Mesothelioma Awareness Day Discussion


Welcome, everyone We're really happy to have you here, as we recognize Mesothelioma Awareness Day

My name is Kathy Goss I'm with the University of Chicago Medicine Comprehensive Cancer Center And I'm happy to have our stellar mesothelioma the team here with me, including Dr Kiran Turaga, Dr Hedy Kindler, and Buerkley Rose

And we're going to be here to talk about the disease, talk about research advances, and all the clinical programs that we have to offer So first, I'd like you to introduce yourselves, if you don't mind, starting with you, Dr Turaga Thanks, Kathy And I think it's an important day for all of us to be here

I'm Kiran Turaga I'm a surgical oncologist with a specific focus in peritoneal disease and peritoneal mesothelioma My interest is in applying modern surgical techniques, including laparoscopic and minimally invasive techniques, to this disease But more importantly, work together with Dr Kindler Dr

Ferguson, Buerkley and our whole team over here, to help advance the treatments for this disease And I'm Hedy Kindler I'm the director of the Mesothelioma Program at the University of Chicago Medicine And I'm a medical oncologist whose clinical focus is on developing new drugs for the treatment of this disease And I'm Buerkley Rose

I'm the nurse navigator for the Mesothelioma Program My role involves the care and coordination of all of our patients Thanks so much So let's maybe start off with you, Dr Kindler, and maybe you could share with us what mesothelioma is and how it's being treated currently

Sure So mesothelioma is a cancer of linings So it can affect the linings around the lung, in which case it's called pleural mesothelioma; the lining around the abdomen, called peritoneal mesothelioma; and occasionally, the lining around the heart, or the lining around the testis Depending upon where it's located, treatments can include surgery, chemotherapy, and occasionally radiation, and at the University of Chicago Medicine, very commonly clinical trials Great

So I know one thing that patients and the public also often think of mesothelioma as being associated with asbestos exposure Are there other risk factors that we know about? So the vast majority of mesothelioma are due to asbestos, but there is also a hereditary component to mesothelioma, what we refer to as a gene-environment interaction So I have very fair skin, which means that I'm likely to get, potentially, a skin cancer if I'm exposed to sunlight, whereas someone with dark skin is not The same way some patients who have certain genes may be more likely to get mesothelioma if they're exposed to asbestos And we have a whole research program led by Dr

Jane Churpek, which is dedicated to trying to understand the genetic underpinnings of mesothelioma Terrific So Dr Turaga, maybe you could share with us a little bit about what makes the clinical program here so special I mean, I think just to build up on an Hedy's point as well– as we all know, mesothelioma is a disease of hardworking people– I mean, normal, ordinary people

And I think when someone is faced with a fairly significant diagnosis like this, they need not only our best clinical expertise, but I think also our best research expertise And I think that's what the University of Chicago does so well I think we're an institution, which is grounded in the fabric of research, and so we're able to bring every single discovery that we make in the lab right down to our patients And I think that's really what's unique about the University of Chicago I think just to tell you a little bit about mesothelioma, especially peritoneal mesothelioma is not a very common disease

It occurs in about 500 to 800 new patients every year in the United States Pleural mesothelioma is much more common, but not quite as common as, say, colon cancer, lung cancer, breast cancer And so sometimes mesothelioma is treated as an orphan disease But here at the University of Chicago, I think, thanks to the program that Dr Kindler and Buerkley have set up and now that I've been able to join, I think we have an incredible wealth of experience

And probably we are one of the largest centers in the world that takes care of patients with mesothelioma We're able to offer our patients standard of care treatments, including advanced surgery, treatments with chemotherapy delivered right to where the cancer is called HIPEC, or Heated Intraperitoneal Chemotherapy We have surgeries of the lung, where we can do pleurectomies, pneumonectomies We're able to do all the advanced surgical techniques We have advanced chemotherapy

And I think, just like what Dr Kindler said, what we have at the University of Chicago is a team that really thinks about each and every patient So every one of us sits together every week discussing this at our tumor board, where each person is identified and clearly we make a treatment plan that's designed for them It's based on the genetics that we have through Dr Churpek's lab

It's based on our radiology research that's done through Dr Armato and his group And we have an entire cohort of research fellows, residents, students, who are all interested in the same disease And we're able to bring forth the best plan for each patient In addition, we have a multidisciplinary clinic, which means that we're able to see patients on the same day

So we're able to alleviate the discomfort of having to make multiple appointments when you come And so I think that's really what makes University of Chicago very special I'm glad you brought that up about the patient experience, because I'd love to turn to Buerkley and hear more about some of the challenges that mesothelioma patients– that you see them going through and how your team can help them overcome some of those challenges, or help them tackle them To elaborate on what Dr Turaga said, I think one of the most challenging things for patients is getting that multidisciplinary aspect all in one place

We have fantastic surgeons and a fantastic oncologist We have great palliative care symptom management that focuses specifically on the day-to-day challenges that mesothelioma patients face, as well as a great social worker who can provide resources for patients who have to travel, because many of our patients travel from out of town, out of state, and even out of the country And so to get all of that in one place is really what makes University of Chicago a unique mesothelioma multidisciplinary center And if I may add one more comment, Buerkley, can you also speak something about your own role? I mean, isn't it very unique that we have a person, such as Buerkley who is fantastic, who is dedicated to mesothelioma? So maybe speak a little bit about that Yes, and I think the nursing expertise and experience in caring specifically for mesothelioma patients is something that you really don't get anywhere else

You know, sometimes mesothelioma care falls under the umbrella of lung cancer It's not lung cancer It's a different disease, with different symptoms, and requires different care and different coordination And so it really is individualized and patient-centered to provide a nurse that can specifically work with you and coordinate your appointments and just help you through the day-to-day struggles that you face Terrific

That's really helpful to see how the team works together and really makes the patient, as you said, at the center I'd love to turn to some– I think both Dr Turaga and Dr Kindler have mentioned our research And I'd really love to turn to that

If perhaps first, Dr Kindler, could you speak to, in simple terms, how the research has led to changes in how this disease– what we understand about this disease and how the treatment has changed over the years So the standard of care treatment for mesothelioma is the drug Alimta, otherwise known as pemetrexed And that drug was initially developed here more than 15 years ago Over the years, we have worked with a class of drugs called angiogenesis inhibitors, which are drugs that target the blood vessels that feed the tumors

And these are now drugs that are being used widely for mesothelioma Our current research focus is on two different types of drugs, drugs that target mesothelin, which is something on the surface of the mesothelioma cell, and even more exciting, immunotherapy drugs We all know about Jimmy Carter and how immunotherapy really transformed his cancer And we have the world's largest experience with immunotherapy in mesothelioma, offering these drugs for patients who've had no prior treatment, previously treated patients, patients who are about to undergo surgery And we're working with our laboratory scientists to try to understand the biology of the disease, so that we can best select which patient should get which combinations of drugs

But it's very exciting when we can have a patient's own immune system turn on to attack the cancer And that tends to lead to sustained responses and therefore, improved activity and hopefully improve survival And you even mentioned before about the genetics It sounds like we've learned a lot about the genetics of the disease, and some that work is being done here And how is that impacting the care of patients? So we have a research assistant [? Magna ?] who has all of our patients spit into a cup, so that they can provide us some information about their genetics

That information then goes to Dr Churpek's lab, where we are trying to understand different genetic factors that may make some patients more likely to have asbestos exposure causing meso– other factors that may make them more or less likely to respond to treatment Some of this work is in its infancy, but we are now also working on drugs that can target some of these specific genetic aberrations And my fellow, Dr Desai, is right now developing a program to do just that

So really, our research feeds our clinical work Our clinical work feeds our research We identify a clinical problem, and we try to then identify what research we can do to target it Excellent, excellent And then, Dr

Turaga, could you talk about some of the research that you're doing in mesothelioma Well, I think one of our biggest challenges with mesothelioma is, like Dr Kindler said, it's a disease along the lining And when we get conventional imaging, like CT scans or MRIs, it's very hard for us to see the lining It's like looking with a satellite down on 94, and you can't see the tar on the roads You can see the big trucks, you can see the motorcycles, but you cannot see the tar on the road

And that's exactly what mesothelioma looks like So I think we've been fortunate to have a very strong imaging group that was already in place before I even moved to the University of Chicago And I think in combination with Dr Armato, who leads that group, and some of our GI radiologists, including Dr Oto and Greg Karczmar, who is one of our PhDs, our hope is to develop better imaging techniques using sophisticated MRIs that are currently available at the University of Chicago in detecting this disease for our patients early

And I think if we really can do that, we may be able to develop better screening programs, et cetera So I think that's one of our big aspects of research on this disease And do you think– and this is for all of you– do you think that that's really where the future lies in this disease? It's really about developing those technologies for better detection and measuring treatment response, but then also, as you mentioned Dr Kindler, really personalized therapy, personalized treatment, so that patients are getting exactly what they need Is that really where we're headed? What can we expect in the next five to 10 years, do you think? I can take it first

I mean, we all know that prevention is better than cure So I think if you can really get down to the degree of detail, where either we can predict this disease early, or we find it very early, there's no question that these patients will do better Because there is enough data to suggest when we get to these patients before the disease is widely spread, they do better And the question is going to be, are we going to be able to intervene with better technology, like surgery? Is it going to be better drugs, like immunotherapy? I mean, these are all open questions, but an exciting field I think this is where us working together with an interest in curing mesothelioma essentially is most important

And I think that's where we're able to bounce ideas off each other Terrific So we've covered a lot of ground here today And do you have– anyone have any sort of final thoughts or final remarks about what we're doing, how we're approaching this disease, how we're caring for patients that you'd like to share before we sign off? Oh, I'll take that Mesothelioma is a rare disease

It's an uncommon disease that most local oncologists might see one or two a year or one or two in their lifetime And it's not a one size fits all disease It's not a disease, where you just look up the cookbook and the recipe It's a disease that has its own individual aspects to it, and we need to tailor our treatment to the patient So only by patients coming to the experts, people who live, eat, and breathe this disease 24 hours a day, and who really are focused on trying to develop a cure or turn this into a chronic disease– only by coming to a place like that are patients really going to get the optimal treatment

Great Well, I can't thank you all enough for sharing your time and your talents with us and really giving us a snapshot of all the fantastic things that you're doing in mesothelioma It's really so important, especially on this day, as we're recognizing Mesothelioma Awareness Day, but also every day really to care for these patients, and also sharing with us how you're blazing the research trail ahead So it's really very much appreciated Thank you

Thank you Thank you, Kathy

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