1. Mesothelioma in the South West Gerry Slade Mesothelioma UK CNS

2. South West – My Aims May 2015 Regionally Work alongside local Lung CNS’s to; – Provide expert advice and support – Raise awareness of Mesothelioma UK info etc Develop already successful Support Group (BBAFS) Encourage discussion of all mesothelioma patients at Regional Mesothelioma MDT – improve trial uptake Nationally Represent SW at NLCFN, BTOG and other meetings – teaching, networking etc.

3. What have I been doing? – Lung CNS’s Visited CNS’s in Gloucester, Cheltenham, Bath, UHB, Yeovil, Weston Super Mare. Liaised with others by phone. Sent monthly email “up-dates” to all CNS’s in the region re; trials, support groups etc. Helped advise re; difficult problems.

4. Patients and families Met with patients from Cheltenham and Gloucester and UHB. With help from BBAFS, set up 2 x monthly support groups in the region – Axbridge and Whitminster and organised Christmas lunch. Sent out bi-monthly newsletters to patients and carers on our mailing list Kept BBAFS website updated

5. Mesothelioma Support Groups Axbridge – sadly closed after 4 meetings Whitminster – monthly. Going strong! New patients each month. Well supported by local Lung CNS’s, Sid and Fiona and BBAFS. Monthly speakers including Benefits, Breathlessness, Exercise, Self Help. 16 attendees in November.

6. Mesothelioma MDT New Referral form hopefully improved ability to discuss patients more fully. Rates still low. Potential Benefits of MesoMDT Provides access to specialist oncologist, thoracic surgeons, chest physician with LAT skills and pathology opinions.(1) Evidence of reduction in time to treatment and increase of systemic chemotherapy use.(2) 1.Duckers J., Williams S., Lester J.F., Butchart E., Gibbs A., Crane M. and Linnane S.J.; Mesothelioma Multi Disciplinary Meeting – effects on quality of care. Lung Cancer Vol 60. Supplement 1, April 2008 pS6-7 2.Martin JE., Edwards JG., Matthews S., Suvarna K., and Fisher P.M ;Reflection of a Specialist Mesothelioma Multi Disciplinary Team; a year on. Lung Cancer Vol 60. Supplement 1, April 2008 pS6

7. Patients with complete info for MDT

8. Meso MDT Completeness of referral information is improving, leading to better discussion Overall referral numbers appear to be falling Please keep referring patients to the regional MDT!

9. Trials Closure of COMMAND due to futility Presently recruiting RESPECT – Early Palliative Care intervention TARGET – see next slide (NIHR funded) On the horizon – MARS 2 – NBT to become a PIC (Patient Identification Centre) Zol-A – February 2016 (NIHR funded)

10. TARGET Aim: to investigate whether PET-CT targeted biopsy has better diagnostic yield than CT guided alone. Eligibility Clinical presentation and imaging suspicious for mesothelioma One negative biopsy Randomisation CT guided biopsy or PET-CT targeted CT guided biopsy (PET-CT first followed by CT biopsy when results known) Recruitment Planned 78 patients over a 24 month period 10 centres in the UK. Currently NBT open and several centres set up (Oxford/Gloucester/Portsmouth/Royal Stoke)

11. Zoledronic Acid (ZA) Already used widely to treat bone metastases and osteoporosis. Good safety record. Shown in mice to slow mesothelioma progression. Not curative. This effect appears amplified when used with certain chemotherapy agents.

12. Zol-A Feasibility study. 50 patients. 3 centres – NBT, Bath, BRI. Randomise 25 ZA +chemo 25 placebo + chemo Planned to open Feb 2016, subject to ethical approval. More information from; Duneesha De Fonseka, Clinical Research Fellow. <Duneesha.DeFonseka@nbt.nhs.ukDuneesha.DeFonseka@nbt.nhs.uk

13. 2016….. Leaving post at end of this year. NBT has applied to retain the post. Successor yet to be identified. Aim to continue with Whitminster Support Group with the help of local Lung CNS’s. BBAFS will continue with support and some Bristol meetings.

14. Thanks to Nick Maskell, Professor of Respiratory and Pleural Medicine,NBT Duneesha de Fonseka, Clinical Research Fellow, NBT Liz Darlison, Consultant Nurse, Mesothelioma UK