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| Dr. Robert Cameron |
Dr. Robert Cameron, Director of the UCLA Comprehensive Mesothelioma Program and Chief of Thoracic Surgery at the West Los Angeles Veterans’ Administration, served as the course organizer and chair. Dr. Cameron has over 19 years of experience treating patients with MPM. He has been an ardent supporter of lung-sparing therapies, including the pleurectomy/decortication surgical procedure, and a number of complementary adjuvant therapies with the goal of treating the deadly disease like a chronic illness, similar to hypertension and diabetes.
“Seeing The Light” About Lung-Sparing Pleurectomy/Decortication
This year’s speakers included Dr. Raja Flores, Chief of Thoracic Surgery at Mt. Sinai Medical Center in New York. Dr. Flores explained that, based on the training he received at Brigham and Women’s Hospital/Dana Farber Cancer Institute in Boston where Dr. David Sugarbaker serves as Chief of Thoracic Surgery, he was “biased” toward extrapleural pneumonectomy (EPP). The EPP is a radical surgery which involves removal of the pleura-based tumor along with the adjacent lung, diaphragm and portions of the pericardium.
Dr. Flores explained that a few years ago, he learned about what Dr. Robert Cameron had been doing with the pleurectomy/decortication (PD) procedure, a much less radical surgery for MPM in which the pleura-based tumor is carefully removed and the healthy lung is spared. A closer look and appreciation for Dr. Cameron’s approach prompted Dr. Flores to review all available data comparing EPP to PD.
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| Dr. Robert Cameron and Dr. Raja Flores |
While Dr. Flores was not surprised to learn that surgical mortality rates for the less radical PD were lower, he was surprised to learn survival rates for PD were marginally better than EPP. Furthermore, the survival rates for PD were as good if not better than EPP for patients with Stage I, Stage II, Stage III and Stage IV tumors.
After reviewing this data, Dr. Flores said he had “kept an open mind” about PD. He performed a number of PD’s and found that he was usually able to achieve the same level of tumor resection, even when tumor was present in the fissures and around the aorta.
Dr. Flores jested that he “loves” doing EPP, which is a much faster procedure, and “hates” doing PD, which is a much more meticulous and lengthy procedure. But he stated that he now favors PD because he believes that in most instances it will provide the patient with a better quality of life. Harder for the doctor, but better outcomes for the patient!
Dr. Flores was joined by Dr. Cameron for a Q&A session where it was revealed that these two mesothelioma specialists had never spoken until a few days before the symposium. The two of them acknowledged that the only randomized trial involving EPP, the 2011 MARS trial from the U.K. which found no advantage to EPP over alternative lung-sparing therapies, has been shot down by many in the U.S. including Dr. David Sugarbaker. Dr. Flores acknowledged that for many surgeons, ego comes into play and they are compelled to do the biggest and most aggressive operation.
Dr. Flores stated that, in his mind, “there must be a difference in survival by a number of years in order to justify doing a big surgery like EPP.” Because the statistics do not reveal any increased survival over PD irrespective of staging, Dr. Flores now approaches every MPM surgery with the intention of doing a PD.
Other Lung-Sparing Therapies
Symposium attendees were also treated to presentations concerning important developments in other lung-sparing therapies and diagnostic techniques for MPM.
Dr. Anne S. Tsao, Director of the Mesothelioma Program at MD Anderson Cancer Center in Houston, Texas discussed recent developments in the identification of molecular or biological markers to determine what treatments are best for a particular MPM patient.
Dr. Michael Fishbein, Chief of Pathology at the David Geffen School of Medicine at UCLA, spoke about the challenges of diagnosing MPM and the use of immunohistochemical staining.
Dr. Nir Hoffman, Director of Thoracic Anesthesiology at the David Geffen School of Medicine at UCLA, discussed the specialized anesthesiology techniques that must be used during a PD. Dr. Hoffman noted that the level of specialized skill required from the entire surgical team, not just the surgeon, emphasizes the need to have a PD done at a treatment center that has established expertise with the procedure. This is a critical factor as it often takes 2 or 3 times longer to perform a PD and an EPP, which means in many cases the anesthesiologists will need to work in shifts.
Dr. Courtney Broaddus, Chief of Pulmonary and Critical Care Medicine at the University of California at San Francisco spoke about recent developments in the use of molecular agents to “prime” tumor cells in order to enhance the effectiveness of systemic treatments for MPM.
Dr. Robert Cameron also spoke about future therapies involving the genetic altering of stromal cells, which are the non-cancerous cells within a cancerous tumor. He is investigating whether altered stromal cells inserted following removal of the tumor during a PD could create an environment which makes it more difficult for tumor cells to grow, thereby reducing the incidence of tumor recurrence. Dr. Cameron plans to continue this research at the Pacific Meso Center.
Dr. Warren Grundfest, Professor of Bioengineering, Electrical Engineering and Surgery at UCLA, spoke about his exciting research into a system to identify and eradicate tumor cells which remain following removal of the tumor during a PD. The system would use fluorescent lifetime imaging to identify tumor cells that remain once the tumor has been removed and then treat these cells intraoperatively via liquid nitrogen cryoablation. The goal would again be to reduce the incidence of tumor recurrence following surgery. Dr. Grundfest plans to continue this research at the Pacific Meso Center.
Dr. James Moore, Professor of Anesthesiology at the David Geffen School of Medicine at UCLA, spoke about long term pain management options for MPM.
Nurse Anne Rorie from the Comprehensive Mesothelioma Program at the David Geffen School of Medicine at UCLA spoke about the initial evaluation and treatment of pleural effusions, which often precede a diagnosis of MPM.
Non-Medical Presentations
Symposium attendees were also treated to a number of non-medical presentations that were of great interest to those involved in the treatment of, or whose lives have been affected by, MPM.
Dr. James WaterNaude, a Public Health Medicine Specialist from South Africa, gave an informative and disturbing presentation about this history of asbestos mining in South Africa and the resulting incidence of MPM and other asbestos-related illness in the country.
Linda Reinstein, President of the Asbestos Disease Awareness Organization, gave a timely presentation on global trends and challenges in preventing environmental and occupational asbestos exposures. Many in attendance were surprised to learn that asbestos use had still not been banned in the U.S. Ms. Reinstein has long been a leader in the effort to ban asbestos in the U.S. and abroad.
Clare Cameron, Executive Director of the Pacific Meso Center, gave an informative and optimistic presentation on the Pacific Meso Center’s ambitious research agenda and the ways in which patients and families can support this much needed research.
The Patient’s Perspective—Patricia Crawford
The symposium concluded with an uplifting presentation from 5-year mesothelioma survivor, and Worthington Law Firm client, Patricia Crawford. Pat is a shining example of Dr. Cameron’s approach to using a combination of lung-sparing therapies to treat MPM as a chronic illness.
Pat underwent a PD performed by Dr. Cameron at UCLA in January 2008, followed shortly by 5 weeks of radiation treatments. Since then, Pat has been closely monitored by Dr. Cameron and has received over 25 cryoablation treatments performed by Dr. Fereidoun Abtin, a Thoracic Radiology doctor with the UCLA Comprehensive Mesothelioma Program, to knock down early signs of tumor recurrence.
Pat credited Dr. Cameron and his team with saving her life and allowing her to be present for the births of five great-grandchildren and the weddings of four of her grandchildren. She also shared many priceless family moments that she has experienced over the last five years. Pat vowed to keep on fighting, promising that “as long as Dr. Cameron and Dr. Abtin stick by me, I’ll keep giving it all I have!”
The Premier Conference on Rational Treatment Options for MPM
In its second year, the Pacific Meso Center’s Symposium on Lung-Sparing Therapies has quickly established itself as the premier conference on current and future rational treatments for MPM. The conference serves as an unrivaled source of information on lung-sparing therapies for physicians and doctors alike.
The Pacific Meso Center plans to release videos of the symposium presentations on its website www.pacificmesocenter.org in the coming weeks.
