Asbestos has deep ties in the fabric of Indian industry and construction. Behind China, India is the second largest market for asbestos in the world, importing hundreds of millions of dollars worth of the material annually. The impact asbestos has on community and individual health is as vast as it is severe. As a versatile material favored by the construction and repair industries because of its heat and fire resistant properties, asbestos use saw its peak in the mid-20th century. However, people began noticing its alarming health effects, including mesothelioma, only decades after exposure to the toxin.

Some of the effects from exposure include certain forms of cancer. Asbestos fibers often remain in the body for years, leading to irritation and the eventual development of malignant cells. Through further research and the development of clinical trials, aggressive cancers that are difficult to treat may stand a better chance with tumor profile-based targeted therapies and experimental treatments such as gene therapy.

Asbestos Use in India

Being the largest global importer of asbestos, much of India’s industry relies on the mineral’s production and use. Asbestos-containing products are manufactured in nearly 200 factories around India. The mineral can be found in a range of products, from cement and roofing to household appliances and automotive parts.

Danger - Asbestos - Cancer and Lung Disease Hazard

Much of India’s asbestos-related health issues can be attributed to occupational and secondhand exposure. Employees who work with the material in factories and shipyards, like those in Gujarat and Alang, are often the primary victims of diseases derived from asbestos exposure. The fibers produced by disturbed asbestos can stick to a worker’s attire, potentially entering their homes and communities. Those living near factories or construction sites are also at risk of airborne exposure, resulting in health complications that can be just as detrimental. Mesothelioma is one of the most significant byproducts of asbestos exposure. This rare form of cancer takes root in the mesothelium, or lining of the internal organs, and is known for its significantly low survival rate.

Patients may not develop symptoms of mesothelioma for upwards of 10-50 years, and these symptoms are typically only discovered in the later stages of the disease. In addition, due to its rarity, mesothelioma can often be misdiagnosed or improperly treated. To fully understand the condition and how it develops, further clinical study and testing needs to be done. Innovative treatment methods and solutions could prove life changing for the majority of patients who do not survive more than a year after diagnosis.

Gene Therapy, Targeted Therapy and Mesothelioma

 Even in its initial stages gene therapy has the potential to hugely benefit cancer patients like those suffering from mesothelioma. At its core, gene therapy works to replace mutated or cancerous cells, leading to correcting the gene completely and deactivating the mutation. In mesothelioma cases, the DNA of a cell is damaged by asbestos fibers, leading to uncontrolled growth and abnormalities.

Mesothelioma patients most often receive treatment through some form of surgery, radiation, or chemotherapy. While a combination of these three treatments sees the highest success rates, the condition’s prognosis continues to be poor. Targeted therapy based on the mutation profile of the tumor is starting to become a reality for some patients (eg Erlotinib for tumors that carry an EGFR mutation) with some success in extending survival beyond one year, in some cases even up to five years. Gene therapy on the other hand is still in its experimental stages for mesothelioma, but is available now to patients through clinical trials. So far, much of the results have seen limited success with notable side effects or complications.

However, researchers have uncovered the TP53 gene as an effective target in treating tumors through gene therapy. This gene comprises a key protein (p53) that regulates normal cell function within the body and is vital in preventing tumor growth. Almost every form of cancer linked to a poor prognosis has a mutation in this gene, making it an ideal target for therapy. Preclinical studies have focused on the common genetic mutation in mesothelioma which deactivates the p53 pathways. This study has been successful in restoring the pathways that prevent tumor growth, but so far researchers have not been able to use this therapy to greatly reduce tumor size.

Mesothelioma in India

On a global scale, the World Health Organization estimates asbestos was linked to an estimated 107,000 deaths in 2004 alone. Although about 60 countries have banned the use of asbestos due to its threat to human health, India’s asbestos industry is worth billions of dollars and continues to grow. Around 80% of mesothelioma cases in the country involve men who experienced occupational exposure or those living in proximity to production.

Yet, mesothelioma is a considerably new condition for India, with the first case being reported as recently as 2015. However, the crux of this cancer is that it will continually be diagnosed for years, even after asbestos has been fully banned. The epidemic of asbestos exposure in India will only come to a halt when the dangers associated with this mineral are fully investigated, and it has been proactively handled or disposed of.

Until this time, it is important that evolving forms of cancer treatment, like targeted and gene therapy, are studied and implemented to help save the lives of those afflicted by mesothelioma. Targeted and gene therapy has the potential to greatly impact the way cancer care is approached, especially for patients with late stage diagnoses and where other forms of treatment would be too risky or ineffective. Further study into these treatment options provides hope in the cancer research community, and gives those who may face hazardous asbestos exposure the chance at a more promising future.

Editor’s Note: We would like to thank the team at Mesothelioma + Asbestos Awareness Center for their contribution to this article.