Richard Archer waits for Dr. Fadlo Khuri to bring him his latest test results at Emory Hospital in Atlanta. Photo: Stephen Gross - The Anniston Star
ATLANTA - Richard Archer's lips draw a tight line as he peruses an
old issue of Southern Accents. Through gold-rimmed glasses, he gives the
same two-second pause for each page.
Setting the magazine aside, Archer sits motionless in a white exam room,
his hands folded as if in prayer.
His short and shallow breaths hint at why he's here. Underneath a plaid
shirt and behind the scar outlining half his chest, a layer of cancer
coats his left lung like the rind hugs an orange.
Twenty-seven months ago, doctors told him he was going to die. Mesothelioma,
a rare, aggressive cancer, would probably waste no time killing him, they said.
Two years ago, he took a chance on a risky operation to remove his left
lung and its stricken lining. A Birmingham surgeon cut him open and found
the cancer had spread to the lymph node beside Archer's aorta.
The doctor closed him up. The odds of slicing into the master artery were
The surgeon's nurses told Archer's wife her husband wouldn't
see another Christmas.
A year ago, Archer came to the Atlanta office where he waits today.
His first visit with medical oncologist Dr. Fadlo Khuri at Emory University
was timed with the federal government's approval of a new chemotherapy
drug - the first for mesothelioma.
Archer had heard horror stories about his former coworkers' chemotherapy
experiences. If he was going to die anyway, he didn't want to make
it more painful.
"Listen," Archer told the oncologist at the start. "I'm
doing pretty good. I'm not going to spend the rest of my life sick."
The doctor convinced Archer he needed to try the new drug.
Today, he waits for Khuri to tell him if it's working.
Searching for a cure
Richard Archer hangs his head as he waits for his test results. Two years
ago, a nurse told Archer's wife, Pat, that he would not live long.
Photo: Stephen Gross/The Anniston Star
Richard Archer is a lifelong Ragland resident who worked 12 years at its
Cement Asbestos Products Co. plant in the 1960s and '70s. He and the
hundreds of Northeast Alabama men who worked at Capco are among the 27.5
million American workers exposed to asbestos between 1940 and 1979.
But asbestos disease takes anywhere from 10 to 50 years to finish its attack
on a life. Those who molded it, breathed it, in the 1960s and '70s
are getting sick now.
As the epidemic grows, lawsuits embroil industry heads, insurers, legislators
and trial lawyers who are debating a way to compensate its victims.
What's missing from that chore, argue patients and doctors, is the
search for a cure.
As of 2004, $70 billion has been paid on some 730,000 asbestos personal-injury
claims, according to the Rand Institute for Civil Justice.
About $1 million a year goes to research mesothelioma treatments, according
to the Mesothelioma Applied Research Foundation (MARF), which studied National Cancer Institute figures and conducted an informal
poll of researchers.
"It doesn't make any sense," said MARF Executive Director
Chris Hahn. "It's contrary to the American spirit of optimism.
We're going to talk about the next 28 years of people getting sick
and all we're going to do is set aside money. Why not take some of
that money and try to prevent these people from dying in the first place?"
A stealthy killer
When an asbestos fiber hits the lung, the body's immune system kicks
in as scavenger, macrophage cells attempt to destroy the invader.
Some fibers move inside the lung, creating a scarring process called asbestosis,
a fatal prelude to lung cancer and mesothelioma.
Mesothelioma starts in the lining of the internal organs, most often the
chest cavity near the lungs. The pleura, a layer of tissue that encloses
the chest cavity, is normally thin and flexible like plastic wrap.
Mesothelioma can turn that layer into a case two inches thick, constricting
the lung in a steady, painful squeeze. The cancer often spreads to the
lung, diaphragm and pericardium, the sac around the heart.
While there is no system of reporting cases of asbestos-caused lung cancer,
federal morbidity statistics show that asbestosis and mesothelioma deaths
steadily have been increasing for decades.
The 2002 Work-Related Lung Disease Surveillance Report from the National
Institute of Occupational Safety and Health said asbestosis deaths had
increased from fewer than 100 annually in 1968 to 1,500 in 2002, according
to the National Center for Health Statistics.
The report's authors note that those numbers likely are low, because
many cases are misdiagnosed and many death certificates are incomplete.
This is supported by a steep annual rise in asbestosis hospitalizations
in the report, from 300 in 1970 to 20,000 in 2000.
Mesothelioma deaths also have increased steadily over the past 20 years,
with 699 deaths a year in 1980, 2,485 in 1999 and 2,573 in 2002, according to NCHS.
For 1.3 million workers in the construction industry, asbestos is still
a hazard - but exposure isn't limited to people on the job.
As many as 100 million Americans have been exposed to asbestos, according
to American Academy of Actuaries, an association of insurance statisticians.
In the mid-1970s, more than 3,000 consumer and industrial products contained
asbestos. The fibers still are used in products such as brake pads and
remain in the attic insulation of 30 million American homes, according
to an Environmental Working Group report.
Asbestosis affects people with prolonged asbestos exposure, and the severity
of a case relates directly to how long someone was exposed. But mesothelioma
is more random, affecting only 10 percent of those heavily exposed.
It also affects people with lesser exposures.
In Ragland, a man who worked two summers at Capco has had a lung removed
because of mesothelioma. A man who worked there just two weeks died of it.
"There is no known safe minimum of asbestos exposure, so theoretically
one can get it from breathing in one fiber once," MARF's Hahn said.
The death sentence
Two Christmases have come and gone since Pat Archer was told her husband
wouldn't celebrate another. The Archers make a point of calling that
surgeon's office to wish the staff a Merry Christmas.
"When you're diagnosed, they tell you you're going to die," she said.
Mesothelioma is so rare that an oncologist might see one case in a whole career.
For years, there were no successful treatments. The best a doctor could
do was use a needle to drain the fluid that pressed against the patient's
lungs. Doctors would tell patients to take a cruise when they were diagnosed.
Nowadays, patients come back to that oncologist's office having researched
treatments on the Internet and often knowing more than the doctor.
Dr. Robert Cameron , a thoracic surgical oncologist at University of California-Los Angeles
Medical School, said patients should get second and third opinions and
they should go to large academic institutions specializing in treating
After her husband's diagnosis, Pat Archer got online and read everything
she could find. When she stumbled across the Mesothelioma Applied Research
Foundation, she called its executive director.
She told Hahn that her husband was in a late stage of mesothelioma and
the doctors said there was nothing they could do.
"It's funny, because he's not feeling that bad," she
recalls saying at the time.
Hahn, knowing that mesothelioma is excruciating in the late stages, referred
the Archers to Dr. Dan Miller, surgical director of the thoracic oncology
program at Emory University.
Surgically, there was nothing that could be done for Archer, because the
cancer had spread to his lymph node. Miller said only 25 percent of patients
are candidates for surgery. In most cases, by the time they're diagnosed,
the cancer has spread too much.
A mesothelioma operation often removes the lining and lung. Cameron's
approach has been to remove the tumors and leave the lung intact.
Followed by chemotherapy and radiation, both types of surgery have had
successful results. Mesothelioma patients have a life expectancy of eight
to 12 months after diagnosis. On average, Cameron's patients'
life expectancies double after surgery, and he's had some live more
than seven or eight years.
But, he said results for his and the more-radical surgeries are misleading
because surgeons identify only the best patients as candidates. Those
individuals would have lived longer anyway.
Randy Henderson, who worked two summers at Capco when he was 21 and 22,
has mesothelioma at age 52. In December, Dr. Robert Cerfolio at University
of Alabama Hospital at Birmingham - the same thoracic surgeon who cut
Richard Archer open - removed Henderson's left lung, the lining around
his left lung and heart, and reconfigured his diaphragm.
After the surgery, a CAT scan revealed no traces of cancer.
Henderson is about to complete his ninth week of chemotherapy on a new
Then it's on to six weeks of radiation. After that, he says, sounding
out of breath, he should be through.
"I'm going to live," Henderson said. "Half those guys
at Capco have not."
Richard Archer's former coworker and next-door neighbor, Hugh Lane,
was diagnosed with mesothelioma in 1999.
He and his wife, Darlene, went from University Hospital to M.D. Anderson
Cancer Center in Houston and were given the same option: surgery removing
a lung, its lining and lining around the heart. They were told he might
not survive the 12- to 14-hour operation. If he did make it, his quality
of life would be diminished.
"Surgical resection of his mesothelioma would be a very aggressive
technique …" read an assessment by Birmingham Dr. James Barton.
"Radiation therapy is generally not helpful … Chemotherapy
is relatively ineffective in many cases."
Lane decided against surgery, but went ahead with chemotherapy.
His wife watched him deteriorate rapidly when the treatments started. She
thinks they may have killed him faster, or at least made him sicker in
his last days than he had to be.
"Somebody who never sat still, who was busy all the time, got to where
they couldn't get up to walk to the bathroom by themselves," she said.
He died Oct. 5, 2000.
An autopsy performed the next day showed the tumor in the lining of one
lung had spread into his lungs, his diaphragm, his chest wall and his
The research grows
Dr. Fadlo Khuri checks Richard Archer's lungs as fellow physician,
Dr. Abeer Abou Yabis, looks on at Emory Hospital in Atlanta. Photo: Stephen
Gross/The Anniston Star
A year before Archer's failed surgery, Dr. Nicholas Vogelzang in May
2002 shared the results of the largest mesothelioma clinical trial ever
at the American Society of Clinical Oncologists annual meeting.
The study involving 448 patients and 114 investigators in 19 countries
showed that a new chemotherapy drug, Alimta, in combination with another
chemotherapy drug, Cisplatin, showed a 41 percent tumor response rate
and improved survival and lung function.
Patients who took Alimta lived a year after diagnosis, nearly three months
longer than patients who took only Cisplatin.
It wasn't a cure. It wasn't even a satisfactory treatment, but
experts said it was a breakthrough.
"After years and years during which everybody was saying that the
mesothelioma tumor is unique and resists all forms of chemotherapy, we
now have evidence that Alimta chemotherapy in 40 percent of cases will
cause the tumor to shrink," Hahn said.
"Lo and behold, mesothelioma is susceptible to chemo."
Waiting for news
"So you're on Alimta and you're tolerating that fine?"
nurse Terry Gregerson asks Archer upon entering Khuri's exam room.
"And you're all done with treatments?"
"I don't know," Archer answered. "That's what the
scan and blood work was for. He was going to see if he could let me off
for three months."
Archer had a CAT scan more than a month ago for which he's yet to receive
results. The scan, combined with his blood work from this morning, will
tell him if he's getting better, and if he gets to take a break from
His wife would usually be by his side, but today she had to stay home because
his mother is sick. After hearing he was going to die, exploring every
option to no avail, and deciding he didn't want to put himself through
chemotherapy, it's hard for Archer to remember how he got to the position
he's in today. He suspects his wife's tenacity had a lot to do with it.
"This says your CT scan had improved," Gregerson says, pointing
to a computer screen. "They measured soft tissue density, between
the lung and the lung lining, and it was 4.5 (centimeters) and current
density is 1.4. That's pretty good. I would assume that you're
going to get your wish."
Archer is still rigid, hands folded in his lap, lips in a perfect line.
It sounds like good news, but he wants to hear what Khuri says.
The nurse leaves and in walks an oncologist Archer hasn't met before,
Dr. Abeer Abou Yabis.
Between questions about how he's feeling - good except for shortness
of breath and spells of nausea - the doctor mentions his results.
His scan showed improvement. They're going to give him a three-month
break from treatment to let his body recover.
Still, Archer sits expressionless, back straight, hands in lap, lips tight.
More living to do
He knows the odds are against him.
Only half of mesothelioma patients respond to the drug. In others, the
tumor stops responding.
Alimta stops tumors from growing by suppressing the two enzymes that cells
use to copy their DNA so they can divide and grow.
The reasons it fails, researchers suspect, is a third enzyme that works
like a backup system to catalyze DNA synthesis.
"If we could use a different drug to block that pathway, we might
be able to give the tumor a knockout blow," Hahn said.
The most promising prospect for sustained life is still early detection.
A new biomarker, the Serum Mesothelin Related Protein, can distinguish
mesothelioma from other malignancies and communicate whether tumors are
shrinking or growing. That means a simple blood or urine test could be
developed to detect the cancer.
Such a test would allow exposed populations, like those in Ragland, to
be monitored and diagnosed long before a tumor shows up.
"The implications of this are huge," Hahn said. "It brings
an incredible amount of optimism."
Researchers also are investigating immunotherapy treatments. "Killer"
T-Cells normally recognize and destroy the cells of a growing tumor, but
they are not properly activated in mesothelioma patients.
In mice, a protein (CD40 Ligand) has eradicated mesothelioma by stimulating
the immune cells.
'I never thought we'd be this far along ...'
Archer is overcome with emotion as Dr. Khuri gives him good news concerning
his chemotherapy treatment. Photo: Stephen Gross/The Anniston Star
The research possibilities, though critical to the next generation of mesothelioma
cases, provide little comfort to Archer as he waits this day for the final
word on his prognosis.
In walks Khuri.
Good news, he says.
Since starting chemotherapy, Archer's cancer has been reduced to less
than one-third of its thickness, a dramatic response for mesothelioma.
The doctor asks if he's told his wife yet.
"No, she told me to call her as soon as I get out of here."
Khuri asks Archer to take deep breaths and briefly taps and feels his back
and chest. His report:
"So far so good, you couldn't ask for any better than this. Your
vacation from chemo continues. Come back in just about three months. Let's
plan for mid-late June."
Archer, still shirtless from his examination, extends his hand.
"I appreciate you," Archer says, barely audible. He's smiling,
face flushed and eyes wet.
"Hey, I appreciate you, too. You're doing great."
"I never thought we'd be this far along a year ago," Archer says.
"If I didn't think we'd be this far along, if I didn't
think there was a chance, we wouldn't have put you through the chemo,"
his doctor replies.
"You got a good heart and you tried and you tried ... ," Archer
says, crying. "You trust the Lord, too. The Lord does it all. He
works through you, and I just appreciate you."
"Likewise, you give Mrs. Archer my prayers," Khuri adds with
a pat on his patient's back. "You're doing wonderful. You
take care of yourself."
The doctor, about to head out the door, takes a good look at his patient's
teary smile, and stops to hug the man who just learned he's not done
living, not yet.
"It's OK to be happy, you know."
"Yeah," Archer says. "It sure is."
*** POSTED APRIL 2, 2005 ***
*** Mr. Richard Archer passed away on May 22, 2009 ***