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
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
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.
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
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
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….].
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.
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
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.
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!