Searching for a cureRichard Archer is a lifelong Ragland resident who worked 12 years at its Cement Asbestos Products Co. plant in the 1960s and ‘70s. He and the hundreds of Northeast Alabama men who worked at Capco are among the 27.5 million American workers exposed to asbestos between 1940 and 1979.
But asbestos disease takes anywhere from 10 to 50 years to finish its attack on a life. Those who molded it, breathed it, in the 1960s and ’70s are getting sick now.
As the epidemic grows, lawsuits embroil industry heads, insurers, legislators and trial lawyers who are debating a way to compensate its victims.
What’s missing from that chore, argue patients and doctors, is the search for a cure.
As of 2004, $70 billion has been paid on some 730,000 asbestos personal-injury claims, according to the Rand Institute for Civil Justice.
About $1 million a year goes to research mesothelioma treatments, according to the Mesothelioma Applied Research Foundation (MARF), which studied National Cancer Institute figures and conducted an informal poll of researchers.
"It doesn’t make any sense," said MARF Executive Director Chris Hahn. "It’s contrary to the American spirit of optimism. We’re going to talk about the next 28 years of people getting sick and all we’re going to do is set aside money. Why not take some of that money and try to prevent these people from dying in the first place?"
A stealthy killer
When an asbestos fiber hits the lung, the body’s immune system kicks in as scavenger, macrophage cells attempt to destroy the invader.
Some fibers move inside the lung, creating a scarring process called asbestosis, a fatal prelude to lung cancer and mesothelioma.
Mesothelioma starts in the lining of the internal organs, most often the chest cavity near the lungs. The pleura, a layer of tissue that encloses the chest cavity, is normally thin and flexible like plastic wrap.
Mesothelioma can turn that layer into a case two inches thick, constricting the lung in a steady, painful squeeze. The cancer often spreads to the lung, diaphragm and pericardium, the sac around the heart.
While there is no system of reporting cases of asbestos-caused lung cancer, federal morbidity statistics show that asbestosis and mesothelioma deaths steadily have been increasing for decades.
The 2002 Work-Related Lung Disease Surveillance Report from the National Institute of Occupational Safety and Health said asbestosis deaths had increased from fewer than 100 annually in 1968 to 1,500 in 2002, according to the National Center for Health Statistics.
The report’s authors note that those numbers likely are low, because many cases are misdiagnosed and many death certificates are incomplete. This is supported by a steep annual rise in asbestosis hospitalizations in the report, from 300 in 1970 to 20,000 in 2000.
Mesothelioma deaths also have increased steadily over the past 20 years, with 699 deaths a year in 1980, 2,485 in 1999 and 2,573 in 2002, according to NCHS.
For 1.3 million workers in the construction industry, asbestos is still a hazard — but exposure isn’t limited to people on the job.
As many as 100 million Americans have been exposed to asbestos, according to American Academy of Actuaries, an association of insurance statisticians.
In the mid-1970s, more than 3,000 consumer and industrial products contained asbestos. The fibers still are used in products such as brake pads and remain in the attic insulation of 30 million American homes, according to an Environmental Working Group report.
Asbestosis affects people with prolonged asbestos exposure, and the severity of a case relates directly to how long someone was exposed. But mesothelioma is more random, affecting only 10 percent of those heavily exposed.
It also affects people with lesser exposures.
In Ragland, a man who worked two summers at Capco has had a lung removed because of mesothelioma. A man who worked there just two weeks died of it.
"There is no known safe minimum of asbestos exposure, so theoretically one can get it from breathing in one fiber once," MARF’s Hahn said.
The death sentence
Two Christmases have come and gone since Pat Archer was told her husband wouldn’t celebrate another. The Archers make a point of calling that surgeon’s office to wish the staff a Merry Christmas.
"When you’re diagnosed, they tell you you’re going to die," she said.
Mesothelioma is so rare that an oncologist might see one case in a whole career.
For years, there were no successful treatments. The best a doctor could do was use a needle to drain the fluid that pressed against the patient’s lungs. Doctors would tell patients to take a cruise when they were diagnosed.
Nowadays, patients come back to that oncologist’s office having researched treatments on the Internet and often knowing more than the doctor. Dr. Robert Cameron, a thoracic surgical oncologist at University of California-Los Angeles Medical School, said patients should get second and third opinions and they should go to large academic institutions specializing in treating the disease.
After her husband’s diagnosis, Pat Archer got online and read everything she could find. When she stumbled across the Mesothelioma Applied Research Foundation, she called its executive director.
She told Hahn that her husband was in a late stage of mesothelioma and the doctors said there was nothing they could do.
"It’s funny, because he’s not feeling that bad," she recalls saying at the time.
Hahn, knowing that mesothelioma is excruciating in the late stages, referred the Archers to Dr. Dan Miller, surgical director of the thoracic oncology program at Emory University.
Surgically, there was nothing that could be done for Archer, because the cancer had spread to his lymph node. Miller said only 25 percent of patients are candidates for surgery. In most cases, by the time they’re diagnosed, the cancer has spread too much.
A mesothelioma operation often removes the lining and lung. Cameron’s approach has been to remove the tumors and leave the lung intact.
Followed by chemotherapy and radiation, both types of surgery have had successful results. Mesothelioma patients have a life expectancy of eight to 12 months after diagnosis. On average, Cameron’s patients’ life expectancies double after surgery, and he’s had some live more than seven or eight years.
But, he said results for his and the more-radical surgeries are misleading because surgeons identify only the best patients as candidates. Those individuals would have lived longer anyway.
Randy Henderson, who worked two summers at Capco when he was 21 and 22, has mesothelioma at age 52. In December, Dr. Robert Cerfolio at University of Alabama Hospital at Birmingham — the same thoracic surgeon who cut Richard Archer open — removed Henderson’s left lung, the lining around his left lung and heart, and reconfigured his diaphragm.
After the surgery, a CAT scan revealed no traces of cancer.
Henderson is about to complete his ninth week of chemotherapy on a new drug, Alimpta.
Then it’s on to six weeks of radiation. After that, he says, sounding out of breath, he should be through.
"I’m going to live," Henderson said. "Half those guys at Capco have not."
Richard Archer’s former coworker and next-door neighbor, Hugh Lane, was diagnosed with mesothelioma in 1999.
He and his wife, Darlene, went from University Hospital to M.D. Anderson Cancer Center in Houston and were given the same option: surgery removing a lung, its lining and lining around the heart. They were told he might not survive the 12- to 14-hour operation. If he did make it, his quality of life would be diminished.
"Surgical resection of his mesothelioma would be a very aggressive technique …" read an assessment by Birmingham Dr. James Barton. "Radiation therapy is generally not helpful … Chemotherapy is relatively ineffective in many cases."
Lane decided against surgery, but went ahead with chemotherapy.
His wife watched him deteriorate rapidly when the treatments started. She thinks they may have killed him faster, or at least made him sicker in his last days than he had to be.
"Somebody who never sat still, who was busy all the time, got to where they couldn’t get up to walk to the bathroom by themselves," she said.
He died Oct. 5, 2000.
An autopsy performed the next day showed the tumor in the lining of one lung had spread into his lungs, his diaphragm, his chest wall and his pectoral muscles.
 |
| Dr. Fadlo Khuri checks Richard Archer’s lungs as fellow physician, Dr. Abeer Abou Yabis, looks on at Emory Hospital in Atlanta. Photo: Stephen Gross/The Anniston Star |
The research growsA year before Archer’s failed surgery, Dr. Nicholas Vogelzang in May 2002 shared the results of the largest mesothelioma clinical trial ever at the American Society of Clinical Oncologists annual meeting.
The study involving 448 patients and 114 investigators in 19 countries showed that a new chemotherapy drug, Alimpta, in combination with another chemotherapy drug, Cisplatin, showed a 41 percent tumor response rate and improved survival and lung function.
Patients who took Alimpta lived a year after diagnosis, nearly three months longer than patients who took only Cisplatin.
It wasn’t a cure. It wasn’t even a satisfactory treatment, but experts said it was a breakthrough.
"After years and years during which everybody was saying that the mesothelioma tumor is unique and resists all forms of chemotherapy, we now have evidence that Alimpta chemotherapy in 40 percent of cases will cause the tumor to shrink," Hahn said.
"Lo and behold, mesothelioma is susceptible to chemo."
Waiting for news
"So you’re on Alimpta and you’re tolerating that fine?" nurse Terry Gregerson asks Archer upon entering Khuri’s exam room.
"And you’re all done with treatments?"
"I don’t know," Archer answered. "That’s what the scan and blood work was for. He was going to see if he could let me off for three months."
Archer had a CAT scan more than a month ago for which he’s yet to receive results. The scan, combined with his blood work from this morning, will tell him if he’s getting better, and if he gets to take a break from chemotherapy.
His wife would usually be by his side, but today she had to stay home because his mother is sick. After hearing he was going to die, exploring every option to no avail, and deciding he didn’t want to put himself through chemotherapy, it’s hard for Archer to remember how he got to the position he’s in today. He suspects his wife’s tenacity had a lot to do with it.
"This says your CT scan had improved," Gregerson says, pointing to a computer screen. "They measured soft tissue density, between the lung and the lung lining, and it was 4.5 (centimeters) and current density is 1.4. That’s pretty good. I would assume that you’re going to get your wish."
Archer is still rigid, hands folded in his lap, lips in a perfect line.
It sounds like good news, but he wants to hear what Khuri says.
The nurse leaves and in walks an oncologist Archer hasn’t met before, Dr. Abeer Abou Yabis.
Between questions about how he’s feeling — good except for shortness of breath and spells of nausea — the doctor mentions his results.
His scan showed improvement. They’re going to give him a three-month break from treatment to let his body recover.
Still, Archer sits expressionless, back straight, hands in lap, lips tight.
More living to do
He knows the odds are against him.
Only half of mesothelioma patients respond to the drug. In others, the tumor stops responding.
Alimpta stops tumors from growing by suppressing the two enzymes that cells use to copy their DNA so they can divide and grow.
The reasons it fails, researchers suspect, is a third enzyme that works like a backup system to catalyze DNA synthesis.
"If we could use a different drug to block that pathway, we might be able to give the tumor a knockout blow," Hahn said.
The most promising prospect for sustained life is still early detection.
A new biomarker, the Serum Mesothelin Related Protein, can distinguish mesothelioma from other malignancies and communicate whether tumors are shrinking or growing. That means a simple blood or urine test could be developed to detect the cancer.
Such a test would allow exposed populations, like those in Ragland, to be monitored and diagnosed long before a tumor shows up.
"The implications of this are huge," Hahn said. "It brings an incredible amount of optimism."
Researchers also are investigating immunotherapy treatments. "Killer" T-Cells normally recognize and destroy the cells of a growing tumor, but they are not properly activated in mesothelioma patients.
In mice, a protein (CD40 Ligand) has eradicated mesothelioma by stimulating the immune cells.
 |
| Archer is overcome with emotion as Dr. Khuri gives him good news concerning his chemotherapy treatment. Photo: Stephen Gross/The Anniston Star |
‘I never thought we’d be this far along ...’The research possibilities, though critical to the next generation of mesothelioma cases, provide little comfort to Archer as he waits this day for the final word on his prognosis.
In walks Khuri.
Good news, he says.
Since starting chemotherapy, Archer’s cancer has been reduced to less than one-third of its thickness, a dramatic response for mesothelioma. The doctor asks if he’s told his wife yet.
"No, she told me to call her as soon as I get out of here."
Khuri asks Archer to take deep breaths and briefly taps and feels his back and chest. His report:
"So far so good, you couldn’t ask for any better than this. Your vacation from chemo continues. Come back in just about three months. Let’s plan for mid-late June."
Archer, still shirtless from his examination, extends his hand.
"I appreciate you," Archer says, barely audible. He’s smiling, face flushed and eyes wet.
"Hey, I appreciate you, too. You’re doing great."
"I never thought we’d be this far along a year ago," Archer says.
"If I didn’t think we’d be this far along, if I didn’t think there was a chance, we wouldn’t have put you through the chemo," his doctor replies.
"You got a good heart and you tried and you tried ... ," Archer says, crying. "You trust the Lord, too. The Lord does it all. He works through you, and I just appreciate you."
"Likewise, you give Mrs. Archer my prayers," Khuri adds with a pat on his patient’s back. "You’re doing wonderful. You take care of yourself."
The doctor, about to head out the door, takes a good look at his patient’s teary smile, and stops to hug the man who just learned he’s not done living, not yet.
"It’s OK to be happy, you know."
"Yeah," Archer says. "It sure is."
