To mark Mesothelioma Awareness Day, Imperial College London’s National Centre for Mesothelioma Research describes its research into the condition.

Mesothelioma Awareness Day in the US takes place annually on 26 September and the aim of the movement is to bring more attention and funding to this cancer.

We sat down with Dr Maija Maskuniitty, the NCMR Centre Manager to find out more about the condition and how research at the Centre is contributing to better treatments as well as earlier diagnosis of mesothelioma.

What is mesothelioma?

Mesothelioma is a cancer that most commonly affects the lining – called the mesothelium – of the lungs, and less commonly of the abdomen. The cancer is aggressive, often producing great pain in the chest wall. To make things worse, mesothelioma responds poorly to all therapies, including surgery. Consequently, the average survival from diagnosis is less than a year. That is why research into new treatments and new diagnostic tools is vital.

What causes mesothelioma?

In the vast majority of cases mesothelioma is caused by past exposure to asbestos. Asbestos is a naturally occurring mineral which was used widely in insulation and fireproofing, for example, in ships, steam engines, power stations, and also extensively in public buildings after World War 2 until 1980. In the UK a total ban of all asbestos import and use was not implemented until 1999 – and many buildings still contain asbestos.

Read Professor Sir Tony Newman Taylor’s new blog post: The Asbestos Story: a tale of public health and politics

What is the scale of the problem?

The UK has the highest known incidence of mesothelioma in the world, primarily now due to unrecognised widespread exposures to asbestos in the construction industry up to about 1980, as well as our legacy of a large shipbuilding industry. This aggressive form of cancer causes some 2,500 deaths a year in the UK, and it is estimated that there will be 50,000 to 60,000 new cases by 2050. Mesothelioma deaths in the UK are expected to reach a peak around 2020 – that’s about 20 years after all use of asbestos was banned in the UK. This is due to the long latency period of mesothelioma – it can take up to several decades from asbestos exposure to development of mesothelioma. Asbestos exposure also has a similarly high risk of causing lung cancer, leading to an estimated further 2,500 deaths each year. Lung cancer itself is the major cause of cancer death in the UK.

Who else has been affected by asbestos exposure?

Spouses and children of those exposed to asbestos have also developed cancer through the transfer of fibres on workers’ clothing. In addition, asbestos exposure has put servicemen and women in the armed forces, particularly in the Royal Navy, at particular risk.

The scale of the problem, however, extends far beyond the UK. Even though asbestos is now banned in the UK and several other countries, asbestos continues to be mined and used widely in many other countries around the world. There is no general ban on asbestos use in the USA.

How is Imperial involved in mesothelioma research?

The National Centre for Mesothelioma Research (NCMR) at Imperial College London was launched in 2016 with a £5m LIBOR grant from the Chancellor of the Exchequer. Led by Professor Bill Cookson, the Centre aims to lead discovery research into the underlying mechanisms of mesothelioma, identifying new diagnostics for patient stratification and new targets for mesothelioma therapy.

Our projects range from genetic and genomic studies of mesothelioma, as well as deciphering the signals that drive the intense fibrosis that typifies mesothelioma, to looking at immunotherapy and using oncolytic viruses to treat the cancer – these are viruses that infect and kill cancer cells without affecting healthy cells. We are also involved in clinical trials at the Royal Marsden Hospital.

In the past, mesothelioma research has received relatively little investment and public interest but this is now changing. NCMR is an active member of the British Lung Foundation’s (BLF) Mesothelioma Research Network whose goal is to bring together all UK mesothelioma researchers and healthcare professionals and to promote investment into research of the disease. In addition, Professor Sir Anthony Newman Taylor, who chairs the NCMR’s Scientific Advisory Board, is regularly invited to the All Party Parliamentary Group’s Asbestos Sub-Committee meetings to give updates on NCMR’s work.

What are some of NCMR’s research highlights from the past year?

We have now finalised our first genetic studies of mesothelioma, in collaboration with MesobanK, Professor Marion MacFarlane’s group at the MRC Toxicology Unit and Professor Mark Lathrop’s group at McGill University and Genome Quebec Innovation Centre. Following on from these studies, we are currently following leads to find genetic weaknesses in the mesothelioma tumours which could be exploited in new mesothelioma therapies.

Some of our latest research findings were presented at the British Thoracic Oncology Group (BTOG) Annual Conference in January 2018. Our postdocs Dr Amit Mandal and Dr Anca Nastase presented their posters, with Dr Manal – pictured – winning the first prize for his poster.

What’s coming up for NCMR?

As we have now completed our first genetic studies of mesothelioma, the next step is to find genetic weaknesses in the mesothelioma tumours and exploit these in new treatments. We will be presenting our latest research findings at the American Society of Human Genetics Annual Meeting in San Diego this October.

Other promising areas of research include early diagnosis of malignant pleural effusions, understanding the immune mechanisms that underpin successful immunotherapy, and dissection of the mechanisms that drive fibrosis in mesothelioma. Each of these programs has a strong collaborative element with outside clinicians and research groups in centres such as Institute of Cancer Research, the Royal Marsden and Royal Brompton Hospitals, and the MRC Toxicology Centre.

How important is patient and public engagement for NCMR?

Patient and public engagement is of major importance to NCMR, particularly as many people have never even heard of this cancer! Raising awareness of this devastating disease is of critical importance. People who are affected by mesothelioma – patients and their families and friends – are a very active community and are an audience who want to be informed of what research is being done and how they can contribute to research.

Our next public engagement activity is in October when NCMR’s Centre Director Professor Bill Cookson will be at Mesothelioma UK’s 13^th Patient and Carer Day in Alrewas, Burton-on-Trent, on Friday 19 October 2018.