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|ISSN 1470-8108||Issue 104||Summer 2017|
Action Mesothelioma Day (AMD) has now come of age. In 2006 when the first AMD was held, the event took place in February. A couple of years of bitter winds and driving rain soon put paid to that idea and the decision was taken to change AMD to the first Friday in July. Despite the odd torrential downpour, which from time to time prevented the release of symbolic as well as real-life doves, the new date rapidly became a calendar fixture for asbestos victims groups, mesothelioma charities and campaigning organizations. Judging by the impressive number of google hits for Action Mesothelioma Day, the scores of well-attended local AMD events on July 7, 2017,1 the coverage generated via print and social media platforms and the feedback from participants, this years activities were a resounding success with tens of thousands of pounds collected for mesothelioma research, public awareness of the killer cancer heightened and the participation of high-profile UK and international speakers.2 From Glasgow to Cardiff via Portsmouth, Manchester, Liverpool, Newcastle and elsewhere, the UKs tragic mesothelioma epidemic was commemorated in churches, assembly rooms, cathedrals, exhibition spaces, civic centers, memorial gardens and hotel venues. Municipal dignitaries rubbed shoulders with leading clinicians, Members of Parliament and local school children, as sufferers, family members and supporters participated in information sessions, candle lighting ceremonies, sponsored dove releases, art exhibitions, memorial services and other activities.
That AMD has now reached critical mass is clear from other events held in the run up to July 7. On July 4, the first ever Asbestos in Schools conference organized by the Joint Union Asbestos Committee (JUAC) took place in Birmingham to focus attention on what has been termed a time-bomb in our schools.3 In attendance, were UK trade unionists, school governors, officials from local authorities and campaigners, including delegates from Spain, France and Italy, countries where toxic contamination of schools is also cause for great concern.4 Chair of the Parliamentary Asbestos in Schools Group MP Rachel Reeves, Coordinator of the Asbestos in Schools Campaign John McClean, TUC Senior Policy Officer Hugh Robertson, Sarah Lyons from the National Union of Teachers and JUAC and Lucie Stephens, whose schoolteacher mother Sue died of mesothelioma, detailed a litany of missed opportunities and failed government policies which have created a perilous situation resulting in asbestos contamination of up to 85% of UK schools. Commenting on the conference, John McClean said:
The conference was held to educate and raise awareness of the ongoing serious issue of asbestos in schools. The wide range of speakers was well received and there was an opportunity for the delegates to ask relevant questions. Unsurprisingly, the speakers from the government departments, the Department for Education (DfE) and the Health and Safety Executive (HSE), received the most challenging questions due largely to the fact that they reiterated the HSE advice/mantra that asbestos is best left in place if it is in a reasonable condition. The delegates took exception to this approach as it was clear from other speakers that there is a severe lack of knowledge among those who manage asbestos in schools and in exactly where asbestos might be present. Following favourable comments from those attending, JUAC will now consider if there is merit in following up with another conference in the future. In the meantime the campaign continues.
The publication this summer of high-profile features on the asbestos-in-schools scandal reinforced the national prominence this issue has achieved. On June 27, 2017, a fortnight after the Grenfell Tower catastrophe,5 a commentary entitled: We cannot compromise safety in schools. Asbestos must be removed appeared in The Guardian:6
Our collective attitude to asbestos in schools mirrors the same sleepwalking into disaster that comes from viewing rigorous safety standards as more rigmarole than necessity. In the wake of the fire at Grenfell Tower, we have a simple choice: we choose to be safe.
If that is the case, we should be using this moment as an opportunity to ask what sort of cognitive dissonance allows for other oversights that cost lives. Are we, the fifth largest economy in the world, perfectly at ease with three-quarters of schools containing asbestos? Thats children snuggling into circle time in primary schools or shuffling along to maths in secondaries, surrounded by a substance so toxic that 2,600 people die each year from the condition mesothelioma. More people die from this condition than do on our roads.
In July, 2017 a feature entitled Managing asbestos in schools is no longer a sensible option,7 in the Health and Safety Bulletin, castigated the HSEs asbestos policy for schools which was, so it was argued, ill-served by a reliance on voluntary surveys and badly skewed by a worrying level of complacency. There was a marked disparity between results of asbestos audits undertaken by the Education Funding Agency and the National Union of Teachers with the former finding that the majority of schools (51.6%) had appropriate asbestos managements in place or had no asbestos, and the later concluding that 85% [of staff] had not been shown their schools asbestos management plan Also in July, a blog on the website of the GMB trade union by Rachel Reeves MP, Chair of the Parliamentary Asbestos in Schools Group, asked: Are our school buildings safe under the Tories?8 The answer to this question, as can be seen by the extract below, was a resounding no:
It could not be any clearer now that there is an undeniable problem with asbestos in schools. Its not going to simply disappear, the lives of staff, pupils and others are being put at risk and so why is the Government continuing to ignore this issue?
Alongside a phased removal, we need centrally funded, mandatory audits in every school built before 1999, with results published or at least stored centrally.
The governments complacent attitude is entirely wrong. Their red tape is another persons crucial protections. The evidence is there. It now needs to be acted on.
On July 5, an Asbestos Study Day was held in Manchester, organized by the Asbestos Victims Support Groups Forum UK (the Forum), the Japan Association of Mesothelioma and Asbestos-related Disease Victims and their Families and the International Ban Asbestos Secretariat. The planning for this event had begun in January 2017 when it was suggested that a delegation of 20 members of the Japanese association named above would like to attend AMD activities in various UK asbestos hotspots. To contextualize their experiences, it was decided to solicit presentations on a range of relevant subjects including: the patients perspective, advances in clinical care, the UKs asbestos legacy, the work of victims groups and the UK compensation system; international speakers discussed challenges faced by the injured in their countries. A field trip in the late afternoon provided the opportunity for a visit to the derelict site of an infamous asbestos factory in Rochdale. As a result of the deliberations on July 5, representatives of participating groups from the UK, Australia, Belgium, France, Italy and Spain issued a Message of Solidarity for Action Mesothelioma Day:
From Australia to Brazil via Japan, Korea, Italy, Spain, France, Belgium a single message goes out today: we are united in our condemnation of all those who profited and are continuing to profit from the commercial exploitation of deadly asbestos.
As we remember those whose lives were ended because of their exposures to asbestos, we think of innocent men, women and children in countries where asbestos is still being produced and used; how many more people will die before this industry of mass destruction is finally shut down? The existence of the global asbestos trade is an anathema and an abomination.9
By Friday, AMD (July 7), four teams of Japanese visitors had made their way to Birmingham, Liverpool, Sheffield and Derby; one of the groups remained behind in Manchester where they were not only able to participate in AMD events including an outdoor rally, commemorative tributes, a dove release and public meeting held by the Greater Manchester Asbestos Victims Support Group in Sackville Gardens and the Mechanics Institute but also to visit the Gay Pride village near their hotel! Thirty miles due west, Ms. Misaki Kato and her colleagues spent the day in Liverpool with members of the Merseyside Asbestos Victims Support Group (MAVSG). Commenting on the warm welcome the international guests received, MAVSG Coordinator John Flanagan said:
All our members were very impressed that we had international visitors on AMD. The presence of Japanese victims was a stark reminder to all of us on AMD of the tragic reality of the use of asbestos globally not just in the past but its continuing devastation in the developing world with the death and destruction it inflicts on workers, their families and the global village we all inhabit.
By a somewhat remarkable coincidence, during the week of mesothelioma mobilization, the Health and Safety Executive (HSE) released annual workplace fatality figures for 2015 which showed a rise in mesothelioma mortality from 2,519 deaths in 2014 to 2,542 in 2015. According to the HSE press release:
The increase in mesothelioma deaths in recent years has been driven mainly by deaths among those aged 75 and above. Of the deaths in 2015, 407 were among women and 2135 were among men again this ratio is consistent with previous years. The latest projections suggest there will continue to be around 2500 deaths per year for the rest of this current decade before annual numbers begin to decline.10
An analysis of HSE mesothelioma mortality data for the years 2000 to 2015 is informative. Over this period, there have been 34,953 mesothelioma deaths with a 56% rise in the number of deaths per year, overall; annual mortality has increased in 13 years and decreased only twice (2011 & 2014).11 When you add together deaths from mesothelioma, asbestosis, asbestos-related cancers of the lung, larynx and ovary, plus mortality from colon cancer, cardiovascular disease and possibly stomach and pharyngeal cancers related to asbestos exposure, the figures are staggering. The stark reality of the national asbestos legacy is an overwhelming indictment of a society which has, for generations, prioritized corporate profits over human life.
In 2006, when the first AMD events took place, there was a therapeutic nihilism about the treatment of mesothelioma with patchy medical care for patients, no specialist mesothelioma nurses or medical support network, a Kafkaesque benefits scheme unnavigable by mere mortals with no special provision for sufferers of mesothelioma (the diffuse mesothelioma payment scheme did not come into force until 2014) and no government funding for mesothelioma research. The higher profile for mesothelioma created by successive Action Mesothelioma Days not only increased public awareness of this deadly disease but also intensified pressure on politicians for solutions to be found to the multifaceted challenges faced by sufferers. After a decade of lobbying, in 2016 the government awarded the sum of £5 million to set up a National Mesothelioma Research Centre at Imperial College; a few months later, a private donation of £5 million was secured for work at the University of Leicester and Papworth Hospital NHS Foundation Trust, Cambridge to develop new treatments and hopefully a cure.
The faces and stories of those whose lives were sacrificed to asbestos continue to resonate and motivate the campaign for asbestos justice not just in Britain but around the world. The unprecedented participation of international delegates and speakers at events in 2017 is testament to the willingness of victims to collaborate with like-minded activists in other countries. In contrast to the ill-judged efforts to take Britain out of the European Union, the connections which bind asbestos victims at home and abroad grow ever stronger.
By Ian Pass of Pass Consulting
Nobody wakes up in the morning and suddenly decides to have an asbestos survey carried out on their property. Buildings get surveyed for asbestos because it has to be done because the owner / dutyholder legally, has no choice in the matter.
All of which begs the question: exactly when does a building need to be surveyed for asbestos?
When the Control of Asbestos at Work Regulations 2002 were enacted in November of that year, the UK asbestos (remediation) industry understood that the Government (HSE?) would mount a publicity campaign to advise all the millions of people whod just become dutyholders, exactly what their new duties would be. In practice, the Government never publicised the relevant guidelines sufficiently widely, so whilst much of big business caught on to the new requirements as various parts of the regulations came into force over the following eighteen months, there was relatively little action or awareness on the part of small and medium sized enterprises ditto builders and architects.
Implications for Sale of Domestic Residences
Unless they are about to be refurbished or demolished, domestic residences dont need to be surveyed for asbestos (theres a domestic property exclusion in Regulation 4). However, if such a residence is being sold, the Bank, Building Society or Pension Fund thats just about to take an equity in it, may well demand a Management Level asbestos survey (as defined in Regulation 4 of the Control of Asbestos Regulations 2012) before they agree a loan to a prospective buyer. Equally, buyers themselves might well want surveys to avoid the possibility of large asbestos remedial work bills following purchase of properties.
Refurbishment or Demolition of Domestic Residences
Frequently, home buyers start refurbishment work shortly after taking ownership of their new property. As soon as were talking about much more than fresh wallpaper and re-painting the skirting boards, then regardless of what an earlier Management Level survey might have shown up, a Refurbishment / Demolition Level asbestos survey becomes mandatory (Regulation 5 of the Control of Asbestos Regulations 2012). Of course, not only new owners are affected by this regulation; the above level of survey is required preceding substantial refurbishment / demolition work even if a property has been owned for years. Whilst, in general, the Management Level survey is designed to look at asbestos issues relating to the surfaces of structures, the Refurbishment / Demolition Level survey is designed to dig deep / be invasive and check out less accessible, hidden asbestos asbestos that would only normally be exposed when the builders came to call to start the refurbishment (or demolition). A mitigating factor is that this level of asbestos survey only needs to be carried out on the affected areas of a structure but includes areas where only new pipework or cabling is to be provided.
In general, prospective buyers intent on extensive refurbishment cannot have a Refurbishment / Demolition Level survey done before they buy properties; since such surveys would be likely to cause a fair amount of investigative damage not a prospect that vendors would countenance prior to a sale contract being signed.
A Common Misconception
When (if?), home owners / builders / architects read the Control of Asbestos Regulations, often the only point they latch on to is the title of Regulation 4 Duty to manage asbestos in non-domestic premises. If their project relates to domestic premises, all too easily they then assume that none of the rest of it applies to them. This is still a very prevalent attitude! Importantly, Regulation 5 has no such exclusion. It applies to any premises which technically means any building of any type in the UK (unless its military property, for which there is an exclusion).
Flats and Apartments
In flats and apartment blocks, the individual flats / apartments count as domestic premises. However, the common areas (stairwells / lift shafts / accessible loft spaces / cellars and external elevations), all count as non-domestic premises. All of these common areas are maintained by some separate management company / residents association, with a commercial responsibility to pay for any asbestos remedial work if the need arises. Residents are not required to pay for such work directly.
Since 21 May 2004, its been the law that every non-domestic building HAS to be surveyed for asbestos to the Management Level on a regular basis. This is the principal obligation of the tenant (because of Regulation 16). If, however, a tenant has vacated a property without providing a current asbestos survey report, then it becomes the landlords obligation. I would expect that every incoming tenants solicitor would require sight of a current Management Level asbestos survey report before agreeing to a new lease. As to what is meant by current the HSE apparently now regards annual re-inspections (to delete record of items now removed and include details of any new damage) a minimum requirement (see: http://www.hse.gov.uk/asbestos/managing/records.htm).
If a property (or part of it), is about to be refurbished or demolished, then a Refurbishment / Demolition Level survey is mandatory in exactly the same way as discussed for domestic properties above.
When a Refurbishment / Demolition Level survey report has been issued, then ALL of the discovered asbestos (regardless of any perceived relative risk assessment), HAS to be removed BEFORE the onset of the refurbishment or demolition. It is important to remember that an asbestos surveyor (no matter how good she or he may be), cannot guarantee to find every fibre (even the HSE admit that), as to do so, would mean that the surveyor would have to demolish the building!
In my experience, all too many builders / architects / Project Controllers forget about asbestos surveys until the last minute. Very often, an asbestos surveyor is only sent in a few days before the main work is due to start. If it is then found that high fibre release asbestos products are present requiring removal by HSE licensed asbestos removers the project shudders to a halt for a few weeks. The costs of such a delay hugely exceeds the cost of the survey!
There are many HSE publications covering asbestos; one of the principal ones is HSG 264 Asbestos The Survey Guide. PLEASE NOTE that although the various HSE publications are not strictly speaking legal instruments (in the same way that Laws and Regulations are), it is best to work on the basis that they are law effectively part of the Control of Asbestos Regulations 2012 because if something goes wrong and you end up in Court, then if you havent complied with any and every aspect of all this HSE guidance it might be very difficult to prove that youre not culpable in some way.
Failure to Survey / Refurbish Correctly
The HSE take a very poor view of those in charge of / involved with building refurbishment or demolition projects that start work without a proper Refurbishment / Demolition Level asbestos survey and / or starting work before all the asbestos is correctly removed. In July 2017, in the latest in a very long line of HSE prosecutions, three companies were found to be negligent in a school refurbishment project and this resulted in total fines of £1,270,000 and total costs of £240,000. Please dont make the same mistake!
By Liz Darlison, Mesothelioma UK
Chemotherapy with a combination of Pemetrexed and Cisplatin remains the only licenced treatment for Mesothelioma despite supporting evidence for its use being published over 14 years ago (Vogelzang et al 200312). In the decade that followed the licencing of this regime there was a handful of radiotherapy and surgical trials that influenced treatment (Treasure et al 201113, Rintoul et al 201414, ORourke et al 200715) but little happened to alter systemic chemotherapy options. However, the last two years has seen what appears to be a long-awaited turn in the tide.
In 2016, a 2.7 month survival benefit was reported with a publication of the findings from the Mesothelioma Avastin Cisplatin Pemetrexed (MAPS) study (Zalcman et al 201616). Szlosarek et al (2016)17 completed a phase 2 study and reported that arginine deprivation with ADI-PEG20 improved PFS in patients with ASS1-deficient mesothelioma and that further study was warranted. This was followed by initial findings from the KEYNOTE-28 study (Alley et al 201718) that showed, in patients with advanced mesothelioma, an overall response rate of 28% with Pembrolizumab in patients with tumours that expressed PD-L1. Additionally, 48% of patients had stable disease, resulting in a disease control rate of 76%.
Following these breakthrough publications there has been a surge in research interest and activity. Currently there are clinical trial treatment options in diagnostics, radiotherapy, surgery, first, second and third line chemotherapy, immunotherapy, palliative care, experience of care and symptom assessment. In addition, there are numerous novel treatment approaches in development which will further expand options for patients.
Information for clinical teams and patients about clinical trial opportunities is not readily available in NHS clinics across the UK. Clinicaltrials.gov, NHS Choices, Cancer Research UK and Mesothelioma UK all collate a register of availability. To further support this, Mesothelioma UK have a team of Mesothelioma Clinical Nurse Specialists expert in all areas of treatment including clinical trials. To avoid unnecessary referral and travel to specialist centres it is worthwhile contacting Mesothelioma UK via the free phone helpline or email to discuss individual circumstances. One of the clinical nurse specialists will explain about the various trials open, assess potential suitability and provide information about where and how the trials can be accessed.
Mesothelioma UK is dedicated to ensuring equitable access to specialist treatment and the opportunity to enter clinical trials the team of clinical nurse specialists is pivotal to achieving this. To facilitate this further the charity has made funds available to support the cost of patient travel to specialist centres. Patients can apply via their Mesothelioma UK Clinical Nurse Specialist or contact the charity direct.
As well as focusing on access to clinical trials Mesothelioma UK aims to increase funds for basic and translational research that will benefit mesothelioma treatment and care. The charity has stated in its five-year strategy document Dedicated to Making Mesothelioma Matter the intention to increase the grants it makes available for mesothelioma research. To date the charity has released £350,000 in research grants and identified a further £175,000 for this forthcoming year. Information about the grant opportunities is available from the charity or the British Lung Foundation or the National Lung Cancer Forum for Nurses.
In summary, there is considerable interest and activity around Mesothelioma basic, translational and clinical research. Whilst this currently isnt impacting on standard treatments available in every clinic it has significantly increased clinical trial treatment options. This coupled with the sizeable investment Mesothelioma UK has made to ensuring equitable access to specialist treatment will undoubtedly translate into improved outcomes in the future.
Asbestos Victims Support Groups Forum vs. Cape Distribution Limited, Cape Intermediate Holdings Limited, Concept 70 Limited (and others) and Aviva Plc
On August 10, 2017, a judgment was handed down by Master McCloud in the Royal Courts of Justice which has been categorized as significant by those working to preserve historical documents relating to knowledge of the dangers of asbestos 19 Master McCloud ruled that should the application submitted by the Asbestos Victims Support Groups Forum (the Forum) not succeed, the Forum would not have to pay Capes legal costs because of the public importance of the case. To prevent the possibility of potentially vital evidence being destroyed, Master McCloud ordered documents belonging to Cape used in a civil case earlier this year, to be delivered to her office for preservation. In October, 2017 there will be a three-day hearing before the Master to consider which documents could be handed over to the Forum.20
The Jackson Report
The long-awaited Review of Civil Litigation Costs: Supplemental Report Fixed Recoverable Costs known more succinctly as the Jackson Report which was published at the end of July 2017 made an exception for mesothelioma and other asbestos-related lung disease claims as specified on pages 101 and 102; on page 65, the report also highlighted the value of input received from the Asbestos Victims Support Groups Forum (AVSGF) on March 10, 2017: The general view of the AVSGF was that such cases were not suited to FRC [Fixed Recoverable Costs].21 In point 3.3 page 102, Lord Jackson explained his reasons for excluding mesothelioma and other asbestos related lung disease claims from the new cost regime focusing on the complexity of these cases and the efficiency of the Asbestos Lists.
Specialist Asbestos Unit Saved
After a huge public outcry over Department of Work and Pensions plans to shut a benefits unit dealing with asbestos-related disease claims and disperse members of the specialist team from the Barrow benefits office to other locations, a last minute reprieve has been granted. On July 6, 2017, Employment Minister MP Damian Hinds informed Barrow and Furness MP John Woodcock of the government U-turn:
Since January, we have been undertaking detailed planning and negotiating new leases with our landlords and partners. We always said that our proposals were not final and we would consult and assess before making final decisions. This has been a very complex commercial process.
For the majority of our sites we are now able to confirm the plans set out in January, and I have provided a further Written Ministerial Statement today outlining where changes have been made to these. We had proposed to close Barrow Phoenix House in 2018, but we will now be retaining the office until 2023. The Centre for Health and Disability Assessment (CHDA) staff and services currently based at Barrow Phoenix House will relocate to Barrow Jobcentre.22
Cancellation of Parliamentary Asbestos Seminar
The annual seminar held by the Asbestos Sub-Group of the All Party Parliamentary Group on Occupational Safety and Health scheduled for May 9, 2017 was cancelled due to the general election announced by the Prime Minister on April 18, 2017 as a result of which Parliament was dissolved on May 3.
1 Mesothelioma UK. Action Mesothelioma Day 2017.
2 Poignant Derby art display unveiled to pay tribute to victims of asbestos cancer. July 7, 2017.
3 Asbestos in Schools the Need for Action (2012).
4 JUAC Asbestos in Schools Conference 4 July 2017.
5 On June 30, 2017, Public Health England admitted that airborne asbestos had been released by the June 14 conflagration in a carefully worded statement intended to downplay any health concerns:
6 Okolosie L. We cannot compromise safety in schools. Asbestos must be removed. June 27, 2017.
7 Fidderman H. Managing asbestos in schools is no longer a sensible option. July 2017.
9 Message of Solidarity for Action Mesothelioma Day. July 5, 2017.
10 HSE releases annual workplace fatality figures. July 5, 2017.
11 HSE. MESO01 Death certificates mentioning mesothelioma 1968 -2015.
12 Vogelzang NJ, Rusthoven JJ, Symanowski J, Denham C, Kaukel E, Ruffie P, Gatzemeier U, Boyer M, Emri S, Manegold C, Niyikiza C, Paoletti P. (2003) Phase III study of pemetrexed in combination with cisplatin versus cisplatin alone in patients with malignant pleural mesothelioma. J Clinical Oncology. 2003 Jul 15;21(14):2636-44.
13 Treasure T, Lang-Lazdunski L, Waller D, Bliss JM, Tan C, Entwisle J, SneeM, O'Brien M, Thomas G, Senan S, O'Byrne K, Kilburn LS, Spicer J, Landau D, Edwards J, Coombes G, Darlison L, Peto J; MARS trialists (2011). Extra-pleural pneumonectomy versus no extra-pleural pneumonectomy for patients with malignant pleural mesothelioma: clinical outcomes of the Mesothelioma and Radical Surgery (MARS) randomised feasibility study. Lancet Oncol. 2011 Aug;12(8):763-72. doi: 10.1016/S1470-2045(11)70149-8. Epub 2011 Jun 30.
14 Rintoul RC, Ritchie AJ, Edwards JG, Waller DA, Coonar AS, Bennett M, Lovato E, Hughes V, Fox-Rushby JA, Sharples LD, MesoVATS Collaborators (2011). Efficacy and cost of video-assisted thoracoscopic partial pleurectomy versus talc pleurodesis in patients with malignant pleural mesothelioma (MesoVATS): an open-label, randomised, controlled trial. Lancet. 2014 Sep 20;384(9948):11181127.
15 O'Rourke N, Garcia JC, Paul J, Lawless C, McMenemin R, Hill J (2007). A randomised controlled trial of intervention site radiotherapy in malignant pleural mesothelioma. Radiotherapy Oncology. 2007 Jul;84(1):18-22. Epub 2007 Jun 22.
16 Zalcman G, Mazieresm J, Margery J, Greillier L, Audigier-Valette C, Moro-Sibilot D, Molinier O, Corre R, Monnet I, Gounant V, Rivière F, Janicot H, Gervais R, Locher C, Milleron B, Tran Q, Lebitasy M, Morin F, Creveuil C, Parienti J, Scherpereel A, (2016). Bevacizumab for newly diagnosed pleural mesothelioma in the Mesothelioma Avastin Cisplatin Pemetrexed Study (MAPS): a randomised, controlled, open-label, phase 3 trial. Lancet. 2016 Apr 2;387(10026):1405-1414.
17 Szlosarek PW, Steele JP, Nolan L et al. (2017). Arginine Deprivation With Pegylated Arginine Deiminase in Patients With Argininosuccinate Synthetase 1-Deficient Malignant Pleural Mesothelioma: A Randomized Clinical Trial. JAMA Oncol. 2017;3(1):58-66.
18 Alley EW, Lopez J, Santoro A, Morosky A, Saraf S, Piperdi B, van Brummelen E.(2017). Clinical safety and activity of pembrolizumab in patients with malignant pleural mesothelioma (KEYNOTE-028): preliminary results from a non-randomised, open-label, phase 1b trial. Lancet Oncol. 2017 May;18(5):623-630. doi: 10.1016/S1470-2045(17)30169-9.
19 Significant judgment for Asbestos Victims Support Group Forum. August 11, 2017.
20 High Court Judgment of Master McCloud in application by Mr Graham Dring for and on behalf of the Asbestos Victims Support Groups Forum (UK) vs. Cape Distribution Ltd. and others
21 Review of Civil Litigation Costs: Supplemental Report Fixed Recoverable Costs. July 2017.
22 Phoenix from the flames: Barrow benefits office saved from closure. July 6, 2017.
Compiled by Laurie Kazan-Allen