Living With Mesothelioma -My Diary- A trip to London to visit Verastem Director. Tea at the Waldorf and talked about the Command Trial

What a day I have had.

This morning I had an Invitation to the House of Commons as Lord Saatchi is  having his official launching his Bill in the House Lords Next week. That has really cheered me up. Its not about only Mesothelioma but all cancers but we would benefit if it was passed.

I set of to London to meet a American that I didn’t know but I was so pleased I did. Although travelling by train is very boring.


We went to Tea at the Waldorf in the West End. We were early and all I knew was I was meeting a tall red haired man.

A tall red haired young man with a beard  appeared and when we said hello he sounded just like Mt Selfridge and looked like him –swoon —

He was the Director corporate Development Of a company making novel drugs targeting cancer stem cells.

We settled down and the waiter bought all the tea, sandwiches, scones, jam and cream but we were so engrossed in conversation, I had so many questions which he answered everyone but everything I asked they were trying to sort out anyway.

I did like his answer about the fact we the patient spend a lot of money on expenses, travel  and hotels. They are really trying to get more hospitals to accept the trial so they are more localised, but they are using capsules more and more for chemo so that the patient can be treated in their own home.

When I was on Vinorelbine  that was in capsule form and I had to keep it in my Fridge.

So the trial is Command a stem cell trial. I will print the info at the end of this write up.  No good for me as it has to be used after Cisplatin and Alimita  chemo has worked and then take the drug.

So I have been invited to do a phone in on a program that he and Professor Fennel are going to do Friday so of coarse I said I would.

He had to go as he was flying out to Holland for a meeting and then he was travelling all around Uk to different hospitals that are going to do the Trial, London included.

If you are interested please contact   Professor Fennel

Chair of Thoracic Medical Oncology

Contact DetailsTel: 0116 252 5174


Office: Room 324, Level 3, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary LE2 7LX, and Laboratory 411, 4th Floor, Hodgkin Building.

Academic Secretary: Jenny McNair, email:, Tel: 0116 252 3170

Clinical Secretary: Nila Parmar, email:, Tel: 0116 258 6295

The trial details are

Citing “significant enthusiasm within the mesothelioma community”, the manufacturers of a promising new mesothelioma drug say they have begun a major test of the drug in patients.

Massachusetts-based Verastem, Inc. focuses on drugs that fight cancer by attacking the stem cells that give rise to them. Earlier this summer, the FDA granted orphan drug status to their stem cell inhibitor, defactinib, for the treatment of mesothelioma. The designation, which is reserved for drugs that fight the rarest of diseases, helps pave the way for testing and faster approval, depending on the results of clinical trials.

“Development of a drug that preferentially kills cancer stem cells is a promising approach, as many standard-of-care treatments have been shown to either have no effect on, or actually enrich the population of, these chemoresistant cells,” observed Verastem’s Chief Medical Officer, Dr. Joanna Horobin, in a company news release.

The new trial, called COMMAND  (Control of Mesothelioma with Maintenance Defactinib) will test defactinib as a “maintenance drug” in mesothelioma patients who experienced a partial response or stabilized disease after first-line chemotherapy treatment with pemetrexed (Alimta). Between 350 and 400 mesothelioma patients will be enrolled in the trial at clinical sites in 11 countries including the U.S., U.K., Australia, Canada, South Africa, New Zealand and Europe.

The trial will also test the theory that defactinib could be especially effective in patients with low levels of the biomarker, merlin. Preclinical research has suggested that patients low in merlin might be more susceptible to drugs like defactinib. Mesothelioma patients who meet the eligibility requirements for the trial will have their merlin levels tested and will be sorted into randomized groups. Half will receive 400 mg of defactinib daily while the other half will receive a placebo. Horobin says the company hopes that adding the defactinib aspect to the trial will help “accelerate the program to a potential regulatory decision”.

“This well-designed study is expected to deliver a one-two punch to the tumor by treating with defactinib following first-line therapy… in an attempt to prolong clinical response,” said Professor Dean Fennell, Chair of Thoracic Medical Oncology at the University of Leicester and Coordinating Investigator for COMMAND in the U.K. “There is significant enthusiasm within the mesothelioma community for the COMMAND study.”

Mesothelioma is a rare but aggressive cancer caused by exposure to asbestos. While the incidence of mesothelioma is slowing beginning to drop in the U.S., the disease is not expected to peak in many other countries for decades.


Verastem Initiates COMMAND: A Registration-Directed Trial of Defactinib in Patients with Mesothelioma, News Release, September 10, 2013, Verastem website.


Cancer stem cells are an underlying cause of tumor recurrence and metastasis. The majority of cancer drugs, while killing the bulk of tumor cells, ultimately fail to induce durable clinical responses because these cells develop a resistance to treatment over time. A reason for this acquired resistance may be the presence of small minority of cells in the tumor called cancer stem cells (CSC). These CSCs are often resistant to existing cancer therapies including targeted drugs, chemo- and radiation therapy.

Scientific cofounder Robert Weinberg, Ph.D., explains the role of EMT in cancer stem cell development.

Standard approach:

The CSCs within tumors have the capacity to regenerate the primary tumor. They also acquire characteristics that increase their invasive potential. The ability of CSCs to move to other sites in the body, combined with the capability to initiate a new tumor mass, may implicate CSCs as an important factor in the formation of metastases. Metastatic tumor sites are the cause of death in more than 90% of human cancer patients. Cancer stems cells have been found in many types of tumors, including leukemia, myeloma, breast, prostate, colon, brain, lung and other cancers.

In order to develop truly effective treatments that can create a durable clinical response it is important to develop drugs that can target and kill CSCs. A major factor that has prevented the discovery of drugs targeting CSCs is that isolated CSCs rapidly differentiate in culture, yielding the non-CSCs that represent the majority of cells in tumors.

Verastem’s approach:

Verastem’s proprietary research has developed a system for the discovery of a new generation of cancer drugs that can selectively target CSCs and provide a strategy for treatment of cancer patients. This has been accomplished by developing novel methods to create large numbers of cells that stably reside within the cancer stem-cell state. By engineering tumor cells to stably transition to CSCs, Verastem has established high-throughput drug discovery systems that make it possible to identify and develop drugs specifically targeting CSCs.

Our Agents Target and Kill Cancer Stem Cells:

Our Agents Target and Kill Cancer Stem Cells

Our technology identifies drugs that are able to target and kill cancer stem cells thereby reducing the initiation of new tumors.

Scientific cofounder Robert Weinberg, Ph.D., explains why targeting cancer stem cells is critical for creating a durable clinical response.

Learn More About Verastem’s Technology and Research

How Ray saw it –Rays Blog


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