The Princess Margaret is further advancing mesothelioma treatment with new trial


(L-R Drs. Marc de Perrot and John Cho who head up The Princess Margaret’s Mesothelioma Program)

Princess Margaret Cancer Centre is leading the way in diagnosing and treating mesothelioma and a new trial called S.M.A.R.T.E.R. – that advances a ground-breaking technique developed here – could further help improve outcomes for patients.

Mesothelioma is an aggressive cancer caused primarily by workplace asbestos exposure and most patients don’t survive beyond two years.

What makes mesothelioma even more challenging to treat is its long latency period, which means the cancer often isn’t caught until it has reached a late stage.  

The Princess Margaret has made great strides in improving survival rates with research being done through its Mesothelioma Program – the first program of its kind in North America. 

In 2008, Drs. Marc de Perrot and John Cho developed an innovative new technique known as S.M.A.R.T. (Surgery for Mesothelioma After Radiation Therapy). It involved treating patients with high doses of radiation first to prevent mesothelioma cells from escaping to other areas of the body during surgery. 

The technique is now becoming the standard of care for eligible patients treated at the Cancer Centre and has doubled survival rates, according to a study published in the Journal of Thoracic Oncology in 2014. Read more about the findings here

It is also being used at cancer centres around the world, including in the United States, Europe and Asia.

Karl Richter was diagnosed with mesothelioma at the age of 59 after being exposed to asbestos while working at a factory almost 40 years earlier. He was one of the original 25 patients to receive the S.M.A.R.T. treatment in 2011 and has since made a full recovery. 

“The Princess Margaret not only gave me my life back, but it had a huge impact on the life of my family as well,” says Richter.

Since the S.M.A.R.T. program was originally developed, research at The Princess Margaret has shown three days of radiation, instead of the current standard of five, can be just as effective. 

A new trial using this protocol called S.M.A.R.T.E.R. is currently being developed at the Cancer Centre. 

Since the procedure poses less risk and is less invasive – removing the lining of the lung instead of the whole lung during surgery – more patients could be eligible to receive this treatment. 

“The actual physical advantage is it’s going to be easier on the patients. Preserving the lung is also a big advantage,” says Dr. de Perrot.

A less invasive surgery means even more cancer centres around the world could adopt the technique. 

Additionally, Drs. de Perrot and Cho are doing research on screening, early diagnosis and radiation. They are also studying how immunotherapy could treat mesothelioma by examining the immune system on a larger scale with a new technology developed at the University of Toronto called mass cytometry. 

“Instead of spending 10 years to find out how the immune system works, we can probably reduce that time of research by tenfold or so because we’re going to study 30 to 40 cell types at one time, instead of studying them one by one. That could be a huge step forward,” says Dr. de Perrot.