2008-04 - Mesothelioma UK update

MARS (Mesothelioma and Radical Surgery) is a multi-centre randomised controlled trial comparing extra-pleural pneumonectomy (EPP) (within the context of tri-modality therapy) versus no EPP. The trial is sponsored by Guy’s and St.Thomas’ NHS Foundation Trust and is currently in the feasibility phase aiming to randomise 50 patients. This will allow reasonable inferences to be drawn regarding recruitment, compliance and feasibility of surgery.

At diagnosis, and following consent, potential MARS patients are registered into the pilot study from one of 14 local participating centres. Patients are then prescribed 3 courses of a platinum based chemotherapy and undergo mediastinoscopy. Following re-staging patients are then reviewed by a virtual multi-disciplinary team (vMDT) comprising members of the Trial Management Group and includes the Chief Investigator (Tom Treasure), at least one surgeon, radiologists, oncologists and members of coordinating trial team within the Clinical Trials and Statistics Unit at the Institute of Cancer Research (ICR-CTSU). The patient’s clinician from the local centre is also invited to join in the discussion.

Following evaluation of suitability for surgery and radical radiotherapy, eligible patients are asked to consent to randomisation. If the patient is allocated EPP this will be performed at one of three specialist surgical centres (currently Guy’s, Leicester or Leeds) and will be dependent upon geographical location (where possible) but also on surgeon availability. Further surgical centres are at present proceeding with approvals which will provide patients with wider availability across the UK.

It is expected that patients who have had EPP surgery will also undergo radical radiotherapy, provided at a separate radiotherapy centre if the local centre is unable to provide this service.

The pilot phase has taken considerably longer than expected to set up, given the need to establish complex logistical and clinical arrangements. Recruitment is now steadily increasing and Cancer Research UK have extended the funding to the Autumn of 2008 by which time recruitment must be complete.

By mid April 2008 ninety-seven patients had been recruited to the registration phase and forty randomised. Centres are therefore urged to screen all mesothelioma patients for entry into MARS to help achieve the target accrual by September 2008. The next phase of conducting a mesothelioma surgical trial will then be considered at a general meeting to which all those involved will be invited.

We are very grateful to all clinicians and research nurses for their hard work in helping with this very important trial and our sincere thanks go to the patients who have kindly agreed to take part.

If you would like any further information please contact The MARS Trial Office via email mars-icrctsu@icr.ac.uk or one of the team on 020 8722 4057/4039.

MALCS

MALCS (UK National Mesothelioma and Lung Cancer Study) was set up over 6 years ago to estimate the Mesothelioma and lung cancer risks caused by specific occupations and work practices across the UK, particularly those involving asbestos exposure. A report based on the first 624 Mesothelioma patients and 1420 controls has been submitted for publication. The well known asbestos exposure hazards in dockyards, on ships, in asbestos factories, in power generation and in insulation still account for 25% of all Mesothelioma cases; but the majority of cases are in construction or other industries.

Part 1 Results

The lifetime Mesothelioma risk for British men born between 1940 and 1960 who did more than 10 years of relevant work before age 30 will be about 6% for carpenters and 2% for plumbers, electricians and painters, with lower but still substantial risks to general construction and other workers exposed to asbestos. The lifetime risk in unexposed men and women (about 0.1%) is doubled in those who lived with an exposed worker before age 30. There was no overall risk in men and women who reported living within a mile of an asbestos factory, shipyard or power plant. The excess of lung cancer in “asbestos exposed workers” appears to be similar to the Mesothelioma risk.

Are you Recruiting?

MALCS is open until 2015. The patient completes a postal questionnaire (not a telephone interview as in part 1). Britain already has the highest Mesothelioma rate worldwide and the rate is still increasing 25 years after asbestos use virtually ceased. Funded by Cancer Research UK and HSE recruitment to MALCS continues. We need to document the origins and evolution of this extraordinary public health disaster. In addition, recruiting lung cancer patients enables further assessment of the relationship between asbestos and lung cancer.

Please notify the MALCS study team of the following patients:

Male Mesothelioma patients born since 1940 Male primary lung cancer patients born since 1940 who have had a lung resection
Female Mesothelioma patients born since 1925

For more information contact the study team by email: MALCS@icr.ac.uk or tel: 0208 722 4298.

Chemotherapy in Mesothelioma Project (ChiMP)

On 24th January 2008 the ChiMP project went to Dublin where it was presented by Liz Darlison to the BTOG members. The Project was received in a positive and enthusiastic manner and delegates were very keen to know more about the project. We had a stand in the main hall which generated a lot of interest and we gave over 30 registration starter packs and leaflets away. ChiMP registered over 20 sites that day which was fantastic for the project.

On the 1st February 2008 the ChiMP project was officially launched and the response was exceptional. In the first two months over 30 sites registered.

In the first week we had our first 3 patients registered from The Queens Hospital Burton, “Congratulations and well done to Burton”. The last 2 months have seen a steady increase in the number of patient registrations and enquiries and we now have sites with several patient registrations due to how user friendly the system is. I hope this will be encouraging for the sites yet to register their patients with us.

We are still looking for more Oncology centres to register, please ensure the Oncology centre you refer to is involved in the audit.

Where We Are Now?

We are now 3 months on since ChiMP was launched and are well on our way to achieving our aim to have all 158 Lung MDT sites throughout England registered with us. We haven’t quite achieved this target yet so if you haven’t registered to date please do so today.

Thank you for your support, we continually need your help to make this project a success.

Jill Lemon

Mesothelioma Audit Manager