Dr. Harvey Pass' comprehensive review of the literature on mesothelioma
diagnosis and treatment is a
must read, for both doctors and patients alike. The article carefully reviews
the diagnostic and therapeutic options for patients from the time of initial
symptoms onward. It addresses without bias the pros and cons of the various
surgical options, with or without chemotherapy and radiation. I say without
"bias" because Dr. Pass to my knowledge is one of the handful
of surgeons in the U.S. who does not commit to either pleurectomy / decortication
(P/D) or extra pleural pneumonectomy (EPP) prior to opening the chest.
In a sense, he let's the tumor decide, and he cannot assess the reach
and span of the tumor without actually studying it "up close and
(This article is provided solely to the Mesothelioma Applied Research Foundation
(MARF), courtesy of Clinical Lung Cancer, published by the Cancer Information
Group located in Dallas Texas, and is copyright protected by the Cancer
The article raises a number of provocative questions. For example, what
will it take to create a nationwide "standard of care" for mesothelioma
patients? When can we say that one surgeon's personal "philosophy"
with regard to "best" treatment option for particular patient
is superior to another surgeon's? If there is no reliable protocol
for curing mesothelioma to date, doesn't the language require that we call
all options "palliation"?
This is the first article to my knowledge that squarely addresses the question
EPP vs P/D? Dr. Pass understands that the tumor is not amenable to a "one
size fits all" fix. The procedure must be tailored to the particular
patient's extent and bulk of disease. When I talk to patients, those
who have attempted to read the literature often speak of "negative
margins" post EPP as the holy grail for survival. Dr. Pass reviews
the data, most of it from Brigham and Women's Hospital (Dr. Sugarbaker),
which shows that about 1/3 of the EPP patients had "margin-free resection,"
and most of these patients had less bulky disease (stage 1) to start with.
He asks"Is it justifiable to spare the functioning lung by performing
a parietal pleurectomy instead of EPP if the visceral pleura is minimally
The answer is that without standards, i.e., criteria for assessing how
many tumor sites are involved, their size, etc., the decision to pursue
EPP vs P/D is largely one of individual preference or style. Without preoperative
guidelines, how does the patient decide? How does he choose the best doctor?
How do we know who is "best" -- the doctor with the best reputation,
the most publications, the warmest bedside manner? Is cost a factor? In
the end, does the patient simply roll the dice? Does he make the choice
at all? We need more data -- starting with an update on Dr. Sugarbaker's
1999 article in which he studied the survival of 183 surgery patients.
It is my hope that Dr. Pass updates his excellent review every 6 months
or so -- this of course is a lot to ask of a doctor who barely has time
to kiss his wife in the morning. The chat rooms are buzzing with rumors
and anecdotes about this or that promising new drug or treatment. It would
be helpful for patients and doctors to tap into a database that gives
us updates on the response and survival rates of new drugs like Alimta,
Onconase, Erissa, Sugen, LNDDP, copper chelate, or procedures like intraoperative
chemo wash, among others.
The reader should note that the Mesothelioma Applied Research Foundation, Inc. (
MARF), is on the verge of collecting data for an international patient registry/database
which, in time, will provide a solid foundation for doctors and patients
to rationally assess which therapies work, which don't, and which
is best for a particular patient. Dr. Pass is the Chairman of MARF's
Science Advisory Board.
--RGW, Feb. 7. 2002
P.S. I wish to thank Dr. Pass and the Cancer Information Group for allowing
me to link to this article. I again want to emphasize that this is a literature
survey article, and as such it would not be possible without the work
of other doctors, scientists and researchers who have had the courage
to both take on this "orphan" disease and publish their results.
Without the noble efforts of others, there would be no progress. Dr. Pass
also wishes to express gratitude to the hundreds of mesothelioma patients
he has known over the years who have willingly and knowingly embraced
experimental clinical protocols. Because of their contributions and volunteer
spirit, there is hope that in time optimism will replace nihilism.
POSTED FEBRUARY 7, 2002
MARF Doctor Urges Congress to Eradicate Asbestos Menace
Dr. Harvey Pass, a surgeon from Detroit, Michigan and science advisory
MARF , was invited by Sen. Murray to educate the public about the need for medical
research on early detection, prevention and treatment of mesothelioma.
Dr. Pass cited areas of progress, but stressed the need for more funding
of basic and clinical research. "Mesothelioma patients themselves
are some of the greatest donators ... and serve as an incredible example
of compassion in the face of adversity." March 23, 2004, Washington DC.