Meet the Experts Recap: Dr. Friedberg on New Frontiers in Surgery

Dr. Joseph FriedbergOver 40 individuals from the meso community joined us Thursday night for our latest Meet the Experts session “New Frontiers in Surgery” with Dr. Joseph Friedberg, a surgeon at the University of Pennsylvania. With an interest in diseases of the pleura, Dr. Friedberg’s surgical protocol involves laser treatments and photodynamic therapy, on which he has published a promising study. During Thursday’s teleconference, Dr. Friedberg explained photodynamic therapy and his surgical treatment process, how it works, and the benefits it may hold for mesothelioma patients.

At the start of the teleconference, Dr. Friedberg explained that photodynamic therapy is a light-based cancer treatment that is minimally toxic, unlike chemotherapy, and not as penetrative as radiation. To administer the therapy, the patient is given a compound similar to chlorophyll, which is used by plants to capture light energy from the sun. The compound enters the patient’s cells, making them very light sensitive and giving them the ability to capture visible light energy. The light energy only penetrates a small distance into the body, which is enough to cause reactions that can kill cancer cells. In a disease such as pleural mesothelioma where, following lung-sparing surgery, microscopic cancer cells generally remain, photodynamic therapy is used to complement or augment surgery in an effort to remove all detectable cancer.

Dr. Friedberg went on to discuss the surgical treatment process for mesothelioma patients at the University of Pennsylvania, but first noted, “All surgery for mesothelioma really remains investigational at this point.” When a new mesothelioma patient goes to UPenn for treatment, a team evaluates their case and determines which type of treatments they qualify for. When a patient is a candidate for surgery, and they decide they want to go this route, Dr. Friedberg notes that they start with surgery followed by photodynamic therapy and then chemotherapy. Most of their patients do not receive radiation treatment.

For pleural mesothelioma patients, Dr. Friedberg performs lung-sparing surgery (as opposed to lung-sacrificing surgery, which is best known as an ‘extrapleural pneumonectomy’ or EPP). In his method, Dr. Friedberg mobilizes the cancer off of the chest wall, diaphragm, and mediastinum, so that the cancer is tethered solely to the lung. The pleural lining is then completely removed from the lung along with the cancer that is connected to it. The median length of stay post-surgery is 13 days with the first 1-3 days spent in the ICU. The photodynamic therapy leaves the patient with light sensitivity that lasts about two weeks and could result in very quick sunburn.

Dr. Friedberg has performed this surgery and treatment process on a few hundred patients, which includes patients with cancers other than mesothelioma. Nonetheless, he notes, “The operation is still in evolution … I’m always trying to think of ways you can make it better and more translatable.”

It is still debatable whether lung-sparing surgery or lung-sacrificing surgery is better for patients. Dr. Friedberg believes that saving the lung allows patients a better quality of life post-surgery. With two lungs, “The patients are doing more; they’re in better shape. They are just more robust.” Additionally, if the mesothelioma reoccurs, “They are typically able to tolerate better and more aggressive treatment.”

As moderator, Mary Hesdorffer, NP, relays the question of a listener who asks, “What is the average lifespan of a surgical patient who goes through a successful surgery?” Dr. Friedberg answers honestly as he states, “This is both the best and the most important, and the least answerable question a patient can ask.” He notes the unpredictable qualities of mesothelioma, as the cancer is not only different from patient to patient, but it also changes character within one patient from one region of the chest cavity to the next.

Dr. Friedberg goes on to explain the questions that arise when a mesothelioma patient is deciding whether or not they should go through with surgery. The patient needs to weigh the benefits and the risks, and also think about lung-sparing or lung-sacrificing surgery. Dr. Friedberg suggests patients ask their surgeons, “What would make you take the lung out and what is the impact of that?” The patient should also make sure the surgeon they speak with will actually be performing their surgery. They should find out who else is on the team, what additional treatments may be necessary, whether or not radiation is needed and why, and so on.

Dr. Friedberg provided a huge amount of information regarding mesothelioma surgery and photodynamic therapy. He discussed who qualifies for his treatment and who will benefit from it, how mesothelioma surgery differs from surgeon to surgeon, what role photodynamic therapy appears to be playing in the treatment process, and much more. We are extremely grateful to Dr. Friedberg for taking part in this Meet the Experts session and providing the community with excellent insight into mesothelioma surgical treatment.

You can listen to the full teleconference on the Meet the Experts page.

UPCOMING MEET THE EXPERTS
The next Meet the Experts session will be held on February 17th at 8PM Eastern with Dr. Valerie Rusch of Memorial Sloan-Kettering Cancer Center. More details will be announced as they become available on the Meet the Experts page.

Mary Hesdorffer, NP, to Present at UPenn Conference

Mary Speaking at 2013 SymposiumMary Hesdorffer, Nurse Practitioner and the Mesothelioma Applied Research Foundation’s executive director, will be presenting at a conference at the University of Pennsylvania (UPenn) on November 15. Penn Mesothelioma and Pleural Program and Penn Presbyterian Medical Center will be hosting the conference titled “Pleural Mesothelioma 2013: Multidisciplinary Diagnosis, Treatment and Investigation.” Mary has been selected to present alongside national and international mesothelioma experts “to provide the full spectrum of perspectives on the many challenging and controversial topics surrounding this cancer.”

Mary Hesdorffer received her undergraduate degree at the College of New Rochelle in New York and went on to receive her Masters of Science at the same institution. She is a fully credentialed Nurse Practitioner and has spent 16 years actively treating patients with mesothelioma. Mary has an expertise in the development and implementation of clinical trials. She is published in peer reviewed journals and has lectured nationally on topics pertaining to mesothelioma with particular emphasis on clinical trials, as well as symptom and disease management.

At the University of Pennsylvania conference, Mary will present “The mesothelioma patient – what are the unmet needs?” This lecture will review what is currently being done for mesothelioma patients and examine what aspects can be improved and what additional measures should be taken to better fulfill patient needs. In the “Pleural Mesothelioma 2013” brochure, Mary Hesdorffer is described as “the person with likely the greatest number of contacts with mesothelioma patients in the world.”

Lee Krug, MD, a member of the Meso Foundation’s Board of Directors, will also be presenting at “Pleural Mesothelioma 2013”. Dr. Krug is an Associate Professor of Medicine at the Division of Medical Oncology at the Memorial Sloan-Kettering Cancer Center. Described as “an acknowledged world leader,” Dr. Krug will present “Mesothelioma – Is there a standard of care, is there a staging system?” This lecture “will discuss the current staging of malignant pleural mesothelioma, including the limitations of this system, and will review what is currently considered ‘standard’ treatment.”

View the full brochure for “Pleural Mesothelioma 2013: Multidisciplinary Diagnosis, Treatment and Investigation” for further conference details.

FROM THE HEADLINES: Photodynamic Therapy Added to Lung-Sparing Surgery Improves Survival for Mesothelioma Patients

The website Medical News Today recently released findings of a new treatment for patients with malignant pleural mesothelioma. The treatment involves PDT (photodynamic therapy) conjunction with lung-sparing surgery. Results look promising in comparison to patients utilizing other mesothelioma treatment options. In this approach, provided the patient can keep both lungs after treatment, patients face better chances in combatting mesothelioma once it returns. Patient are given a photosensitive drug that cancer cells absorb, and then Fiber optics direct light onto the tumor site, which activates the drugs, and destroys the cancerous cells.

Leading this research from the Perelman School of Medicine, University of Pennsylvania, is Dr. Joseph Friedberg, MD. In this battle against mesothelioma, considered one of the most aggressive forms of cancer, Dr. Friedberg has stated, ”While I don’t consider anything short of a cure as a victory against mesothelioma, I am encouraged by our results. Based on our new findings, we are redoubling our clinical and translational research efforts to find a way to further improve and refine this multimodality treatment approach for mesothelioma.” Continue reading “FROM THE HEADLINES: Photodynamic Therapy Added to Lung-Sparing Surgery Improves Survival for Mesothelioma Patients” »