Recently, I learned about a team of researchers in Italy who are working on a new combination treatment that brings together vitamin C, the chemotherapy agent gemcitabine and EGCG, which is an antioxidant found in green tea.

On the surface of it, this may sound like a strange approach to treating mesothelioma. However, the paper, which was published in the journal PLOS ONE, suggests researchers found promising results.

Looking at the individual components
Before we get into the details of what the scientists did in the laboratory, it may help first to understand what components they were working with.

First, there’s the use of antioxidants. These are nutrients that help stabilize the destructive forces of free radicals, which are molecules that degrade the cells in your body, drive the aging process and increase the risk of cancer. Free radicals come from all over the environment: air pollution, ultraviolet radiation, unhealthy food – even the simple act of food metabolism in the body creates free radicals. However, antioxidants help neutralize the effects of free radicals.

Vitamin C, which is also known as ascorbate or ascorbic acid, is a popular example of an antioxidant. You consume this nutrient every time you eat any of a large variety of fruits and vegetables.

Green tea also has antioxidants, including EGCG, which belongs to a class of plant molecules known as polyphenols.

Usually, in the context of cancer care, antioxidants are discussed as a preventive measure. However, previous studies convinced the scientists from Italy that vitamin C and EGCG may actually be able to act directly against tumor cells. For their study, the researchers combined these two antioxidants with the chemotherapy drug gemcitabine. This medication interferes with cancer cells’ ability to replicate the DNA that they need to reproduce and grow, thereby curbing the growth of malignancies. Currently, doctors prescribe gemcitabine for diseases such as breast cancer, ovarian cancer, pancreatic cancer and non-small cell lung cancer.

Researchers test-drive their drug-antioxidant combo
The researchers’ goal for this study was to find a possible new treatment for mesothelioma, a disease that currently has no cure. In the laboratory, they combined vitamin C, EGCG and gemcitabine. They referred to this mixture as Active Nutrients/Drug, or AND. In order to test the effects of AND, the scientists created both cell models and rodent models of mesothelioma.

In the cell model, they observed that the individual components of AND seemed to work in a synergistic manner, with each active ingredient enhancing the effects of the others, causing the diseased cells to die.

In the mouse model, the researchers found that AND reduced the size of the animals’ tumors, decreased the number and size of metastases, and prevented abdominal bleeding.

“Here we show that a triple combined treatment based on EGCG, ascorbate and gemcitabine (AND therapy) reduces mesothelioma growth and metastasization,” the researchers wrote in PLOS ONE. “Due to the lack of side effects, we propose that this combined therapy should be evaluated in other preclinical and clinical models.”

Because this experiment was conducted using cell and animal models, it may be years before scientists evaluate the performance of AND in human clinical trials. Still, this study is important because it provides the foundation for a potential new way to tackle mesothelioma.

We at Kazan Law look forward to the future direction of this work.

There are several therapeutic approaches that doctors may take in order to treat malignant mesothelioma. Both chemotherapy and radiation are capable of killing diseased cells. Additionally, some patients may be eligible for surgery that can remove as much of the cancerous tissue as possible.

However, even with these treatments, patients who have mesothelioma are still at risk for medical complications if their disease metastasizes.

What is metastasis?

We understand cancer as a disease in which a group of cells within one piece of tissue in the body goes rogue and multiplies far beyond what is considered a normal, healthy rate. This leads to the growth of tumors, which can become deadly if they interfere with the function of the surrounding tissues.

Metastasis occurs when these malignant cells break off from the tumor, travel to another part of the body and produce another tumor. Experts from the American Cancer Society (ACS) describe this process as occurring through one of three pathways in the body: circulation through the lymph nodes, circulation through the blood vessels or along the surfaces that line the body’s cavities. Mesothelioma is one of the few cancers that can spread via the cavity linings.

The metastasis process takes place over four steps:

1. A group of tumor cells stops growing.
2. This group breaks away from the tumor.
3. The cells move out of the affected tissue and either enter one of the circulatory systems, or travels along the body cavity lining.
4. The cells settle in a new location and grow into a new tumor.

Metastasis is deadly in part because its symptoms can easily be mistaken for another health condition.

Metastasis can affect mesothelioma patients

When doctors need to determine how bad a case of mesothelioma is, one of factors that they measure is how far the cancerous cells have spread.

For example, the National Cancer Institute describes localized stage I mesothelioma as being confined to the lining of the chest wall, diaphragm or possibly the lung. However, in the advanced stages of the disease, cancer may spread beyond these tissues and affect the diaphragm and lungs themselves, as well as the lymph nodes, trachea, esophagus, fatty tissues, soft tissues, peritoneum, ribs, the sac that encapsulates the heart, or the heart itself. In some stage IV cases, the malignancy may travel even further and strike the spine, brain, prostate and thyroid.

Scientists are taking a closer look

In order to tackle metastasis more effectively, some scientists who study cancer have decided to make this specific phenomenon their niche.

“Fewer than 8 percent of researchers mention the word ‘metastasis’ in their grant applications, in the context of actually working on the problem…Figuring out how to prevent cancer – a key research focus today – would be the best approach…but that’s of little help to patients who already have cancer,” said Dan Welch, a member of the ACS Scientific Council, as quoted by the ACS. “To prevent something, you have to know its cause. We have no idea why cancer cells spread, let alone what prompts them to disseminate throughout the body.”

One possible key to understanding metastasis is the study of the tumor microenvironment in which breakaway cells settle. Scientists are also exploring the genes that are involved in metastasis, and why certain clusters of breakaway cells can remain dormant for decades before forming new tumors.

The Environmental Working Group projects the incidence of asbestos-related diseases to increase for another 10 years or so.  At Kazan Law, we are optimistic that scientists are on the right track to helping such cancer patients and truly understanding the cause of metastasis.

Individuals who have been diagnosed with malignant mesothelioma share certain things in common. Asbestos exposure was a likely cause of your condition. Respiratory difficulties are a prominent problem. If you were not aware that you were developing the disease until its symptoms manifested, you were probably diagnosed while the cancer was in its advanced stages.

With all these similarities, you would expect that all patients with your illness would respond the same way to the same treatments. Unfortunately, this is not true. Not all mesothelioma patients react equally to chemotherapy, radiation or surgery. One of the most important reasons for this is that the diseased tissues in patients may be genetically different.

At Kazan, McClain, Satterley, Lyons, Greenwood & Oberman, we keep track of the most promising advances in the medical field. One active area of scientific research, known as personalized medicine, is giving scientists hope that they can treat patients more effectively.

Personalized medicine is shifting the focus in cancer
Currently, most patients (and even some medical professionals) think of cancer in terms of the organ or tissue from which it originates. For example, people are familiar with prostate cancer, breast cancer, liver cancer, lung cancer and so on. They also think of leukemia as affecting the blood-forming cells of the bone marrow.

However, Edward Benz, Jr., M.D., the president of the Dana-Farber Cancer Institute, discussed new ways of thinking about malignant diseases in a blog post on the website for Stand Up To Cancer, an advocacy group that supports basic research. He noted that in recent years, scientists started understanding that tumors in individual patients, even when they are the same type of cancer, may have important differences that can impact the success of treatment.

For example, women who have breast cancer have diseased cells that may be classified according to the presence or absence of a cell receptor that responds to hormones and hormonal treatments.

Additionally, women can have certain mutations in specific genes that can make them more likely to develop breast cancer or other malignancies. Knowledge of these mutations can help doctors determine whether certain women need to be monitored more closely.

These approaches are part of what is known as personalized medicine, in which treatments can be tailored to patients at the individual level rather than with sweeping, broad strokes.

How can mesothelioma patients benefit from personalized medicine?
The reason why personalized medicine can be valuable for people with mesothelioma is that it can help doctors determine which therapeutic approaches may be the most appropriate for different patients.

For example, one team of scientists from around the U.S. released a study in 2004, which demonstrated how a panel of 27 genes helped doctors predict survival time among mesothelioma patients who underwent surgery.

By 2009, researchers from this team refined this approach further by predicting survival among surgical patients with the help of a four-gene expression ratio test.

“Patients whose gene ratio test results predict a good prognosis after surgery may more confidently select the treatment option that includes surgery,” Raphael Bueno, M.D., and his colleagues wrote in their study.

Knowing who to operate on could be important because such procedures are invasive and, if approached haphazardly, can actually hurt patients.

The search continues
While personalized medicine sounds promising for mesothelioma patients, this scientific advance is still relatively young.

“For all its promise, the field of cancer genomics is less than a decade old. The progress in mapping out cancer’s genetic variety, though substantial, is still at a relatively early stage,” Benz wrote in his blog. “As we fill in the map and develop a new taxonomy for cancer – a new system for distinguishing tumor types and subtypes – the advances promise to be enormous. But we are still learning how to use these powerful new tools. Much remains to be done.”

And we, along with our clients, can’t wait to see what comes next.

Related posts:

Mesothelioma Clinical Trials: What They Are, How They Work, How to Participate

Mesothelioma Treatment by Stage

Current Mesothelioma Treatment Research and Studies