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| Dr. Robert Cameron iMig 2012 |
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.
Enjoy the read and keep questioning, searching, learning and leaning towards the light.
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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.
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IMIG
2012: Steven Albelda confirms that immunotherapy is a very promising treatment
for mesothelioma.
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| 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.
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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….].
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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. “
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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.
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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
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| Roger G. Worthington |
