Mesothelioma Awareness Day: Editor interview with Emanuela Felley-Bosco on translating mesothelioma research into clinical outcomes

As we gear up for Open Access Week next month, we would like to take a step back to recognize that open access to research is part of a much wider process of sharing research in the world. Our mission at PeerJ is to efficiently publish research findings and to cut down the cost and time it takes for scientific discovery and dissemination. But we also know that facilitating scientific discovery isn’t just about labs, citations, and getting the next funding grant – it supports the latest breakthroughs, directly and indirectly, impacting people’s lives.

Today, in parallel with Mesothelioma Awareness Day, we’ve teamed up with the Mesothelioma Cancer Alliance to provide a look at how mesothelioma research and advocacy go hand-in-hand. We interviewed PeerJ Academic Editor Emanuela Felley-Bosco about her research on chronic inflammation linked cancers and treating mesothelioma and below, the Mesothelioma Cancer Alliance share why access to rare cancer research is vital for their continued advocacy efforts.

Editor Interview with Emanuela Felley-Bosco

How did you first become interested in studying mesothelioma?

I trained as a pharmacologist and toxicologist and during my scientific career I have been focusing on chronic inflammation linked cancers. When I had the opportunity to work at Zurich University Hospital I used my expertise to contribute to the efforts done in this Institution to treat mesothelioma.

What can you tell us about the causes of this rare type of cancer?

Mesothelioma development has been associated with exposure to asbestos fibers since the Sixties when Dr. Chris Wagner made a seminal epidemiological observation about the high incidence of this usually rare cancer in South Africa regions where asbestos was mined. His observation paved the way on mechanistic studies aimed at understanding how exposure to asbestos fibers may lead to cancer development. We know now that exposure to other fibers with physico-chemical properties similar to asbestos are also associated to increased risk of developing a mesothelioma. There are also genetic factors contributing to the disease.

Can you explain your work on the 11th hallmark of cancer?

Hallmarks of cancer concept were first proposed by Dr. Weinberg and Dr. Hanahan to highlight the different pathways that cancer cells use to expand. They include: self-sufficiency in growth signals, insensitivity to anti-growth signals, evading programmed cell death, limitless replicative potential, blood vessels generation, tissue invasion, and metastasis, deregulated metabolism, evading the immune system, genome instability, and inflammation. Recent studies have revealed an additional pathway involving modification of the way a gene is read (alternative splicing) and of the proteins binding to the DNA, resulting in altered control of gene expression. One of the gene frequently mutated in mesothelioma participates to the latter process and we aim at understanding how we can exploit this knowledge for the treatment of mesothelioma patients.

Why is translational research in thoracic malignancies so important for clinical outcomes? What is the hardest part in translating fundamental research into medical practices?

Translational research is important for clinical outcome because it allows addressing several aspects necessary for a better handling of the patients. Indeed, using samples from the patients we can obtain information on disease’s mechanisms, markers for early diagnosis, response to treatment. Using experimental models, including some established from tumor themselves like primary mesothelioma cultures, we can understand mechanisms at the molecular levels, allowing testing the effect of new drugs.

The hardest part in translating fundamental research into clinical practice is that it takes time to accomplish all steps necessary for proceeding from an experimental observation to a clinical application. In addition in the treatment of rare cancer it is best to work within large consortia where diverse clinical centers can participate and this requires important coordination and communication efforts. Luckily there is a strong commitment from a large majority within the community of scientists/clinicians treating mesothelioma patients (, which renders studies feasible. An additional difficulty is derived from diagnosis still too often at late stages, when treatment is more difficult. Part of the community is heavily involved in investigating earlier detection strategies.

Is cancer research embracing more open practices and open access?

Data sharing and open access are mandatory in research projects financed from public money and this transparency increases the robustness of findings and follows the worldwide efforts of participative action where entire communities build up knowledge.

What challenges and developments can we expect to see for this field of research in the next few years?

One challenge in this field of research is to foster creative synergies between interdisciplinary scientists aimed at a comprehensive understanding of the difference between patients to implement the best treatment strategies. A recent development is immunotherapy, where patient’s own defense system is stimulated to fight his cancer. A further development includes a better understanding of the non-coding genome, which is likely to be involved in the 11th hallmark of cancer.

What kinds of lessons do you hope the public takes away from Mesothelioma Awareness Day?

Mesothelioma Awareness Day will make the public aware that although asbestos has been banned in several countries more than twenty years ago, mesothelioma incidence is still rising. Because other fibers with similar properties may lead to the same effects it is important to remain vigilant about potential human exposure. As with other rare diseases, it is important not to neglect its existence.

Connecting patients with the information they need has been a vital step to ensuring informed decisions and successful communication between physician and patient. Yet most patients cannot be presented with all the available options and emerging therapies for a variety of reasons. Lack of access, limited information or specific eligibility requirements to participate in clinical trials for advanced treatment options all pose barriers for patients to take full advantage of current cancer research and the subsequent findings. Unfortunately, those with rare diseases can often face all of these scenarios, and many patients are unable to fully explore and participate in the available options. Awareness and advocacy can help bridge the gap in research and available information, which can benefit researchers and patients with rare diseases.

Patients have a lot to benefit from cancer research, as the potential breakthroughs can directly impact their treatment and survival. Rare cancers, in particular, can be difficult to treat due to low rates of incidence, as well as the unique ways in which these cancers need to be treated. With an average of 3,000 people diagnosed each year in the United States, mesothelioma, a cancer caused by exposure to asbestos, is a perfect example of the difficulties of treating rare cancer. After exposure, this environmental cancer has a long latency period of 10-50 years before general symptoms start to show. Misdiagnoses are common, and all these factors together too often lead to patients receiving late-stage diagnoses. This aggressive cancer leaves patients an average life expectancy upon diagnosis of just 12-21 months.

Patients left with limited treatment options often look towards research and clinical trials for hope and potential ways forward in treatment. Advocacy organizations offering extensive information, support and the latest news in the space can help bridge the gap between research and patients. For example, with the discovery that the PDL-1 protein is shared by multiple cancers, including lung cancer and mesothelioma, patients have been able to benefit from participating in clinical trials and drug therapies targeting this protein. Researchers have also made advancements in diagnostic testing, which can be vital to early diagnosis and thus give patients better odds of successful treatment. From new blood tests in development for faster diagnosis to immunotherapy clinical trials paving the way for new treatment methods, advocacy organizations can help explain the science and results of these studies. Ultimately, this not only helps keep the patients better informed, but can provide hope.. Making ties and relaying what’s happening within their community is a way that advocacy groups can take research and translate it into findings and glean them into accessible takeaways for patients and families.

The Mesothelioma Cancer Alliance is an organization committed to providing information, resources, and support for those affected by mesothelioma.

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