Putting Out the Fire: Working Toward a Strategy to Kill Mesothelioma if it Recurs

Mesothelioma can be like a campfire that won’t go out.

Even with the best surgical technique, chemotherapy and radiation, every doctor worth his or her salt will tell you that none of these therapies – alone or combined – will always put out the fire completely.

You can pour water on it, stomp on it and try to smother it, but no matter how diligent you are, the odds are if you dig deep and look hard enough you’ll find a glowing ember. Over time, that ember can eventually catch fire and spark a wildfire.

The word for that is “recurrence.”  As in, we’ll slash, poison or burn as much tumor as we can see, but after it’s all said and done there will still be micro-tumors seeding in your chest, which can eventually grow into a bigger tumor.

That’s not comforting. What is comforting is knowing that smart people are working on strategies to knock down recurring tumors before they can spark a wildfire. 

I’m pleased to continue supporting this important research initiative with another $100,000 donation to the Pacific Mesothelioma Center.  The scientists and doctors at PMC have developed a novel way of treating mesothelioma recurrences with cryoablation. The strategy involves delivery of compressed argon gas through a needle which freezes and kills the tumor cells on contact. The treatment is minimally invasive and can be done on an outpatient basis.

Cryoablation is currently being used to treat mesothelioma recurrences at the Comprehensive Mesothelioma Centers at both UCLA Medical Center and the West Los Angeles Veterans Administration Medical Center. 

  

PMC is researching ways to enhance the effectiveness of cryoablation by combining it with cancer vaccines.   

At Worthington & Caron, we see every day the stress endured by mesothelioma patients. Not only do they have to worry about finding the right doctors to treat their cancer, they also have to contend with the probability that even if all goes well, they’ll still need to deal with a recurrence.

Mesothelioma patients are fortunate to have access to the Comprehensive Mesothelioma Centers at UCLA and the West Los Angeles VA. Doctors at each venue are uniquely qualified to both put out the fire, and knock it down again if it flares up down the road. 

Sincerely,

Roger Worthington

6/9/15

UCLA Health Releases New Video Chronicling Treatment of Six-Year Meso Survivor Martha Munoz

Martha and Arturo Munoz

On March 23, 2015, UCLA Health released a new video which chronicles the medical treatment of Worthington & Caron, PC client Martha Munoz. Martha was 68 years old when she was diagnosed with malignant pleural mesothelioma in March 2009. Her husband Arturo states in the video that Martha’s doctors were giving her only 9 to 10 months to live.

In April 2009, Martha consulted with Dr. Robert Cameron, thoracic surgeon and director of the Comprehensive Mesothelioma Program at UCLA Medical Center. The video chronicles Martha’s treatment at UCLA, beginning with a lung-sparing pleurectomy/decortication surgery performed by Dr. Cameron in May 2009.

“Surgery is actually the most reliable treatment,” Dr. Cameron states in the video, “The goal is to remove all tumor we can see and take it off the lung and leave the lung in place." 

The video shows a striking comparison of radiology films of Martha’s right lung before and after the surgery. The “before” films show tumor encasing and compressing the lung, making it extremely difficult to breathe. The “after” films show all visible tumor gone and the lung expanding fully to the rib cage.

Following the surgery, Martha’s treatment included chemotherapy, state-of-the-art tomotherapy and novel cryoablation therapy which freezes and destroys new small tumors.

As Dr. Cameron explains, “Our idea is to treat this as a chronic disease, so what we do is use surgery to get rid of all the tumor we can see and use the other things like radiation, immunotherapy and cryoablation to keep it that way, just like we do with other chronic diseases that people can live a long time with.”

The video reports that six years after her diagnosis, Martha is now cancer free. “This is what you call a miracle,” says Arturo. While Martha states, “We are a very close family, and with God’s help and Dr. Cameron’s help, I can have a healthy longer life.”

To schedule an appointment with Dr. Cameron:

Contact his office at (310) 470-8980.

Dr. Cameron sees patients in consultation at his Los Angeles, California clinic located at:

Thoracic Surgery Associates

10780 Santa Monica Boulevard, Suite 100

Los Angeles, CA 90025-7613

Percutaneous Outpatient Cryoablation for Localized Recurrent Pleural Mesothelioma Following Lung-sparing Pleurectomy and Decortication Surgery

As presented by Dr. Robert Cameron at the 11^th International Conference of the International Mesothelioma Interest Group (iMig) 

Boston, MA – September 11-14, 2012

Recurrence for patients with malignant pleural mesothelioma is extremely high following surgery, most patients are ineligible for repeat surgery and management of mesothelioma is among the most challenging of cancer therapies. Many of our clients have experienced good results with post-surgery cryoblation therapy. (including Martha Munoz, Patricia Crawford and Sylvia Ramirez) 

Cryoablation for localized recurrent malignant pleural mesothelioma following surgery can be performed safely as an outpatient procedure. It is a minimally invasive procedure, which uses a needle to target argon gas directly to the tumor killing the cells it touches in a relatively safe and quick manner. It can be performed on multiple lesions at a time and is also a safe and relatively quick method to control pain and improve the patient’s quality of life.

Doctors at UCLA have published a promising study with the International Mesothelioma Interest Group which identifies 24 UCLA patients who have received one or more cryoablation treatments for localized recurrence of malignant pleural mesothelioma following surgery with or without adjuvant therapy. The patients in the study were found to have a minimal morbidity rate of 5.6%, a very high efficacy rate of 95.3%, and an impressive overall survival rate of 36.1 months.

Currently only a handful of centers specialize in the use of cryoablation in the management of mesothelioma, most notably diagnostic radiologists, Dr. Fereidoun Abtin and Dr. Robert Suh at UCLA.

Meso Empowerment Exclusive: Dr. Cameron shares his brilliant insights on breakthrough moments at IMIG Conference in Boston or, Galileo is Smiling

Dr. Robert Cameron
iMig 2012

Dr. Robert Cameron, thoracic surgeon and mesothelioma specialist, was kind enough to provide us with his tweets as he attended the recent IMIG conference in Boston. His “boots on the ground” tweets were simply too compelling to leave alone so we followed up and asked him to elaborate

If you’re reading this, you’re no doubt aware of Dr. Cameron’s pioneering efforts to re-introduce “rationality” to the macho “bigger is better” mentality that unfortunately has tended to dominate meso surgery in the US. Although his pleurectomy/decortication (P/D) model is now becoming not only accepted but strongly endorsed, it wasn’t always this way.

I remember vividly at a meeting among surgeons 12 years ago where his fellow surgeons literally shussed Dr. Cameron when he tried to speak up against powerful, East Coast-driven forces who decreed that their big gnarly “extra-pleural pneumonectomy” (EPP) was as unassailable as a papal decree. For years, Dr. Cameron toiled away, mainly in the dark, while the spotlight remained brightly fixed on the “curative” EPP. But he never lost faith.  Like so many myth busters of lore (Galileo comes to mind), Dr. Cameron’s belief that removing the tumor and sparing the lung was the only rational way.

I can’t speak for Dr. Cameron, but for this cancer warrior, it feels good that his brethren have finally embraced the P/D on which Dr. Cameron based his career and his passion.

Here’s a few of the good doctor’s tweets and the follow up.

Enjoy the read and keep questioning, searching, learning and leaning towards the light.

*   *   *   *   *  

IMIG 2012: for the future of treatment of mesothelioma: the future is clearly immunotherapy!

Why is Dr. Cameron so optimistic? Let’s ask.

Dr. Cameron: Although we are only just now learning how to harness the power of immunotherapy, there is already evidence from decades ago that something as simple as stimulation with IL-2 into the pleural space can result in survivals that have rivaled "trimodality therapy" with median survivals as long as 28 months.

Furthermore, the immune system when it does work has been shown in other cancers, such as melanoma and renal cell carcinoma, to eradicate even bulky disease. We are now on a new learning curve with better understanding not only of what it takes to stimulate an immune response but what it takes to reverse the tumor-mediated escape mechanisms present at the actual tumor site. With the accelerated development in this field that has happened over the last few years, we should make good progress in the near future.

*   *   *   *   *  

IMIG 2012: Steven Albelda confirms that immunotherapy is a very promising treatment for mesothelioma.

Dr. Steven Albelda
iMig 2012

No need for explantion here. Dr. Cameron’s succinct appraisal speaks for itself. Good news! I remember years ago when I was a director on MARF feeling proud to help sponsor Dr. Abelda’s futuristic benchwork research. Smart guy. Good guy. Glad Dr. A is on the team.

David Sugarbaker: "Can't we all just get along and operate on mesothelioma?"

Funny question, coming from the Pope of the EPP himself who for years dominate the conversation, owned the paradigm, and didn't give much heed to his few naysayers. Let’s face it, we love a title fight between heavyweights, so I couldn’t resist asking Dr. C for his reaction to the EPP’s loudest and most cocksure advocate sudden plea for tolerance. Is Dr. S presuming that surgery, no matter what form it takes, must be bedrock of every treatment regimen for meso?

Dr. Cameron: Despite the continued lack of randomized prospective trials showing exactly what, if any, benefit that surgery offers, Sugarbaker must be feeling the heat of all the mounting data that EPP is not necessary.  In my view, he’s now trying to deflect that argument and avoid controversy by calling on all surgeons regardless of which operation you perform to tell medical oncologists and pulmonologists that surgery forms the cornerstone of treatment.

*   *   *   *   *  

IMIG 2012: David Sugarbaker admits that "EPP has no superiority" as an operation over pleurectomy and decortication

Dawgies! Is this one of those “Yes, the earth revolves around the sun” belated acknowledgements? So, Dr. C, why is this such a big deal (picture me feeding the tiger a little red meat).

Dr. Cameron:  “You're kidding right? Most of the posters at this meeting were people trying to do EPPs because they are all under the impression that the "data" shows that it is better.  [Which unfortunately means that for too many ‘get her done’ surgeons with yank-the-lung-it is the earth continues to be the center of the universe….].

*   *   *   *   *  

IMIG today: Sugarbaker admitted that he is now doing 2/3 pleurectomies for mesothelioma....a huge change from a few years ago

This is a radical reversal. We asked Dr. C if he knew whether the Titan of Tri-modal had ever publically debunked or disparaged PD for meso?

Dr. Cameron: “I’m not sure he’s ever disparaged the P/D for meso directly but he has said that the only curative operation for the disease was the EPP. “

*   *   *   *   *  

Pac Meso Center’s Presentation: "The timing of chemotherapy in the multimodality treatment of malignant pleural mesothelioma" received praise from IMIG.

Congratulations!  To read the abstract of this presentation (by Dr. Cameron), please click here.

Note, it was great to learn that the other surgeon who helped form MARF back in the day (1999), Dr. Harvey Pass, one of the most talented, gifted and intelligent doctors on the planet, complemented the presentation and agreed that chemotherapy may not be such a crucial part of "trimodality" therapy (patient ALWAYS want to avoid chemo; losing their hair, nausea, vomiting, etc.) Thank you Dr. Harvey Pass, one of my heroes in the topsy-turvy turbulent Mesoworld.

Our Presentation: Percutaneous outpatient cryoablation for localized recurrent pleural mesothelioma was likely the highlight of IMIG meeting

This is great news. My law firm is particularly proud of this since cryoablation has been used successfully on several of my meso clients (including Martha Munoz, Patricia Crawford and Sylvia Ramirez) who were relieved and impressed with it’s ease, efficiency and results.

The Pacific Meso Center is currently writing two papers that will be published soon. Consequently, since journals won’t publish anything that’s already been publically circulated, the PMC cannot a this time post it’s powerpoint slides on the internet. Dr. Cameron did however reveal, happily, if not surprisingly, that Dr. Sugarbaker mentioned cryoablation specifically as one of the highlights of info being presented. High praise from the High Priest of Meso! And well should the Big Guy be impressed – preliminary data show that the practice for recurrent patients was effective in 95% of the cases.

*   *   *   *   *  

David Sugarbaker TOTALLY BACKS OFF his beloved EPP to "MCR" Macroscopic Complete Resection, which is code for pleurectomy and decortication

We asked Dr. C to flesh out what this means for the typical meso patient. The backstory of course is that Dr. C has always pointed out that total eradication of all tumor is a pipe dream and they only reasonable goal was the removal of all “visible” tumor? (Note to patients – make sure your surgeon is wearing telescopic lens gear).

Dr. Cameron:  Yes, that’s been my common sense approach, but the EPP crowd never embraced this until now. This basically recognizes that what I have said for decades is actually now widely accepted and people like even Dr. Jablons who abandoned P/D for EPP were bowing to peer pressure not acting on data.”

Well, dear readers, hope you enjoyed the ride. It’s been fun. Please drop us a line if you want to learn more. In the meantime, praise hope!

RGW

Sept. 18, 2012

Roger G. Worthington

International Panel of Medical Specialists Convene for First-Ever Medical Symposium Dedicated to Lung-Sparing Therapies for Patients With Malignant Pleural Mesothelioma

The UCLA Mesothelioma Research Program, in conjunction with the Pacific Meso Center, held the 1st International Symposium on Lung-Sparing Therapies for Malignant Pleural Mesothelioma on May 21 in Santa Monica, California. The Law Office of Roger Worthington was proud to co-sponsor this first-ever medical seminar focusing on treatment options for patients with pleural mesothelioma.

In recent years, a growing number of the world’s top mesothelioma experts have questioned the value of a radical surgical procedure known as extrapleural pneumonectomy, or EPP, which involves removal of the pleura-based tumor along with the adjacent lung, lymph nodes, portions of the pericardium and the diaphragm. Despite a 60 percent complication rate, the radical surgery continues to be advocated by a number of leading mesothelioma specialists, including Dr. David Sugarbaker of Brigham and Women’s Hospital/Dana Farber Cancer Institute in Boston.



(left - right) Mr. David Waller, MD, Mr. Tom Treasure, MD and

Dr. Robert Cameron, MD

Led by Dr. Robert Cameron, Director of the UCLA Mesothelioma Research Program and Chief of Thoracic Surgery at the West Los Angeles Veterans’ Administration Medical Center, a wide range of medical specialists reviewed information from a variety of U.S. centers as well as from the recently concluded Mesothelioma And Radical Surgery (MARS) trial from the U.K. The results of this randomized clinical trial were presented by English surgeons, Tom Treasure and David Waller, and clearly demonstrated that radical removal of the lung through EPP holds no advantage over alternative, less radical, lung-sparing therapies.

In a press release issued by the Pacific Meso Center, where Dr. Cameron serves as Scientific Advisor, he commented that, “The information presented at this Symposium makes an incredibly strong statement that surgical removal of the lung for treatment of malignant pleural mesothelioma should no longer be performed anywhere in the world, just like it has been abandoned already in the U.K." Dr. Cameron went on to say that, "Although it's usually hard to get physicians to agree on anything, there was unanimous agreement by the end of the conference that lung-sparing pleurectomy was the preferred surgical procedure if surgery was to be used at all."

The distinguished faculty at this landmark meeting also addressed the role of non-surgical therapies such as cryo and radio frequency ablation, radiation, chemotherapy, immunotherapy, gene therapy and promising future therapies. Dr. Cameron and others described how some of these therapies can be used in the model of treating mesothelioma as a chronic disease once the tumor has been removed through lung-sparing surgery.



Terry and Maryla Latham

One such adjuvant therapy that has only recently been utilized for pleural mesothelioma is cryoablation. UCLA Radiologist Dr. Fereidoun Abtin explained that cryoablation is an outpatient procedure in which compressed argon and helium gas is delivered through 3 mm probes inserted into a tumor to essentially freeze the tumor cells. It can be determined in a matter of a few weeks whether the procedure is successful and, because it is an outpatient treatment with a low incidence of pain, it can be performed many times over a relatively short period. UCLA Medical Center is currently the only institute where cryoablation is being used to treat mesothelioma.

The Symposium also featured a touching presentation from Geraldine Lepore about living with mesothelioma from a family’s perspective, as well as an inspirational speech from mesothelioma survivor Terrence Latham who underwent a lung-sparing pleurectomy in 2010 and credits Dr. Cameron for saving his life.

The Pacific Meso Center plans to release videos of many of the Symposium presentations on its website www.pacificmesocenter.org in the coming weeks.