Introduction: My name is Todd Armstrong. On February 24th, 1997, my Dad, Bill Armstrong, was diagnosed with malignant mesothelioma (M.M.). I wanted to try to help my dad find some treatment for this, so I started looking on the Internet. I found several treatments for M.M., most of which it seemed only hastened the disease. This essay focuses on the approach I found made the most sense to me, the one we eventually chose to try. It is called gene therapy. It sounded the best to me and my Dad because there were very few side effects and the treatment was very easy on the patient.

PROCEDURE: The process involves using a gene from a herpes virus which is genetically inserting into a cell. These gene-modified cells can bind to tumor cells and when these cells are exposed to an anti-herpes drug, such as ganciclovir, both the gene-modified cells and the attached tumor cells are killed. In this case, the mesothelioma tumor cells are the target for the gene-modified cells. A chest tube is placed into the area in the pleural cavity where there is room to administer the modified cells. This is done by making about a ¾" incision where various scans show there is room for the modified cells.

After the tumor is infected, ganciclovir is placed in the patient's bloodstream using a standard IV injection. This drug, I have been told, is a very low-end form of chemotherapy, without all the side effects of some of the nastier stuff, like cisplatin, cytoxin, etc. It only attacks the cells which have been infected with the gene. You know, the tumor. The patient then receives the ganciclovir periodically throughout a week in the protocol we enrolled into in New Orleans, Louisiana at LSU. Periodically, checkups (i.e. scans) are done. The first CAT scan is done at LSU. The follow up scans can be done remotely. That's the whole of it.

RESULTS: Most patients with M.M. have a grim prognosis. There have been several patients treated with gene-therapy who are not showing any signs of improvement or decline. One patient in particular was treated 25 months ago at the University of Pennsylvania. His tumor has recently been scanned and shows no signs of growing. From what I've read about this disease, this seams to me a major triumph in the fight against M.M.

WHERE: This treatment is being done in two places that I know about. The University of Pennsylvania in Philadelphia and the Louisiana State University Medical Center (LSUMC) in New Orleans. Both of the doctors are very easy to talk to and very much want to help you understand what's going on. My hat's off to both of them. Here are there names and email addresses:

Daniel H. Sterman, M.D.
University of Philadelphia
E-mail Address: sterman@mail.med.upenn.edu

Dr. Jay Kolls
Louisiana State University Medical Center
E-mail Address: jkolls@pop3.lsumc.edu

Differences in Philadelphia and New Orleans treatments: There are very few differences in the treatments offered in these two places. Here are the major differences that I know about:

1. UPENN uses a cold virus to implant the gene, while LSU uses irradiated ovarian cancer cells to deliver the package, so to speak.

2. At UPENN, the chest tube which is inserted in the patient remains in the patient for two days. At LSU, the chest tube remains in place for a full week. The chest tube stays in a week in the LSU trial so they can measure local ganciclovir levels in the pleural fluid as well as the immune cell numbers in the fluid during the treatment. Pleural fluid is fluid in the pleural cavity between the lung and the rib cage.

Todd Armstrong
silk@value.net

** POSTED DECEMBER 10, 1997 **