Gendicine works by combining the p53 gene, which is a tumor suppressant, with a utility virus. When the Gendicine virus is then injected into the cancerous tumor, the virus inserts the p53 gene into the cancer cells. Once the p53 gene is in the cancer cells, it causes them to self destruct. Clinical trials have shown a 64% success rate in this therapy combined with radiation therapy…. (more…)
(Re)insurers will welcome recent clarification in the long-running pleural plaques and Employers’ Liability ‘Trigger Litigation’ cases.
The House of Lords’ decision in Rothwell v Chemical and Insulating Company Limited and Others (2007) that pleural plaques did not constitute compensatable damage stands following the recent announcement by the Ministry of Justice. This article considers the announcement along with the developments in the Employers’ Liability Trigger Litigation.
The issue of whether pleural plaques should be compensatable has been debated heavily during the past two years. Insurers and the public have been able to witness how different the Scottish and UK governments are in their approach to the problem. In the last week of February 2010, the Ministry of Justice issued a statement clarifying the UK Government’s intentions on pleural plaques, which highlights such difference. Insurers will welcome this latest, and perhaps final, instalment in the long-running saga as to whether pleural plaques are compensatable, in the rest of the UK, at least. In Scotland, the position is currently very different.
The House of Lords, in Rothwell, decided that the existence of pleural plaques did not constitute compensatable damage. The Scottish parliament legislated to overturn this ruling and made pleural plaques a condition capable of constituting actionable and compensatable damage. The Damages (Asbestos-Related Conditions) Scotland Act 2009 is now law, notwithstanding resistance from insurers, who challenged the Act by judicial review. In January 2010, Lord Emslie in the Court of Session in Edinburgh rejected the insurers’ case. However, that decision is being appealed, and it may yet end up before the Supreme Court in London.
Government Response to the Rothwell Decision
Following Rothwell, the UK Government published a consultation paper seeking views on a number of options, including whether to overturn the House of Lords’ judgment or to establish a compensation regime based on a ‘no-fault’ basis. However, the Ministry of Justice confirmed on 25 February 2010 that “on the basis of medical evidence received during the course of this review, including authoritative reports from the Chief Medical Officer and the Industrial Injuries Advisory Council, we are unable to conclude that the Law Lords’ decision should be overturned at this time or that an open-ended no full compensation scheme should be set up.”… (more…)
A new addition to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines™), the NCCN Guidelines for Malignant Pleural Mesothelioma (MPM), was presented at the NCCN 15th Annual Conference. Lee M. Krug, MD of Memorial Sloan-Kettering Cancer Center and a member of the NCCN Guidelines Panel discussed recommended treatment options for patients with MPM as well as first-line therapy regimens.
Mesothelioma is a rare form of cancer in which malignant cells are found in the mesothelium, a protective sac that covers most of the body’s internal organs. Pleural mesothelioma refers to the thoracic-based form of the disease, the most common type of mesothelioma.
Although asbestos exposure is a major risk factor for mesothelioma, it can remain latent for more than 20 years and may require a predisposition to the disease. In addition, it can also occur in individuals that previously experienced radiation exposure (e.g. treatment for Hodgkin’s lymphoma).
Dr. Krug noted that, “Diagnosing mesothelioma is often difficult, because the symptoms are similar to those of a number of other conditions. In addition, a physician’s initial evaluation of a patient may reveal pleural effusion, but it can often be missed on pleural fluid cytology.”
Common symptoms of mesothelioma are shortness or breath or chest pain among others including tumor fevers, sweats, weight loss, and pneumonia.
A surgical biopsy is often required to effectively diagnose a patient with mesothelioma according to Dr. Krug. PET scans can aid in staging as well, detecting unexpected metastases in 10 percent of cases.
Prognostic factors include gender, lymph node status, and histology, but Dr. Krug also pointed to other potential markers that may be indicative of the disease.
“Serum markers may also have prognostic significance as studies show that patients with mesothelioma have higher levels of Soluble Mesothelin-Relation Protein (SMRP) and Osteopontin,” said Dr. Krug.
Like any cancer, treatment for mesothelioma depends on many factors including the stage of the cancer, where the cancer is, and how far the cancer has spread. Dr. Krug described treatments such as surgery, chemotherapy, and radiation that may benefit patients as described in the NCCN Guidelines for MPM.
Surgical procedures for MPM can range from a pleurectomy/decortication for those patients with early stage disease to more aggressive procedures, such as extrapleural pneumonectomy. Extrapleural pneumonectomy includes the removal of pleura, the lung, diaphragm, and pericardium, but can result in major complications and should only be performed by experienced surgeons.
“The role of aggressive surgery remains controversial,” said Dr. Krug. “As outlined in the Principles for Surgical Resection for Malignant Pleural Mesothelioma in the NCCN Guidelines, physicians need to be highly selective when choosing potential candidates for this procedure.”
Surgery alone can be inadequate due to residual disease and a high rate of relapse, so the NCCN Guidelines recommend a combined modality therapy approach for select patients noted Dr. Krug.
The NCCN Guidelines consist of a section detailing the Principles of Radiation Therapy for MPM that stress the need for a multimodality approach including evaluation of the patient by radiation oncologists, surgeons, medical oncologists, diagnostic imaging specialists, and pulmonologists.
“Radiation is recommended as an adjuvant therapy to improve local control after surgery, and it is also an effective palliative treatment for relief of chest pain that is often associated with mesothelioma,” said Dr. Krug…. …. (more…)
