Chemotherapy may not affect survival or quality of life for patients with advanced mesothelioma

May 22, 2008

Researchers from the UK and Australia involved in a multicenter randomized trial have concluded that chemotherapy for advanced pleural mesothelioma may not improve survival or quality of life. The details of this study appeared in the May 17, 2008 issue of The Lancet.1Pleural mesothelioma is a rare and lethal form of cancer caused by asbestos exposure. There are about 2,500 new cases a year in the United States. Because the disease is often advanced at the time of diagnosis, average survival for those with pleural mesothelioma has been significantly less than one year. Recent studies have suggested that chemotherapy can improve quality of life and prolong survival compared with supportive care measures.

The current study compared active symptom control (ASC), with one of two chemotherapy regimens (mitomycin, vinblastine, and cisplatin [MVP] or vinorelbine alone) in 409 patients with advanced pleural mesothelioma. The following table summarizes the main findings of this trial.

ASC MVP Vinorelbine
No. of Patients
Response 0% 10% 16%
Stable Disease 0% 62% 59%
Deaths 97% 96% 95%
Median Survival 7.6 months 8.5 months 9.5 months
PFS 5.1 months 5.1 months 6.2 months

There were no differences in quality of life parameters between the three groups. These authors concluded that the addition of chemotherapy to supportive care did not affect survival or quality of life. However, there was a suggestion that vinorelbine could be more effective than supportive care or MVP chemotherapy.

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California soccer mom in tough match with meso

April 7, 2008

Gloria Serrins is a 54 year-old mother of three beautiful daughters who lives in Mission Viejo with her husband, Phil, to whom she has been married for 31 years. Outgoing, vivacious, and completely dedicated to her family, Gloria now finds herself in a scenario that on one could have predicted.

In July, 2007 Gloria realized that something was wrong with her health. Vigorous, athletic, and normally full of energy, she could feel that something was out of synch, but didn’t know what it was. At first Gloria thought it might be the flu, but that didn’t explain the constant discomfort she felt whenever she was seated.

The discomfort caused her to fidget, and ultimately to have problems sleeping. Since Gloria always slept on her right side, it was too painful to lie down.

Trouble in paradise

Gloria and Phil were approaching their 31st wedding anniversary and he had set up a cruise to Alaska. Normally engaged and excited to be doing things with “the love of her life,” Gloria simply couldn’t muster any excitement about being away from home. The trip was extremely important to Phil so that they could celebrate their marriage, and also because Phil’s father had died at an early age after a lifetime of hard work. “I made up my mind early on that I’d take those extra minutes, hours, and days to be with my family. I miss my father every single day, and vowed that the only thing we really have in life—time—I would share with Gloria and the girls.”

Phil Serrins adores his wife, and he had sacrificed an 80-hour week career track to lead a lifestyle that would let him be there for them. Whether it was the school play, a family weekend trip, or traveling for soccer games, Phil and Gloria pulled together for thirty-one years, always in the same direction, always with the same goals in mind, always bound together by love.

Gloria vowed not to say anything to Phil about the pain because she knew that if he had any inkling, he would cancel the cruise and have her in front of a doctor immediately. The cruise was terrible, with Gloria’s discomfort descending into misery, compounded by an inability to sleep more than a couple of hours each night. Gloria was still afraid to say anything because Phil had developed a pain in his right eye during the trip and she was petrified that they would both be sick at the same time. Unable to withstand the pain any longer, she told Phil when they returned to California, after having endured almost unbearable pain and sleep deprivation on an ocean-bound cruise.

Web detective

Just as she had known he would, Phil whisked Gloria to St. Joseph’s, where a CT scan, MRI, and x-ray revealed spots on her lung. Dr. Brian Palafox was unable to conclusively diagnose, so Phil took charge. He got on the Internet and began consulting with doctors who he knew through his chiropractic practice.

Dr. Palafox affirmed that the only way to get a conclusive diagnosis was via a tissue biopsy. On Oct. 15 Gloria went in for surgery and, and the surgeon performed the biopsy and a talc pleurodesis. Subsequent immunohistochemical staining confirmed mesothelioma, biphasic type. When the Serrins learned that the oncologist recommended by Dr. Palafox only saw one mesothelioma case per year, they decided to continue looking.

Gloria was diagnosed with bi-phasic pleural mesothelioma on October 16, 2007.

Following her diagnosis, Gloria consulted with Dr. Cameron in Los Angeles, and Dr. Rusch and Dr. Pass in New York. All three surgeons determined that Gloria as not a candidate for surgery because of the cell type and advanced stage of her disease. Gloria began treating with one of the nation’s leading medical oncologists, Dr. Vogelzang at the Nevada Caner Institute in Las Vegas.

Despite an aggressive and arduous regimen of chemotherapy, Gloria consulted with Dr. Cameron again after her doctors determined that the Alimta/cisplatin regimen was not working. Unfortunately, she was still ineligible for surgery. Although a different chemo cocktail showed no progression of the tumor, it failed to show that the tumor had shrunk, either.

Chemotherapy has been discontinued, and five weeks from now she will do another CT scan to look into additional treatment. Gloria is struggling her hardest to keep the cancer at bay.

An American family

Gloria was born in 1953 in Goeppening, Germany, the daughter of a U.S. WWII army veteran and a German national. Her father, Francisco “Frank” Carillo, brought the family to the U.S. that same year, and the family relocated in southern California.

Gloria and Phil’s first daughter, Ricki-Ann, was born in1980. The family moved to Mission Viejo because Phil was studying to be a chiropractor. Gloria and Phil’s second daughter, Stacy, was born in 1981, and their daughter Lindsey was born in 1984. After Lindsey’s birth, Gloria became a full time housewife.

The dynamic and loving Serrins family has been built in large part by the unstinting love and devotion of Gloria. The unique character of each daughter was carefully nurtured so that each grew up to be a mature and responsible adult. Ricki-Ann loved being outside, and never played with dolls but liked sports, bikes, and action. Ricki-Ann played little league baseball as the only girl on her team, and later became an accomplished soccer player. Stacy loved play with Gloria’s jewelry, makeup, and clothing. At age three she entered dance school, and learned tap and ballet. Gloria would drive Ricki-Ann to soccer practice and Stacy to dance class and had to coordinate the transportation so no time was wasted. Stacy danced until she was twelve. The family never missed going to one of Stacy’s recitals.

Like her older sisters, Lindsey was always busy with sports and dance, and Gloria spent all her time taking care of the three girls. Gloria would volunteer at the girls’ elementary school until eventually she was at the school every single day. With three daughters at the same school at the same time, she helped the teachers any way she could. Gloria took care of other children as well, and when she became familiar with the kids and their parents she’d set aside Friday as the day to take her daughters and their friends to lunch at Taco Bell. The kids loved having Gloria in the classroom, and Phil would often come by the school on his lunch break. The daughters loved having their parents around at school.
Ricki-Ann graduated from the University of Maryland on a soccer scholarship.

Ricki-Ann is an assistant soccer coach at Tulane University in New Orleans. Stacy attended Santa Barbara City College where she studied art and dance. Stacy graduated from beauty college and works as an esthetician at the Montage Resort at Laguna Beach. Lindsey was recruited to UCLA for their crew team, and graduated in 2005 as a history major. She now works as an elementary school teacher in New Orleans, near her older sister. All three daughters attribute their success to their nurturing, involved, and tireless mother. Gloria’s devotion and dedication to her family, and her extraordinary toughness, are exemplified best when she says, with no trace of pride, “All three of my girls were natural childbirths. I didn’t want it any other way.”

After thirty-one years of marriage, Gloria and Phil have grown together spiritually and emotionally. They both love to garden and spend their weekends together in the yard. With numerous flowers in the yard, the centerpiece is Gloria’s rose garden. Gloria loves crafts, decorating, wildlife, and dogs. She has a blue-gold macaw that chatters gregariously in their home, and two Australian shepherds, Berkeley and Mac. She and Phil love to take their daily promenade around the neighborhood, and they enjoy walking along the nearby nature trails and wilderness areas.

“Gloria always kept things in check and kept me on track,” Phil says in disbelief, shaking his head at the catastrophic calamity that has befallen his family. “She was the one who was reasoned and even-handed with the kids. She never rushes to judgment or breezes past things. Gloria sees life, where most people just run through it. If she’s on skis, she won’t race down the mountain, but will stop and look at the trees and the animals, and even at the snow. We go to movies all the time. While the kids were growing up it was about Gloria being there to see them and raise them. We went to every school function, not just to be supportive but to be together. And now…” his voice trails off, “…this.”


All-American Mom and home decorator puts meso in its place

March 25, 2008

Healthy, active, and always involved in a dozen different projects, Marilyn Stratton’s active lifestyle meant that she was accustomed to lots of physical activity without ever batting an eye.

As a career interior decorator, Marilyn was used to lifting boxes, carrying heavy samples of rugs, tiles, wallpaper, carpets, and countless catalogs that showcased the tools of her trade. Until the summer months of 2006, when she began experiencing pain in her chest, Marilyn had been healthy her whole life long.

Concerned that someone as fit and active as she would be suffering from chest pains, her husband insisted on a visit to the doctor. X-rays taken in early June revealed a build-up of fluid around her lung. Was this pneumonia? The doctor was concerned and insisted on a thoracentesis later that month at St. Vincent’s Hospital in Portland.

What began as a simple chest pain developed into news of the most horrific sort: pathology analysis of the fluid resulted in a diagnosis of malignant pleural mesothelioma.

Circling the wagons

On October, 16, 2006, her doctor performed a biopsy and talc pleurodesis. Like most people diagnosed with mesothelioma, Marilyn had to make a series of complex, rapid-fire decisions with her doctor about what next to do.

The difficulty with meso, of course, is that even the physicians who specialize in its treatment have different opinions on the best course of treatment. The disease is almost individualistic, requiring doctors to carefully weigh their options depending on staging, lymph-node involvement, age, co-morbidity factors, cellular type, and a host of other criteria. All of this must be done at utmost speed, because time is always the enemy.

Marilyn was referred to an oncologist in Portland who had her undergo four rounds of Alimta/cisplatin chemotherapy. Although this regimen is the only procedure approved by the FDA for treatment of mesothelioma, surgeons and oncologists recognize that the best survival outcomes are generally obtained by multimodal therapy that includes surgery as the bedrock treatment.

While she was undergoing chemo, Marilyn was referred to Dr. Eric Vallieres at the Swedish Cancer Institute in Seattle for a surgical consultation. One of the nation’s leading meso surgeons, after meeting with Marilyn Dr. Vallieres concluded that she was a candidate for the surgery. Marilyn decided to undergo an extra-pleural pneumonectomy (EPP) with Dr. Vallieres.

Girding for battle

In the work-up prior to surgery, it was discovered that Marilyn had a lump in her throat. On January 5, 2007, Dr. Vallieres performed a mediastinoscopy. Pathology analysis of the node was negative for malignancy. This was a huge relief to Marilyn, because the lymph nodes are the super-highway of the body, capable of instantly spreading cancerous cells to distant locations. Because the node was not malignant, the surgery could go forward as planned.

This major operation went extraordinarily well, owing in part to the skill of Dr. Vallieres and in part to the toughness and resiliency of Marilyn. She came through it with flying colors and was on the fast track for the day that every patients dreams of: a hospital discharge and ticket to go back home.

Aftershocks

One week after surgery, however, Marilyn got a lung infection and had to go back into the hospital for antibiotics to quell the infection. Having only one lung, any type of viral attack could be critical. From the end of January through the onset of radiation was when she felt the worst. She was weak, out of breath, and not feeling good for months. The combination of the infection and the inflammation had taken a toll early on in her recovery, but as a strong and tough fighter she finally she got beyond it.

One consequence of the EPP that has remained with Marilyn is chronic shortness of breath. She was admitted to Swedish Hospital in Seattle in March to determine the cause of the shortness of breath. As soon as the testing for the cause of her shortness of breath is completed, Marilyn is scheduled to begin a course of 30 radiation treatments that will be administered over a period of six weeks.

Calm waters

Marilyn had a December consultation with her pulmonologist and surgeon, as well as a CT scan, and the results were completely clear. Her next scheduled appointment is in April. As a result of the CT scan she’s been taken off all her medicines: heart medications, coumadin, Alimta/cisplatin, prednisone (steroid for post-surgery infection and inflammation in remaining lung, high dosage), prilosec, sulphasalazine (colitis—still taking), metotrolol (heart medication), warfarin (heart medication), magnesium because level had dropped post surgery (quickly regained normal rates), oxycodone (painkiller), and zofran (anti-nausea drug to combat side effect of steroid).

Dr. Vallieres is very optimistic and has been positive through the whole process. Even during the lung infection he said it was “just a bump in the road,” and is very pleased with the good health and strength of this courageous woman. The pulmonologist said that she would never completely get her breath back, but time would tell and significant improvement has always been a reasonable and very attainable goal. The radiologist said that she had every reason to be optimistic because it appeared that the chemotherapy did a very good job. Dr. Vallieres’s skillful hands seemed to have removed all of the gross tumor, and the radiation had “sterilized the area.”

Marilyn is constantly amazed at how an extremely busy surgeon like Dr. Vallieres seems to have all the time in the world for her when she’s in his office. “He’s so friendly and always gives me a hug. He’s very different from many of the other physicians with whom I’ve had to deal,” Marilyn says with a laugh.

Marilyn couldn’t be happier about the results of the CT scan and being “cancer clear.” Although she doesn’t feel 100% yet, she’s very pleased with her status. She’s feeling better and her friends tell her she looks wonderful.

Living with mesothelioma

Marilyn’s life has been night and day different since surgery. Before, she rarely sat down, was a workaholic, always healthy, and didn’t tire easily. Meso has pulled her former lifestyle up short. During these last few months Marilyn has led a totally different lifestyle. She used to walk five miles twice/weekly, and all her other activities and she worked full time.

Marilyn continues to amaze the doctors who treat her. She’s already made a habit of walking 1.25 miles, and her GP was astounded. To Marilyn the recovery has gone slowly but in perspective she thinks the recovery has been fast. She doesn’t have the strength for pulling fabric off shelves and putting them back up again, or for furniture delivery and hoisting large area rugs she used to carry by herself. On the other hand, she’s discovered that the world has no shortage of people who make a living doing these very things!

Her skills as a decorator have been showcased in three “Street of Dreams” homes and a number of “Showplace Homes” in the Portland area during her lengthy and respected career. At the spry and vigorous age of 73, Marilyn is still coping with the dent that meso has made in her active, productive, and fulfilling lifestyle prior to the onset of symptoms.

Marilyn and her husband Richard once kept active by going on walks together. Their favorite place was at downtown Portland’s waterfront. Now, she is out of breath after simply walking across the room. This has made getting around their multi-story home difficult and painstaking.

In recent years, Marilyn and Richard traveled the world together. Singapore, Bangkok, Canary Islands, New Zealand, Australia, and an annual trip to Mexico are just a few of the destinations they have enjoyed.

A loving mom and grandmother, Marilyn also enjoys spending time with her two daughters, Susan and Shari, both of whom live nearby. She also enjoys spending time with her five grandsons, three of whom are students at Oregon State University, of whom is serving in the U.S. Air Force, and one who is in high school. With courage and an indomitable will, Marilyn continues with great cheer and grace.


Phase II trial of pemetrexed and gemcitabine in chemotherapy-naive malignant pleural mesothelioma

March 20, 2008

PURPOSE: Pemetrexed and gemcitabine have single-agent activity in malignant pleural mesothelioma (MPM). The combination of pemetrexed/gemcitabine has not previously been studied in MPM to our knowledge.

PATIENTS AND METHODS: Patients with histologic or cytologic diagnosis of MPM were included. Cohort 1 received gemcitabine 1,250 mg/m(2) on days 1 and 8, with pemetrexed 500 mg/m(2) on day 8, and cohort 2 received gemcitabine 1,250 mg/m(2) on days 1 and 8, with pemetrexed 500 mg/m(2) on day 1. Cycles were repeated every 21 days; all patients were supplemented with folic acid and vitamin B(12) and received dexamethasone. Results One hundred eight patients (cohort 1, n = 56; cohort 2, n = 52) with pleural mesothelioma were enrolled. Among assessable patients, response rate was 26.0% in cohort 1 and 17.1% in cohort 2. Median time to disease progression was 4.34 months for cohort 1 and 7.43 months for cohort 2. Median survival was 8.08 months for cohort 1 (1-year survival = 31.14%) and 10.12 months for cohort 2 (1-year survival = 45.80%). In cohorts 1 and 2, incidence of grade 4 neutropenia was 25.0% and 29.4%, grade 4 thrombocytopenia was 14.3% and 3.9%, grade 3 or 4 anemia was 5.4% and 5.9%, and grade 3 or 4 fatigue was 23.2% and 15.7%, respectively.

CONCLUSION: The combination of pemetrexed and gemcitabine resulted in moderate clinical activity in MPM. However, the median survival times are similar to those with single-agent pemetrexed and inferior to outcomes observed with cisplatin in combination with an antifolate.

1: J Clin Oncol. 2008 Mar 20;26(9):1465-71, Jänne PA, Simon GR, Langer CJ, Taub RN, Dowlati A, Fidias P, Monberg M, Obasaju C, Kindler H.

Corresponding author: Pasi A. Jänne, Dana Farber Cancer Institute, Lowe Center for Thoracic Oncology, 44 Binney St, Dana D820A, Boston, MA 02115; e-mail: pjanne@partners.org.

PMID: 18349397 [PubMed – in process]


Getting ready for Alimta/cisplatin chemotherapy for mesothelioma

March 19, 2008

This was written by Lois Schwarting, regarding her husband’s experience with Alimta/cisplatin chemotherapy for his mesothelioma.

Marty and Lois Schwarting

Marty got Alimta/cisplatin. Carboplatin is a little bit easier on the body, or at least easier on the kidneys. Here’s some things to do to prepare for the chemos! If your husband has more trouble with being constipated than he does having loose stools, buy a stool softener and have ready for him. Here in the states we can easily get Dulcolax and that is what Marty uses.

Now, with Alimta Marty was to take folic acid something like 600 to 1000 mcg or 1 mg each day for one week prior to chemo. We bought 400 mcg tablets at COSTCO–anyhow, he took one tab in a.m. and one tab in evening since two to take for good dosage. I have decided to scan his calendar for last May (2007) and you can see how I marked calendar so be sure to have him taking his meds properly! Guess better to know what your husband is going to be given as chemo b4 tellyouwhat all….

Ah! Anyhow, using Alimta/cisplatin…Day before, day of and day after chemo – dexamethasone to be taken twice day. Day following chemo go back to doc office for Neulasta shot (this is to increase white blood cells to help fight off any infection or bacteria from ANYTHING – because the chemo is hopefully going to destroy all cells, including cancer ones, but it is not “smart enough” to detect the good red and white cells are needed so destroys them too. So, reason for the Neulasta and also the B12 shots the doc will give you as necessary! Anyhow the Neulasta shot can cause bone pain and/or body rash or itching, so we were told to buy over-the-counter Claritin D & Aleve and Marty was to take one tablet of each after receiving the Neulasta shot – we bought on way home and he swallowed them with water when we got home. He took one of each of those tablets the day of the Neulasta shot and one of each tab on all three days following. Marty did not have any bone pain, and he did not have any rash. Some times he would have some itching, but slight.

To begin with, Marty had his chemo on Thursday. One week we switched it to Friday, and so he went back for his Neulasta shot on Monday, and it didn’t seem to make any difference.

Now, on the calendar, you will see where I had written blood draw on Wednesdays. That is because he was to have his blood drawn the day prior to chemo infusion. If his blood counts were too low, the doctor would not have given him chemo the next day. However, he never had that problem and always was able to get the chemo every 21 days until he had a total of 7 infusions.

Marty was released from hospital, Mar 9, 2007.

On Mar 14, 2007 he went to doctor office and agreed to chemo and we were told which meds used and given Rx for dexamethasone. Marty was given a B12 shot and we were told to get the folic acid and he was to start on that the same day so he would be on it for one week prior to chemo. (also, be aware that ALWAYS schedule and plan to take Folic Acid (FA on my calendar notes) every day and mark out at least 21 days from the day of chemo — NO MATTER WHAT… Because even at the end of chemotherapy, the patients are to take folic acid for 21 days following last Alimta chemo treatment.

Be sure you have a prescription for compazine (brand name) was given for nausea – JUST IN CASE! We got that filled, as well. Oh, note that I wrote compazine on the days of chemo as well as the day following chemo. YOU DO NOT WANT TO WAIT UNTIL NAUSEA SETS IN AND THEN TRY TO FIGHT IT. TRY TO WARD IT OFF BY TAKING THE COMPAZINE AFTER YOU GET HOME THE DAY OF CHEMO, AND TAKE EVERY 4 HOURS TIL BEDTIME. NEXT A.M. start the day off with compazine and continue every 4 hours. If not trouble with nausea, could discontinue taking it.
Ask for a prescription of Ondansetron Orally Disintegrating Tablets (ODT) – they are a bit expensive and may have to get prior approval by insurance. We had to! I’d actually gotten these before we were to go on a cruise in case Marty might have problems with nausea even though would be off chemo by then. We happened to have in the house already when he got the “dry heaves” and I gave him a tablet and it stopped the dry heaves RIGHT NOW! YEP, RIGHT NOW IT WORKS!

FOOD: I made puddings and soups and gravy with WHOLE MILK (not less fat or fat free) and even used HALF & HALF. I tried whipping cream but it was so rich and thick it was yuck or not good! The texture more like ice cream! Anyhow, I hope you like to make home made food, Marjory. If so, cook lots of fresh vegetables and protein foods. It is better for your husband to eat small portions several times a day — try to get him to eat every 3 hours or so. Use plastic sandwich bags or some small containers to freeze little “meals” for your husband to eat “on demand”…. if you have food put away in the freezer from each meal you cook, you can say: “I have ________, _________, ___________ and __________ tell me which one you want! Then, you can just reheat and give him a meal.” At first Marty liked sweets, and I’d made triple batches of strawberry/rhubarb cobbler and would freeze packages of it. I’d make puddings. Bought all kinds of fresh fruits. Had bought Ensure for him. After his second chemo he no longer wanted to eat sweets – the “taste buds” on the tongue are affected by chemo! He liked salty foods! Like pork roast cooked with sauerkraut. Dill pickles.

He has ALWAYS wanted to eat eggs and though you will read to make sure you cook the eggs until they are “hard” we did not abide by that!

If your husband likes deviled eggs (cut the hard-boiled egg in half, scrape out the yolk and mix with “stuff” then place back in the hard-cooked white of the egg) – fix some of them for him. At first I would mix the yolk with mayonnaise and little bit of mustard and maybe bit of chopped onion for more flavor. When he wanted “salty” or “sour” type, then I would add some vinegar to the yolk.

Anyhow, EVERY SINGLE MORNING SINCE CANCER WAS DIAGNOSED, I have fixed him two eggs “over easy” (with the yolk still runny), two slices of bacon, one slice of wheat bread, and gravy made with milk or half and half and the bacon drippings. He has ALWAYS LIKED THAT. Before cancer I did not cook breakfast for him. I worked and he often times would not even eat breakfast. Since “Mr. Meso” breakfast is his FAVORITE MEAL of the day, and so I always fix it for him about 1/2 hour after he awakens.

Chemo calendar

For a full profile on Marty and Lois, click here.


Anti-cancer drug CYT997 update

March 14, 2008

Cytopia Limited (ASX: CYT) has commenced dosing patients in the first of a suite of Phase II clinical studies for its vascular disrupting agent (VDA), CYT997. These studies will investigate the activity of this anti-cancer compound in specific cancer types with high unmet medical need and poor prognoses.

VDAs are a new class of drugs to treat cancer and have potential for “blockbuster” sales in the treatment of vascularized tumors. CYT997 has a dual mechanism of action shutting down established blood vessels that supply the tumor with nutrients and oxygen and also direct cytotoxic properties. Capable of being delivered orally as well as intravenously, the compound was discovered by Cytopia scientists in 2003 and an Investigational New Drug application was accepted by the US Food and Drug Administration in 2005 to commence Phase I studies. During the 2008 financial year Cytopia has: — commenced dosing in its first Phase II study — finalized preparations for its second Phase II study — concluded its first Phase I safety and tolerability study with intravenous administration — continued dose-escalation in its Phase I capsule dosing study (oral administration)

Phase II clinical programs

Following favorable findings in mesothelioma patients in Cytopia’s Phase I trial, the company is undertaking feasibility analysis for a Phase II study in mesothelioma patients who have failed the currently approved drug, Alimta (pemetrexed). This single-arm study of 20-30 patients would potentially be conducted at multiple centers in Australia, the United States and Asia. Activity in second-line mesothelioma could lead to expedited drug approval and a fast-to-market strategy for the compound in this cancer indication. It is anticipated that appropriate regulatory submissions to support this study will be filed in the third quarter of 2008.

Click here for the full press release: http://www.cytopia.com.au