For a decade, Dr. Raphael Bueno has worked to sequence mesothelioma tumors in order to identify mutations. He published his work in Nature Genetics and offered his findings to mesothelioma researchers and clinicians all over the world.
“We find that there are novel mutations and biological pathways that give us clues as to what target we might select for new drugs and some of those drugs already exist,” Bueno, one of the country’s top mesothelioma doctors, explained. “We just need to see if they work.”
Bueno, Chief of Thoracic Surgery at Brigham and Women’s Hospital in Boston, immerses himself daily in the battle to find new and improved treatments for the deadly disease.
The Importance of Personalized Treatment Plans
In an interview with the Mesothelioma Applied Research Foundation (MARF), Dr. Bueno shared his concern that current mesothelioma treatments serve too much as a “one size fits all” method. His desire is to tailor therapy to individual patients and their tumor characteristics.
“We are pushing more innovative biological drugs of various types and creating situations where we test the drug early on in the disease to identify which patient should get which drug,” Bueno said.
According to Bueno, most mesothelioma patients get the same treatment, unlike those diagnosed with other cancers. Bueno breaks that mold by offering his patients biological therapy for 2-6 weeks prior to standard treatment of surgery and/or chemotherapy.
Clinical Trials More Effective if Biomarkers Existed
By looking at the patients who did better than those who stayed the same or got worse, Bueno and his team can identify biomarkers that predict who will respond to which drug.
This has applications for mesothelioma clinical trials that usually show a 10-25% rate of positive response.
While this number is low when looking at the entire group who participated in the trial, if certain biomarkers were indicated, those responding well to the treatment would increase. Bueno said this strategy is employed with other cancers but not with mesothelioma trials currently.
Additionally, advanced work now exists on mesothelioma staging systems. Bueno and his team have developed a careful algorithm to predict how an individual would react to different therapies or surgery.
This algorithm is based on:
- Lymph node status
- Molecular testing
- Tumor volume
- Other parameters
Four to five stages of the cancer have been named with median survival rates from six months to 47-60 months. More precise staging will be helpful for any clinical trial.
“You are comparing apples to apples,” Bueno said. “Otherwise, it looks like nothing works and that’s not true. No one drug works for everyone.”
Bueno’s Research Should Aid in Approval of New Drugs
Mary Hersdorffer, executive director of MARF, applauds Bueno for his molecular analysis because in her words: “It will give you a leg to stand on when trying to get drugs approved.”
Bueno’s desire is to see every mesothelioma patient participate in a clinical trial. Because the disease is rare, there always exists a shortage of information on the disease.
Clinical Trials and Patients
The greater the number of patients who participate in clinical trials, the more advancement can develop in treatment and targeted drugs.
MARF seeks to increase clinical trial participation by helping patients get involved and even offering to pay for their transportation to get back and forth to the clinic where the trial is offered.
“Most hospitals are clueless about [mesothelioma] and the outcomes and complications,” Bueno said. “I keep seeing patients who got ignored or pushed around or sent around the block, and delaying therapy is huge in [mesothelioma] because of how fast it grows.”
Bueno urges patients to visit a mesothelioma cancer center that specializes in treating this deadly disease. Not suggesting his own, it is obvious that Bueno serves as a leader in mesothelioma research and the advancement of new and more effective treatments.