Friday saw our catch up meeting with the Guy’s consultant, to confirm the official end of the tremi trial and that we didn’t want to be involved in any follow up scans etc. After the meeting we managed to go out for lunch, which was the first time since early January to be out together in a social sense. The rest of our year has been dominated by hospitals and hospices.
Although better than a couple of week ago, there are still long periods of fatigue and pain, which without the morphine is harder to control. However, the opiods have such a devastating effect on his will to live that they are very much a drug of last resort.
Whilst he has gained back 2kgs of weight , the overall loss means all sorts of bumps and lumps are now visible. They aren’t all meso , but some of them probably are which is both scary and yet another unwelcome new element. The full focus is now on whether a suitable trial is out there, ideally involving Keytruda or equivalent. There is nothing coming up at Guy’s or UCLH, so we have now been referred to the Marsden. Fingers crossed something becomes available soon ( we may even bump in to Ray and Mavis in the waiting room).
Several blisters later , a friend and I completed Maggies Culture Crawl on Friday. Thankfully it didn’t rain, although I can confirm that 12 miles is my definite limit- the last three miles were really hard going. The walk started in Paternoster Square and ended in Covent Garden around 2.00am, having gone via various sites such as Tate Britain, Brompton Cemetery, V& A etc. A full cultural tour of central London, including the delights of Leicester Square at 1.30am!! Not somewhere I intend returning. You know you have got to a certain age, when you keep thinking gosh those girls must be cold. totally forgetting that you probably wore just as little at age 20.
The weekend was perfect for recovery, with a full sports agenda. We managed to fit in some gardening in the good weather. All the old bedding plants are out – waiting for some new winter colour to be added.
The wasp nest in the airbrick is due to be killed off shortly – which will hopefully stop the wasp expeditionary force from continuing to make excursions into the wardrobe cupboard.
The other good news is that fatigue is far better since he has reduced the chloramphenamine- he is now down to 2 a day and the itching is still under control. He has gone back on the amyltriptoleine which has helped control the pain so he is getting a better night’s sleep. Fingers crossed this new drug regime delivers a better balance.
A growing number of studies have pointed to the value of unconventional treatments like immunotherapy for mesothelioma.Immunotherapy refers to any treatment protocol which aims to harness the body’s own immune system to fight cancer cells. In a recent article in The Lancet Oncology, two National Cancer Institute researchers summarized some of the most promising immunotherapy approaches now being investigated for mesothelioma:
In dendritic cell-based immunotherapy, dendritic cells are harvested from the patient. Outside the body, these cells are stimulated to activate a cytotoxic response against cancer cells. When they are returned to the body – usually by attaching them to an inactivated virus – the dendritic cells stimulate an immune response against tumor cells (such as mesothelioma) that produce a particular kind of antigen. The cancer vaccine Provenge is an example of dendritic cell-based immunotherapy.
Listera-based cancer vaccines use a live bacterium (Listeria) to carry tumor-specific antigens into cells. The Listeria virus produces certain chemicals that allow it to escape detection in the body until it is inside the target cells, making in a good vector for delivering anti-cancer antigens.
Other vaccines being tested against mesothelioma include allogeneic tumor cell vaccines, which use specially treated cells removed from the mesothelioma tumor itself and returned to the patient and WT1 analogue peptide vaccines. WT1 analogue peptide vaccines seek out certain chemicals that are overexpressed in cancer cells and have been shown to induce T cell immune responses in patients with mesothelioma and non-small cell lung cancer.
As always it is promising to see this research is underway- just need to hang on in there long enough.
Immunotherapy involves manipulating the immune system to fight disease. Some types of cancer, including mesothelioma, take hold in the body in part by ‘shutting down’ the natural immunotoxins, or cell killers, that would normally attack them. Now, scientists are working with a number of molecules designed to jump start the immune system and help it recognize, target, and even ‘remember’ invading mesothelioma cancer cells.
Using a mouse model of mesothelioma, Harvard researchers investigated the roles of three factors effecting immunity: regulatory T-cells, intratumoural transforming growth factor (TGF)-â and cytotoxic T lymphocyte-associated antigen-4 (CTLA4). The researchers then treated the mesothelioma with a combination of monoclonal antibodies and a TGF-â soluble receptor, specifically designed to target these three immune system factors.
With this ‘triple treatment’, the team reports, not only did the tumors clear up long term, but the cancer-killing immune cells appeared to retain a memory of the mesothelioma tumor cells that would prepare them to ward off future invasion. The report goes on to suggest that clinical application of immunotherapies against mesothelioma “may be improved by simultaneously targeting multiple mechanisms of immune suppression”.
Another recent study of the regulatory T-cells, for example, suggests that their manipulation may be a way to improve the effectiveness of chemotherapy for mesothelioma.
I think there are already TGF trials underway in this country, so progress is being made. It does look as though this line of treatment is where there is currently greatest focus so lets hope results come through sooner rather than later.