In the May 2013 edition of The Lancet Oncology we find this article, “Mesothelioma: closer to the target?” (free registration required to access), by Harvey I. Pass, M.D., from the Department of Cardiothoracic Surgery, NYU Langone Medical Center.
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.
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