The 10 priorities for mesothelioma research

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Over the last year, we’ve been working as part of a James Lind Alliance initiative to find the most importantresearch priorities for mesothelioma, a form of lung cancer – and now I can share with you our top 10 unanswered questions.

 

Mesothelioma is most-often caused by breathing in asbestos dust. It can take decades for any symptoms to show, and sadly, the chances of long-term survival are currently very slim.
Around 2,500 people will be told they have it this year – and yet so far there’s been very little research into the best ways to diagnose, treat and support them.
It’s vital that the research we do now focuses on the things that will make the biggest, quickest improvements for people with the disease.

Working with the James Lind Alliance

We’ve been working as part of a group called the James Lind Alliance to discuss mesothelioma research. We helped oversee the process used to consult people living with the condition, their families and carers, and the health care professionals and researchers.
We had a major role in ensuring the work was carried out in a robust manner and everybody had to chance to have their say. Together we wanted to find the research questions that, when answered, will make the biggest difference to the way we diagnose and treat mesothelioma.
Last year Katherine Cowan, who led the project, wrote a great blog about the way we’ve worked together. Now, after a year of hard work, we’re ready to publish the results.

Top 10 mesothelioma research priorities

  1. Does boosting the immune system (using new agents such as PD-1 or PD-L1) improve response and survival rates for mesothelioma patients?
  2. Can individualised chemotherapy be given to mesothelioma patients based on predictive factors such as the type of mesothelioma they have?
  3. What is the best way to monitor patients with diffuse pleural thickening and a negative biopsy who are considered to have a high risk of developing mesothelioma (for example repeat biopsies, imaging, etc)?
  4. In mesothelioma patients, what is the best second line treatment (for example what chemotherapy drugs should be used if a cancer has recurred following first line chemotherapy, usually with cisplatin and pemetrexed)?
  5. Which is the most effective current treatment for ascites (excessive accumulation of fluid in the abdominal cavity) (for example Denver shunt, pleurex catheter, etc) in patients with peritoneal mesothelioma?
  6. What are the relative benefits of immediate standard chemotherapy compared to a watch and wait policy for mesothelioma patients?
  7. For mesothelioma patients, what is the best follow-up strategy post-treatment, to identify and treat emerging side effects and other problems?
  8. In mesothelioma, is there a role for intrapleural immunostimmulants (drugs designed to stimulate an anti-cancer immune response, such as corynebacterium parvum extract) in addition to any other treatment?
  9. Does an annual chest x-ray and/or CT scan and medical examination in high-risk occupations (for example carpenters, plumbers, electricians, shipyard workers) lead to earlier diagnosis of mesothelioma
  10. What, if any, are the benefits of pleurectomy (pleurectomy/decortication) compared to no surgery, and which mesothelioma patients might benefit?

See the full report for more details on the priorities and other unanswered questions discussed.

This list will inform the mesothelioma research community about the questions they should be trying to answer next. The National Institute of Health Research (NIHR), who funded the work, has also encouraged researchers to carry out research into these priority areas.
Mesothelioma is one of our research priorities. We will use the results of this project to help choose which research to fund in the future, aiming to answer some of the questions identified. Last month, 2 insurance companies – Aviva and Zurich –  agreed to donate a combined £1 million over 2 years to our mesothelioma research programme.
That means we can now fund an additional £1 million worth of extra ground-breaking research, of the kind we hope will one day discover new treatments or even a cure for mesothelioma.
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