While sobering in his assessment of the current state of the medical research concerning malignant mesothelioma, Dr. Pass points out a sensible way forward:

… Wieneke Buikhuisen and colleagues’ long awaited, superbly designed and executed switch maintenance trial with thalidomide is a landmark achievement in mesothelioma, despite the fact that it failed to show improvement in time to progression compared with best supportive care….

So what are the implications that no benefit was reported for yet another attempt to control the angiogenic pathway in mesothelioma? The outcome means that despite our greatest efforts to understand the biology of this disease, and to target promising pathways that seem to contribute to mesothelioma progression, we have no idea which of these pathways is most important, and specifically in which patients we should target that pathway…. Certainly logic would dictate that it is high time to use specific agents to hit specific targets in mesothelioma.

But do we have any reasonably specific targets for mesothelioma? Many of the ongoing trials, unlike thalidomide therapy, are based on targeting a molecule that seems to be specific to the disease….

There is no question that we need more randomised trials in mesothelioma to help us to discard useless therapies and pursue promising ones; however, we need to pick up the pace for all inclusive phase 2 ventures that have enough power not only to define promising efficacy to move to phase 3 but also to define molecular or biochemical reasons for this efficacy, as well as to validate more quantitative ways of recording responses…. Obviously, funding for these efforts is crucial, but without proper insightful and forward-looking trial planning, funding support will certainly be as difficult as improving survival for these patients.

For the sake of those patients, and the families of patients, with a malignant mesothelioma diagnosis, we hope “the incredibly small portfolio of efficacious treatment options in this disease” (Dr. Pass’ words; emphasis added) is made larger, sooner, by such well-guided research.

 Mesothelioma, Asbestos, and Legal Compensation: Basic Facts

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Essentially, this appellate court ruling states that the NCIC erred when determining which insurer was responsible for paying benefits to an asbestos claimant who had developed the asbestos cancer mesothelioma – as opposed asbestosis, which is chronic pulmonary fibrosis caused by prolonged and regular exposure to asbestos dust.

In this unpublished appellate opinion, Richardson v. PCS Phosphate Co., the NC Court of Appeals found that the Industrial Commission had incorrectly used the standard for asbestosis, instead of mesothelioma, cases when determining the plaintiff’s so-called “last injurious exposure”. This determination is critical in asbestos-related workers comp (WC) claims in North Carolina because it determines which employer and/or its insurance company is responsible for paying WC benefits to the worker or his family.

Specifically, this recent 2013 NC court ruling about the last injurious exposure standard held that the requirement in N.C.G.S. section 97-57 — a 30 day exposure to asbestos dust within seven (7) consecutive months — did not apply to mesothelioma cases but, rather, only to asbestosis cases in North Carolina.

For more information, see:

• NC Workers Compensation Asbestos Claim: How to Identify Which Company Is the Responsible Employer
• North Carolina Workers Compensation Asbestos Disease Claims Filing Deadline

 Mesothelioma, Asbestos, and Legal Compensation: Basic Facts

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From the Pittsburgh Post-Gazette article, “Pittsburgh Corning’s asbestos legal woes grinding on — Appeals, number of claimants keep Pittsburgh Corning’s asbestos bankruptcy grinding through the court system”:

The reorganization plan signed May 24 by U.S. Bankruptcy Court Judge Judith Fitzgerald clears the way for creation of $3.5 billion trust that will assume Pittsburgh Corning’s asbestos-related liabilities and pay out the claims. The two companies that own Pittsburgh Corning — PPG Industries and Corning Inc. — will contribute millions of dollars to the trust and eventually give up their stakes in the company….

More than 400,000 asbestos-related lawsuits named the company as a defendant. Pittsburgh Corning settled about 200,000 before it filed for Chapter 11 bankruptcy in 2000, saying the remaining cases could exhaust its assets….

Under the final plan proposed for Pittsburgh Corning, PPG would pay about $825 million to the trust through 2023 along with 1.4 million shares of PPG stock or the cash equivalent. Corning would pay $290 million for the next six years. Their insurers would kick in $1.7 billion.

As the approved bankruptcy plan stands now, the Pittsburgh Corning (PC) Asbestos Trust payments are expected to cover about 37 percent of their claims, i.e., the PC Trust would pay 37 cents-on-the-dollar of the full value of an asbestos disease claim, such as a mesothelioma case.

However, unfortunately, it is likely that insurance companies for Pittsburgh Corning will appeal before a U.S. District Court judge gives the PC Asbestos Trust plan final confirmation — meaning that the hundreds of thousands of asbestos claimants will have to wait even longer for payments, possibly into next year, 2014.

Meanwhile, while the legal wrangling continues, more asbestos workers with claims against Pittsburgh Corning — for exposure to PC’s Unibestos pipe insulation that was manufactured from 1964 to 1972, as one example — will die before they receive any payment to compensate them for their asbestos disease.

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The primary author of this relatively new mesothelioma medical journal article is David J. Sugarbaker, MD, of the Division of Thoracic Surgery at Brigham and Women’s Hospital, Harvard Medical School, in Boston.

This study, as seen below, shows the benefit of hyperthermic intraoperative cisplatin chemotherapy lavage in certain patients with malignant pleural mesothelioma.

From the Abstract for this 2013 mesothelioma treatment medical article:

Objective:  Local recurrence limits long-term survival in patients with malignant pleural mesothelioma. We investigated whether hyperthermic intraoperative cisplatin chemotherapy lavage affects the interval to recurrence and overall survival among patients with favorable prognostic factors.

Methods:  Using a preoperative risk assessment algorithm we had previously developed and validated, we retrospectively identified a cohort of patients treated with cytoreductive surgery from 2001 to 2009. The patients had epithelial histologic findings on biopsy and were characterized as having a low risk of early recurrence and death….

Results:  The cohort criteria identified 103 patients: 72 who received hyperthermic intraoperative cisplatin chemotherapy and 31 who did not….

Conclusions:  A favorable outcome and minimal incremental morbidity support the incorporation of hyperthermic intraoperative cisplatin chemotherapy into multimodality treatment strategies for patients with low-risk epithelial malignant pleural mesothelioma.

Be assured that when we learn of other possible medical advances as regards the treatment of mesothelioma, we will report them here on Asbestos HUB.

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This study is the subject of “Asbestos, Asbestosis, Smoking and Lung Cancer: New Findings from the North American Insulator Cohort”, which was published online in April 2013 by the American Journal of Respiratory and Critical Care Medicine medical journal

An April 12, 2013 report found at the ScienceDaily web site, “Asbestos Exposure, Asbestosis, and Smoking Combined Greatly Increase Lung Cancer Risk”, does a good job of summarizing this asbestos lung cancer study, as well as adding some commentary from the lead author.

As for the findings, from the April 2013 ScienceDaily report:

Among non-smokers, asbestos exposure increased the rate of dying from lung cancer 5.2-fold, while the combination of smoking and asbestos exposure increased the death rate more than 28-fold. Asbestosis increased the risk of developing lung cancer among asbestos-exposed subjects in both smokers and non-smokers, with the death rate from lung cancer increasing 36.8-fold among asbestos-exposed smokers with asbestosis.

Among insulators who quit smoking, lung cancer morality dropped in the 10 years following smoking cessation from 177 deaths per 10,000 among current smokers to 90 per 10,000 among those who quit. Lung cancer rates among insulators who had stopped smoking more than 30 years earlier were similar to those among insulators who had never smoked.

And here’s how the lead author described this new study’s findings, overall:

“The interactions between asbestos exposure, asbestosis and smoking, and their influence on lung cancer risk are incompletely understood,” said lead author Steven B. Markowitz, MD DrPH, professor of occupational and environmental medicine at the School of Earth & Environmental Sciences at Queens College in New York. “In our study of a large cohort of asbestos-exposed insulators and more than 50,000 non-exposed controls, we found that each individual risk factor was associated with increased risk of developing lung cancer, while the combination of two risk factors further increased the risk and the combination of all three risk factors increased the risk of developing lung cancer almost 37-fold.”

“Our study provides strong evidence that asbestos exposure causes lung cancer through multiple mechanisms,” said Dr. Markowitz. “Importantly, we also show that quitting smoking greatly reduces the increased lung cancer risk seen in this population.”

We will continue to watch the medical journals for study articles that focus on asbestosis, lung cancer, and mesothelioma.

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As background,  lung cancer has been shown to be caused by both tobacco smoke and asbestos exposure, as well as other carcinogens. Exposure to both tobacco smoke and asbestos greatly enhances that risk so that the total risk is greater than adding the individual effects (a toxicology effect called synergism). If asbestos exposure increases your chance of getting cancer by 5 times and smoking increases your chance of getting cancer by 12 times, then being exposed to both of them can increase your chances by 60 to 100 times.

From the Absract for this February 2013 Mutagenesis article, which was based on a French study:

Given the interest in defining biomarkers of asbestos exposure and to provide insights into asbestos-related and cell-specific mechanisms of neoplasia, the identification of gene alterations in asbestos-related cancers can help to a better understanding of exposure risk. To understand the aetiology of asbestos-induced malignancies and to increase our knowledge of mesothelial carcinogenesis, we compared genetic alterations in relevant cancer genes between lung cancer, induced by asbestos and tobacco smoke, and malignant pleural mesothelioma (MPM), a cancer related to asbestos, but not to tobacco smoke…. While genetic changes in [non-small cell lung cancer (NSCLC)] are dominated by the effects of tobacco smoke, the increase of transversions in TP53 gene is consistent with a synergistic effect of asbestos. These results may help to define cell-dependent mechanisms of action of asbestos and identify susceptibility factors to asbestos.

Lastly, we want you to know that there is evidence that quitting smoking will reduce the risk of lung cancer among people who have been exposed to asbestos dust, perhaps by as much as half after at least 5 years without smoking tobacco.

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On April 12, 2013 The Lancet Oncology medical journal published early online this article, “Thalidomide versus active supportive care for maintenance in patients with malignant mesothelioma after first-line chemotherapy (NVALT 5): an open-label, multicentre, randomised phase 3 study”.

From the Abstract of this new medical study article concerning malignant mesothelioma disease progression:

Background
Standard chemotherapy does not lead to long-term survival in patients with malignant pleural mesothelioma. Malignant pleural mesothelioma is strongly dependent on vasculature with high vessel counts and high concentrations of serum vascular growth factors. Thalidomide has shown antiangiogenic activity, and we hypothesised that its use in the maintenance setting could improve outcomes.

Methods
In this open-label, multicentre, randomised phase 3 study, eligible patients had proven malignant pleural or peritoneal mesothelioma and had received a minimum of four cycles of first-line treatment containing at least pemetrexed, with or without cisplatin or carboplatin, and had not progressed on this treatment…. Thalidomide was given for a maximum of 1 year or until unacceptable toxicity….

Interpretation
No benefit was noted in time to progression with the addition of thalidomide maintenance to first-line chemotherapy. Different treatment strategies are needed to improve outcomes in patients with malignant mesothelioma.

This study involved 222 patients during the time period May 2004 to December 2009.

We will continue to watch for medical developments concerning mesothelioma treatments.

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In effect, this House bill is a one-sided attempt to hurt asbestos victims by allowing the asbestos industry to delay and deny accountability so victims die before they are able to receive justice.

To learn how H.R. 982, the FACT Act of 2013, is a misguided piece of legislation, read this insightful piece:  “What “Lies” Beneath the Wall Street Journal Asbestos Article, Myths and Facts Exposed”.

Here are some important points that you may want to include in the email or letter which you send to your respective member of Congress in Washington:

• The dangers associated with asbestos exposure have been known since the early 1930s.
• Still the asbestos industry hid the facts, exposed workers and families, and now nearly 10,000 Americans are killed by asbestos diseases every year. This bill does not focus on banning asbestos nor does it look at ways to expedite asbestos cases.
• This bill, H.R. 982,  instead would require private asbestos bankruptcy trusts to publicly release extensive individual information about asbestos victims and slow down asbestos cases by allowing asbestos defendants to bury the trusts in information requests, no matter how unnecessary or irrelevant. This denies and delays justice for asbestos victims who do not have time on their side.
• Congress should focus on keeping Americans safe from asbestos exposure and not protecting corporations that deliberately exposed workers and consumers for decades. Oppose H.R. 982!

 Mesothelioma, Asbestos, and Legal Compensation: Basic Facts

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In North Carolina there is legislation being considered currently that offers immunity to Crown Cork & Seal (and possibly others) for asbestos liability it legally acquired when it bought another manufacturing company, Mundet Asbestos, back in 1963. In effect, this legislation, if it became law, would bailout an out-of-state corporation allowing it to escape responsibility for its business dealings and shift the burden of caring for people in North Carolina with asbestos-related diseases from the legally responsible corporate entity to the NC taxpayers.

North Carolina Senate Bill (SB) 429 filed by Sen. Harry Brown (R-Onslow) and NC House Bill (HB) 415 filed by Rep. Jacqueline Schaffer (R-Mecklenburg), Rep. John Blust (R-Guilford), and Rep. Tom Murry (R-Wake) were filed in late March 2013. These pieces of proposed legislation are identical and based on a model bill created by the American Legislative Exchange Council (ALEC) – Successor Asbestos-Related Liability Fairness Act — that 16 states have now passed and which gives virtual immunity to corporations that purchased an asbestos-making company in the past.

This proposed legislation recently filed in North Carolina — and  which has been made law in 16 other states, already — says that if one company purchased another company which had manufactured asbestos-containing products, the parent company is only liable to people who developed an asbestos disease or cancer like mesothelioma due to being exposed to that asbestos product up to the amount the parent paid for the acquired company.

This law would mean that companies like Crown, Cork and Seal (CC&S) would be immune from any and all future asbestos and mesothelioma lawsuits because CC&S has already paid out more in asbestos lawsuits than it paid for Mundet 50 years ago, back in 1963.

It is important to known that the dangers associated with asbestos exposure have been known since the early 1930s. Still the asbestos industry hid the facts, exposed workers and families, and now nearly 10,000 Americans are killed by asbestos diseases every year.

Essentially, CC&S bought an asbestos company and, rather than be stuck with Mundet’s legal liabilities pursuant to well-established tort law, CC&S wants to undo their bad business decision (in hindsight) and go to the state legislatures by means of ALEC to make this happen for them.

Not a bit surprising to me, at least, is the fact that Crown, Cork and Seal (CC&S) is a member of ALEC, according to Source Watch.

States where this asbestos lawsuit immunity law has passed thus far are Alabama, Arizona, Florida, Idaho, Indiana, Michigan, Mississippi, Ohio, Oklahoma, South Carolina, South Dakota, Nebraska, North Dakota ,Texas, Wyoming, and Utah.

As a North Carolina asbestos-mesothelioma attorney, I am opposed to NC SB 429 and NC HB 415 and I urge our state legislators in Raleigh to not join the states above that have the dubious distinction of having been led astray by the American Legislative Exchange Council (ALEC) and its Successor Asbestos-Related Liability Fairness Act.

In order to learn more about why this ALEC asbestos immunity legislation should be defeated in North Carolina, see this Lawyers.com article, “ALEC Puts the Screws to Asbestos Victims”. And thereafter, if you live in North Carolina or you have been affected by an asbestos disease or cancer like mesothelioma, you should contact one or more of the following NC legislators and voice your opposition to NC SB 429 and NC HB 415  – which may be good for ALEC and its corporate members like Crown Cork & Seas (CC&S) but is absolutely no good for the people of North Carolina.

Those North Carolina legislators who are being led astray by the American Legislative Exchange Council (ALEC) and its Successor Asbestos-Related Liability Fairness Act are:

Sen. Harry Brown (R-Onslow);

Rep. Jacqueline Schaffer (R-Mecklenburg);

Rep. John Blust (R-Guilford); and,

Rep. Tom Murry (R-Wake).

 Mesothelioma, Asbestos, and Legal Compensation: Basic Facts

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Cytoreduction surgery (CRS) with intraoperative or perioperative high-dose regional chemotherapy has been established as the preferred approach in selected patients.

Hyperthermic intraoperative peritoneal chemotherapy (HIPEC) is another treatment regimen for patients with peritoneal mesothelioma.

In this new medical study article, “Treatment Factors Associated With Long-Term Survival After Cytoreductive Surgery and Regional Chemotherapy for Patients With Malignant Peritoneal Mesothelioma”, we learn what factors affect survival rates for patients who underwent the CRS surgery and the HIPEC regimen.

From the Abstract:

Conclusion:  Operative CRS with HIPEC is associated with prolonged survival in patients with [malignant peritoneal mesothelioma (MPM)]. Factors associated with survival include age, complete or near complete gross tumor resection, histologic tumor grade, and HIPEC with cisplatin. Cisplatin (versus mitomycin-C) was independently associated with improved survival and demonstrates a salutary effect for HIPEC with cisplatin in the management of patients with [malignant peritoneal mesothelioma (MPM)].

“The median, actuarial overall survival was 38.4 months’, according to the authors of this article published online March 13, 2013 by the Surgery medical journal (Epub Ahead of Print).

When will continue to watch for new articles about mesothelioma survival and treatment options so that we can report significant findings to you here on Asbestos HUB.

If you know of any developments that we should be reporting on, please leave a Comment below or send me an email.

 Mesothelioma, Asbestos, and Legal Compensation: Basic Facts

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