienced in the four weeks between each of the scans.

The researchers found that the more stress mothers reported, the more frequently foetuses touched their faces with their left hands.

A significant number of touches by the foetuses of stressed mothers were done with their left, rather than right hands - therefore foetal touches of their own faces, indicated a left-handed tendency.

As right-handedness is more common in the general population, the researchers had expected to see more of a bias towards right-handed movements in the foetuses as they grew older.

The high percentage of left-handed behaviour, observed only when mothers reported being stressed, led them to conclude that maternal stress has an effect on the lateral behaviour of the babies they scanned.

"Our research suggests that stressed mothers have foetuses who touch their face relatively more with their left hand," said lead author Dr Nadja Reissland, in Durham University's Department of Psychology.

"This suggests maternal stress could be having on effect on the child's behaviour in the womb and highlights the importance of reducing maternal stress in pregnancy.

"Such measures may include increased emphasis on stopping stressful work early, the inclusion of relaxation classes in pre-natal care and involvement of the whole family in the pre-natal period.

"While we observed a higher degree of left-handed behaviour in the foetuses of stressed mothers than had been expected, we are not saying that maternal stress leads to a child becoming left-handed after birth, as there could be a number of reasons for this.

"The research does suggest, however, that a foetus can detect when a mother is stressed and that it responds to this stress," said Reissland.

The findings are published in the journal Laterality: Asymmetries of Body, Brain and Cognition.

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