In a nondescript hub of offices and labs at the QEII Medical Centre in Perth, 30 of the world’s best researchers are unlocking the dark secrets of malignant mesothelioma.
 The disease is a fatal cancer that affects the lining of the lungs, the abdominal cavity or the heart.

It is almost always caused by exposure to asbestos and encroaches by stealth upon the body so symptoms don’t appear until the cancer is well-advanced. There is no cure and even the best treatments, surgery and chemotherapy, can extend lives by, at most, a year. The researchers based at the National Centre for Asbestos-Related Diseases are working to combat the cancer on several fronts, chasing earlier and more accurate diagnosis, better treatments and – the Holy Grail for cancer scientists – a vaccine against the disease.

Research into causes

The director of NCARD Professor Bruce Robinson cuts to the heart of the main question puzzling researchers into mesothelioma:

“Why is it that one person gets mesothelioma and the person next to him who breathed in asbestos at the same time doesn’t?” To find answers, NCARD must go back to the building blocks of the body.

The Genetic Understanding of Asbestos-Related Disorders (GUARD) project will create a large-scale DNA bank for mesothelioma and other asbestos-related diseases, linking WA cohorts with others from around Australia.

Vital to this work is data from the landmark Wittenoom cohort studies, which have followed the people who lived and worked in the asbestos-mining town of Wittenoom in the north of WA.

“If you find the gene that can tell you why asbestos causes cancer, you could block it or use (other) gene-therapy tricks to fight it,” Professor Robinson said.

Diagnostic research

Led by Professor Robinson, the research team has already found a more successful way of diagnosing the disease. In 2004, the researchers developed a blood test that measures the blood concentration of a “marker” for the disease – soluble mesothelian-related (or SMR) protein. The test is now used all over the world and won Professor Robinson the international Wagner Medal for mesothelioma research.
“The test has been a real winner,” Professor Robinson said. “But we’re trying to develop an even better one. SMRP can detect some people early, but it’s only one in every six. And, hopefully, if the disease is discovered early, it could be cured early.”

Research into Treatments

Chemo-immunotherapy 
Professor Robinson and his team are undertaking several promising clinical trials into chemo-immunotherapy, where traditional chemotherapy is combined with meticulously timed treatments to boost the body’s immune response.

“The immune system puts up a very weak fight against cancer,” Professor Robinson said. “One of the reasons for this is that cancer disguises itself. We are working on a bunch of tricks to change that.”

To have this once-controversial strategy accepted by the medical establishment has been a challenge, says NCARD team leader Richard Lake.
“The dogma has been that receiving chemo is not a good time to receive immunotherapy, but there has been a change in attitude over the past decade,” Professor Richard Lake said. “The basic response has moved from, ‘You are idiots – chemo kills the immune response’, to ‘There might be something in this idea’, to ‘Of course, we knew that it would work all along’.”

NCARD researcher Anna Nowak’s work in this area has been recognised internationally with the International Mesothelioma Interest Group New Investigator Award in 2002 and several other local and national awards.

Professor Robinson points out that chemo-immunotherapy is “not a simple bit of science”.

Researchers must monitor the “incredibly intricate dynamic” that is the immune system, boosting, targeting and, of course, halting the immune response at the right time.

Cancer cream
Other experiments involve using existing treatments in new ways. In another world-first, NCARD is undertaking human clinical trials of a skin cancer cream called Imiquimod to treat mesothelioma. Researchers found that the cream killed advanced mesothelioma when injected into tumours in combination with a drug called anti-CD40.

According to NCARD team leader Professor Richard Lake “We’ve made a strategic decision to work with drugs that are already available,” Prof Lake said. “This has obvious benefits in that we can verify their safety and perhaps fast-track any potential treatments.”

A vaccine for meso?
The research done by NCARD in relation to genetics and the immune system could pave the way towards the development of a vaccine which in future might help people to fight mesothelioma. According to Professor Bruce Robinson.

“A vaccine that you can give somebody who already has mesothelioma is really helping the immune system to do its job,” he said.“We have made discoveries that are relevant to this and it’s an easier task than getting a vaccine to thousands of people because only a small percentage (of them) may be susceptible to mesothelioma.”

Professor Lake is optimistic about NCARD’s chances.

“When you look at what has happened in the research of other cancers, things have got better. Look at Ian Frazer’s success with his creation of a vaccine against the virus that can lead to cervical cancer. It is magnificent. And although cervical cancer is virally caused and mesothelioma is not, we know in our own models that a vaccine is possible. I think we are reaching a tipping point in which major breakthroughs are going to be possible.”

Visit the NCARD website.