Pacific Meso Center
, in conjunction with The Office of Continuing Medical Education of the
David Geffen School of Medicine at UCLA, held the 2nd International Symposium
on Lung-Sparing Therapies for Malignant Pleural Mesothelioma on May 14,
2012 in Santa Monica, California. We were proud to once again be a platinum
sponsor of this unique medical seminar focusing on rational
treatment options for patients with pleural mesothelioma (MPM)
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
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
(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.
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
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.
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.