Dr. David Sugarbaker spoke about the effectiveness of surgery and some of the adjuvant therapies that can be used to clean up the surgical site or to combat recurrent disease. We heard about biologics, photodynamic therapy, and there will be sessions later today on intracavitary heated chemotherapy during surgery, and then more on staging, imaging, chemotherapy and immunotherapy. There will be a dedicated session for peritoneal mesothelioma.
In the early afternoon, the Meso Foundation will be hosting a lunch where Meso Foundation funded grantees will present their work. All of our grantees’ posters were selected to discuss their work in sessions throughout this meeting, thus highlighting the ability of our Scientific Advisory Board to identify promising new research. This is only possible due to the generous donations of our mesothelioma community.
There has been some heated debate during this meeting about the differing surgical options of EPP vs. PD or even if surgery should remain an option. Those attending the meeting have a focused dedication to irradiating mesothelioma and this debate moves the field forward.
Question under discussion during the surgical session: Is it better to treat neo-adjuvant (chemo before surgery) or post- surgery. Seems there might be a light advantage using neo-adjuvant but the evidence is not strong so it remains surgical choice.
Yesterday we learned that histology can change in approximately 20% of the cases – larger samples allow for more accurate diagnosis of histologic subtype. Another reason why we describe mesothelioma as a disease best staged and described through surgery.
What factors are relevant for treatment decision? Role of mediastinoscopy – perhaps we need to rethink nodal status as some with lymph nodes (N2) still did well following surgery though the numbers were small. Discussion ensued that with larger numbers there would be a demonstrable difference. It was suggested that this group (those with nodal involvement) may benefit from neo-adjuvant chemotherapy.
Tumor volume has prognostic value. We can measure this on scans and the evidence is solid. It has been suggested that we factor this in.
Waiting for the discussion of the IASLC Mesothelioma Staging Project which will take place this afternoon.