Mesothelioma: Scientific clues for prevention, diagnosis, and therapy.

Mesothelioma affects mostly older individuals who have been occupationally exposed to asbestos. The global mesothelioma incidence and mortality rates are unknown, because data are not available from developing countries that continue to use large amounts of asbestos. The incidence rate of mesothelioma has decreased in Australia, the United States, and Western Europe, where the use of asbestos was banned or strictly regulated in the 1970s and 1980s, demonstrating the value of these preventive measures. However, in these same countries, the overall number of deaths from mesothelioma has not decreased as the size of the population and the percentage of old people have increased. Moreover, hotspots of mesothelioma may occur when carcinogenic fibers that are present in the environment are disturbed as rural areas are being developed. Novel immunohistochemical and molecular markers have improved the accuracy of diagnosis; however, about 14% (high-resource countries) to 50% (developing countries) of mesothelioma diagnoses are incorrect, resulting in inadequate treatment and complicating epidemiological studies. The discovery that germline BRCA1-asssociated protein 1 (BAP1) mutations cause mesothelioma and other cancers (BAP1 cancer syndrome) elucidated some of the key pathogenic mechanisms, and treatments targeting these molecular mechanisms and/or modulating the immune response are being tested. The role of surgery in pleural mesothelioma is controversial as it is difficult to predict who will benefit from aggressive management, even when local therapies are added to existing or novel systemic treatments. Treatment outcomes are improving, however, for peritoneal mesothelioma. Multidisciplinary international collaboration will be necessary to improve prevention, early detection, and treatment.

The Use of Radiation Therapy for the Treatment of Malignant Pleural Mesothelioma: Expert Opinion from the National Cancer Institute Thoracic Malignancy Steering Committee, International Association for the Study of Lung Cancer, and Mesothelioma Applied Research Foundation.

INTRODUCTION: Detailed guidelines regarding the use of radiation therapy for malignant pleural mesothelioma (MPM) are currently lacking because of the rarity of the disease, the wide spectrum of clinical presentations, and the paucity of high-level data on individual treatment approaches. METHODS: In March 2017, a multidisciplinary meeting of mesothelioma experts was cosponsored by the U.S. National Cancer Institute, International Association for the Study of Lung Cancer Research, and Mesothelioma Applied Research Foundation. Among the outcomes of this conference was the foundation of detailed, multidisciplinary consensus guidelines. RESULTS: Here we present consensus recommendations on the use of radiation therapy for MPM in three discrete scenarios: (1) hemithoracic radiation therapy to be used before or after extrapleural pneumonectomy; (2) hemithoracic radiation to be used as an adjuvant to lung-sparing procedures (i.e., without pneumonectomy); and (3) palliative radiation therapy for focal symptoms caused by the disease. We discuss appropriate simulation techniques, treatment volumes, dose fractionation regimens, and normal tissue constraints. We also assess the role of particle beam therapy, specifically, proton beam therapy, for MPM. CONCLUSION: The recommendations provided in this consensus statement should serve as important guidelines for developing future clinical trials of treatment approaches for MPM.

Competitive Funding Strategies for the Conquer Cancer Foundation of ASCO.

PURPOSE: The Conquer Cancer Foundation (CCF), the philanthropic arm of ASCO, is responsible for funding innovative clinical research. CCF wants to broaden its donor base instead of relying predominantly on health-care companies. Our Leadership Development Program (LDP) group was tasked with identifying potential donor sources and making recommendations to increase funding. MATERIALS AND METHODS: We selected three sources to research: the general public, crowdsourcing/social media, and ASCO members. We subsequently focused our efforts on ASCO members, of whom only 2% to 3% are donors to CCF and < 8% are repeat donors. To analyze this low rate, we sent out two separate surveys to various groups of members within ASCO. RESULTS: We identified lack of knowledge as a major deterrent to giving; surprisingly, even those who hold ASCO leadership positions or participated in committees lacked knowledge about CCF funding. Also, the misconception that ASCO is rich and does not need philanthropic support deterred giving; however, respondents would donate if given the right message that stresses the need of continued member-led donations. CONCLUSION: ASCO members, including those in leadership positions, need to be engaged more aggressively to support CCF. Increased education and updating the CCF message is likely to provide the greatest impact on higher member donation, repeated donations, and facilitate CCF's goal of diversifying its donor base away from healthcare companies. Furthermore, we recommend using technology, such as mobile applications, and providing incentives and visibility to major donors.