1. What are the Latest Developments in Research and Treatment
related to Malignant Mesothelioma?
New research is consistently being undertaken in the field of
malignant mesothelioma. Research scientists are trying to identify
causes and ways to avoid mesothelioma. Doctors are trying to
achieve more accurate diagnosis and improve the effectiveness of
treatment. However, despite the recent developments, there is still
plenty that needs to be learnt about the effective ways of treating
these types of cancers.
Causes and prevention
A significant percentage of research studies on malignant
mesothelioma has focused primarily on finding out how exactly
asbestos alters mesothelial cells and modifies their DNA to cause
these types of cancers. Understanding how exactly these fibers lead
to cancer can help us devise better methods to prevent those
changes.
The link between asbestos and an increased risk of mesothelioma
is an explicit public health concern. Scientists are constantly
gathering more information about fibers that lead to cancer, how
exactly they cause cancer, and exposure levels that can be
considered safe. Since dangers of asbestos have been identified, it
is now possible to limit or prevent exposure in homes, workplace,
and public buildings. Unfortunately, some countries have less
stringent rules and regulations for protecting workers from
exposure to asbestos.
Research studies are also underway to study the role (if any) of the
SV40 virus, which has been associated with mesothelioma in
certain specific studies.
Treatment

2. Cancers such as mesothelioma are still difficult to treat, and
doctors are continuously making efforts to improve current
treatment approaches. The effectiveness of treatment options such
as surgery, radiation therapy and chemotherapy remains highly
debatable. Treatment approaches that rely on using a combination
of surgery, radiation therapy and chemotherapy, are referred to as
multimodality therapy. These are currently being studied and it is
possible that they may provide the most effective treatment option
for some patients.
Radiation therapy
Mesothelioma, in most cases, does not develop as a well-defined
tumor. As a result, doctors find it difficult to use radiation therapy
without affecting the neighboring healthy tissues. The use of
radiation therapy for treating mesothelioma has thus been limited.
Newer techniques of administering radiation, for instance,
intensity-modulated radiation therapy (IMRT) and three-
dimensional conformal radiation therapy (3DCRT) rely on
computers to accurately map tumors and deliver radiation at the
right spot. These new techniques have reduced side-effects,
allowing doctors to administer increased doses of radiation to the
affected area (body part).
Chemotherapy
There are some chemotherapy drugs that can shrink tumors or slow
down their growth. However, the effects usually last only for a
short period of time. Many new types of chemotherapy drugs, for
instance raltitrexed, are currently being used in clinical trials, along
with other treatment protocols.

3. Research is underway to identify how chemotherapy drugs can be
administered directly into the chest or abdominal cavity,
immediately after surgery. In certain cases, the drugs may be
heated before they are administered in order to increase their
effectiveness. Doctors assume that placing the drugs directly onto
the tumors increases their effectiveness and also reduces the side-
effects that they may have.
Photodynamic therapy
Another technique that is currently being studied is called
photodynamic therapy (PDT). In this treatment procedure, a light-
activated drug is administered into a vein. The drug then spreads
all throughout the body and collects inside cancer cells. After a few
days (generally immediately after surgery for mesothelioma), a
tube with a special red light on its end is positioned inside the chest
cavity. When the light comes in contact with the drug, it causes a
chemical reaction. This activates the drug, which kills the cancer
cells. This technique of administering drugs has limited side-
effects because the drug is active only in areas that are exposed to
the special red light. PDT is being tested and studied for the
treatment of mesothelioma in many of the ongoing clinical trials.
Targeted drugs
Generally, the effectiveness of chemotherapy drugs is limited
when it comes to treating advanced mesothelioma. With more
information now available on modifications in cells that lead to
cancer, researchers have been able to develop many new drugs that
have the ability to specifically target these changes. Referred to as
targeted drugs, these drugs work in a different manner in
comparison to standard chemotherapy drugs. Also, these usually
have different (and less serious) side-effects.

4. One specific group of targeted drugs is referred to as angiogenesis
inhibitors. They work by targeting the development of new blood
vessels (angiogenesis) that tumors need to grow. Among this
category, there are some drugs that are already being used for the
treatment of other types of cancer. These are now being studied to
assess their potential for mesothelioma treatment. A few examples
of these drugs would include bevacizumab (Avastin) and sorafenib
(Nexavar).
Other new drugs currently available use different approaches. For
instance, ranpirnase (Onconase) is an enzyme that targets RNA (a
part of the genetic material of a cell) and destroys cancer cells at
the right time. There is evidence (gathered from some early
studies) that these drugs have helped some mesothelioma patients
to live longer. Other larger clinical trials are being undertaken
currently.
Other types of targeted drugs currently being studied in
mesothelioma clinical trials include the following:
• Imatinib (Gleevec)
• Erlotinib (Tarceva)
• Dasatinib (Sprycel)
• Bortezomib (Velcade)
• Sunitinib (Sutent)
• Vorinostat (Zolinza)
Gene therapy
Gene therapy is one of the latest approaches being used in the
treatment of mesothelioma. This technique seeks to replace or
repair the defective genes present in cancerous cells. A particular
approach to gene therapy relies on special viruses which have
undergone modifications in the lab. The virus used in this

5. technique is introduced in the pleural space, thereby infecting the
mesothelioma cells. Once the infection happens, the virus
introduces the desired gene inside the cells. Gene therapy and
research related to it is still in its early stages.