Cancer Newsline Audio Podcast Series
Date: September 28, 2009
Duration: 0 / 12:38
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Lisa Garvin:
Welcome to Cancer Newsline, a weekly podcast series from the University of Texas, M.D. Anderson Cancer Center. Cancer Newsline helps you stay current with the news on cancer research, diagnosis, treatment and prevention, providing the latest information on reducing your family's cancer risk. I'm your host Lisa Garvin. Today we have 2 guests in our studio: Dr. Anne Tsao who is an Assistant Professor in the Department of Thoracic Head and Neck Medical Oncology, and Dr. Reza Mehran who is a Professor in the Department of Thoracic and Cardiovascular Surgery. Today we'll be talking about Mesothelioma which is a disease of the lungs and we're going to be talking about some new programs and other things going on here at M.D. Anderson. Welcome to you both today. Thank you for joining us.
Dr. Reza Mehran:
Good afternoon.
Dr. Anne Tsao:
Thank you for having us.
Lisa Garvin:
Let's start with Dr. Mehran. Let's go back to the basics. Let's talk about what is Mesothelioma?
Dr. Reza Mehran:
Mesothelioma is a terrible cancer. It occurs as a tumor that originates in the lining of the lung and it usually occurs after years of exposure to asbestos. Manifestation that the patients are presented with are usually shortness of breath and chest pain.
Garvin:
And this is something that develops 10 to 40 years after exposure, correct?
Mehran:
Yes, that's correct. And that's the problem. And patients don't expect to ever develop anything like this. The source of exposure is often unknown until
patients are questioned deeply about their occupational hazards in the past. And it's a terrible surprise.
Garvin:
And there are only about 3 thousand people who are diagnosed with Mesothelioma each year so it is a rare cancer.
Mehran:
Yes and that's a problem by itself: being rare. It's a difficult cancer to study. It's a difficult cancer to treat.
Garvin:
The treatment options are fairly limited. If I remember correctly, it's mostly a surgical treatment, correct?
Mehran:
Not exactly, Surgery is only reserved for very limited and localized Mesothelioma. And unfortunately that consists in a very small percentage of the disease. Most patients presented with a very diffused variety of the cancer and surgery by itself is not effective to cure these patients.
Garvin:
Why is it so difficult to treat? It's not just one just tumor that just pops right out.
Mehran:
There are multiple reasons for that. Number 1, it's a diffused cancer. As you can imagine, if you have a lump somewhere, you go after it. You remove it. You cure the patient. You don't have such a lump in Mesothelioma. The disease is very diffused. As I said, it involves the lining of the lung, so it occurs usually anywhere from the apex of the chest all the way down to the diaphragm. So very large surface. It's difficult to treat by surgery alone.
Garvin:
Why is M.D. Anderson a good place to come to treat such a rare cancer as Mesothelioma?
Mehran:
M.D. Anderson is a perfect place to be treated for cancer and the main reason is because we treat diseases and we treat the patients here in a multi-disciplinary fashion. That means that we get all the specialists that can be involved in the care of the patient all at once in the treatment of the patient. So the patients get the benefit of being seen and evaluated by multiple people with different role in the management of the cancer. And particularly in those patients where a single treatment is not the best option such as Mesothelioma. We get to treat these patients in multiple with aspects using the expertise of multiple colleagues all at once.
Garvin:
And we treat about 150 Mesothelioma patients a year at M.D. Anderson?
Mehran:
That's correct and the number is increasing.
Garvin:
As far as the Mesothelioma program, this is something new: a new initiative. Dr. Tsao, tell us about the program.
Dr. Anne Tsao:
Yes, we're actually very proud of this program because it's comprised of well over 30 different experts from both thoracic surgery, thoracic medical oncology, radiation, pulmonary, pathology all of whom have an expertise dedicated and focused on Mesothelioma. So this program not only has the clinical arm where we treat the patients, but it also has the clinical research program that has offering clinical trials for every single setting for our patients, and it also has a basic [inaudible] and translational research program because we're still looking for that cure for Mesothelioma. So our program is comprehensive. It's one of the very few centers in the world that has such a comprehensive program.
Lisa Garvin:
Tell us a little bit about there are some new innovative things that are being tried through the program?
Tsao:
That's absolutely correct. We are moving towards a new era in oncology: something called personalized medicine. Because everyone who walks in through the door - just like we're unique individuals - their cancer's unique. And so we're trying to learn more about each individual's molecular biology. And so we have designed our program to address that issue and all of our clinical trials are focused in some form or fashion on personalized medicine. One example would be our new [inaudible] trial which is -- we use a targeted agent called dasatinib. And it specifically targets a protein called Src kinase [assumed spelling]. And we found in some of our Mesothelioma patients that activated Src kinase can be predictive for more aggressive tumor. And this pill dasatinib can actually lead to a response in some of our patients. So we give them this pill in the neoadjuvant setting. They get tumor tissue collection pre and post the neoadjuvant phase and if their tumor is highly responsive to this pill, they get it for free for 2 years after their surgery.
Garvin:
Now is this done before surgery for debulking or after surgery?
Tsao:
The 2 year maintenance period occurs after the surgery but part of Mesothelioma, the reason why it's so hard to treat is often times people have more extensive disease than what we initially realize from the radiographic imaging. So here at M.D. Anderson before we make the patient undergo a very large surgical procedure, we have to do a smaller surgery that stages the patient to be sure that they're a correct candidate for that surgery. And we take advantage of that in our clinical study. Instead of you know the lag time that you usually have in between the 2 procedures, we enable the patients to take a pill so that it can potentially control their cancer while they're getting set up for their larger second surgery.
Garvin:
So Dr. Mehran, the staging is done surgically? Is that how Mesothelioma is staged?
Mehran:
Yes, it's a very important part of -- in the management of the patient. We establish their operability essentially by doing this and operability means staging the disease and surgery is not available for all stages of Mesothelioma. And so it's important to establish what stage the patient is and who is the best candidate for surgery.
Garvin:
Now is it a minimally invasive or a laparoscopic procedure the staging part?
Mehran:
The staging is done minimally invasively, yes.
Garvin:
In keeping with M.D. Anderson's multi-disciplinary or holistic care, there are also some non-clinician types that are involved in the Mesothelioma program. Can you explain?
Tsao:
Absolutely, and that's part of the remarkable nature about our program is we have a lot of people that support the clinicians not only through our nurses in the clinic but also dedicated physician assistance, both in surgery medical oncology and radiation oncology, that not only specialize in the clinic, but they also go out into the community and teach about this. And they specifically focus on patients and their family members and caregivers on how to help support patients working through this disease. They also have a website set up to educate. So there are so many people that contribute to this program that help in so many different ways. Another example would be our social workers. They are very committed to try to help our patients come here to M.D. Anderson often times arranging for Angel Flights if they live a certain ways away so that they… you know, we don't allow the travel to be the impediment for them to potentially get a life saving procedure on a clinical trial.
Garvin:
Let's talk about the Tissue Bank. I know in some of the more common cancers you have banks of tissue that people can use for study and so forth.
Tsao:
Absolutely, that is crucial to finding a cure eventually for this disease. So for every patient that comes in through M.D. Anderson we ask them to - and most people are more than willing - if they already have a tissue block that we obtain that tissue block for our research repository. We also do ask every patient that comes in with Mesothelioma if we can take a small specimen of blood while they're getting one of their other lab tests so they don't get an extra stick, but we look at the plasma and the serum for potentially proteins we can target to find that cure. And certainly one of the other options is if they're undergoing a surgical procedure, we can obtain pleural effusion. That's the fluid that surrounds the lung that sometimes develops in our patients. We do take samples of that as well. Now these plasma tissue and pleural effusion repositories are done for research purposes and we make that very clear. We never obtain them without the consent of the patient, but it is critical for us to eventually find that cure for them.
Garvin:
And it's easy to obtain these samples, correct?
Tsao:
Yes it is. It is always done usually in the context of they're already getting something else done so in the case of the blood sample, if they're getting blood work done to be evaluated for medication, we could just take a small amount - an extra sample - during that time.
Garvin:
How many samples would it take to reach critical mass or useable data I should say?
Tsao:
Well that's a very difficult question to answer because many different proteins have variable amounts that are required to study. What we're doing with the serum is actually looking for new targets for therapy and so the amount that we require is very small.
Garvin:
Dr. Mehran, let's talk about -- are there any surgical innovation like robotics or anything else that has been applied to Mesothelioma?
Mehran:
Many, many ways of surgery and robotic surgery can be used in some specific situations in the management of Mesothelioma. And this is certainly available here at M.D. Anderson for the benefit of our patients.
Garvin:
Do you all have any final thoughts to take home for our listeners before we go Dr. Mehran?
Mehran:
Absolutely, I want the patients to know that there is hope and there is a way to treat them. Not everybody can be cured, but we can make a giant stride to improve the quality of life of the patients who can not be cured and cure those who can be cured. So keep the hope up and come and see us. We'll do everything possible to manage your cancer.
Garvin:
And Dr. Tsao, it sounds like your program has - as Dr. Mehran says - some hope for the future in getting some critical data.
Tsao:
Oh we absolutely believe it. It just will require some more research and for the clinicians you know compiling the resources and focusing it on finding that cure ultimately for our patients. But we certainly are believers here at our institution that one day we will find that cure for these patients.
Garvin:
And the need to go to a comprehensive cancer center for this is high.
Tsao:
That is absolutely the case because so often out in the community they may see one case per every few years and they may not be familiar with how to treat this disease. And all too often I hear from my patients that they were given no hope at all and were given no treatment. And so it is absolutely essential that they get a second opinion if they have a new diagnosis of Mesothelioma or even a situation where they are unclear about the diagnosis.
They need to come to a comprehensive cancer center where we can take a look at them and try to help them.
Garvin:
Great! Thank you both for being with us today.
Mehran:
You're welcome.
Tsao:
Thank you!
Garvin:
If you have questions about anything you've heard today on Cancer Newsline, contact Ask M.D. Anderson at 1-877-MDA-6789 or online at www.mdanderson.org/ask. Thank you for listening to this episode of Cancer Newsline. Tune in next week for the next podcast in our series.
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