What steps can one take to receive the best treatment?

The next thing that we would be wondering is what steps can one take to receive the best treatment? And if this is something that we talked about a little bit while you were gone. We talked about getting a good specialized mesothelioma team, but in addition to getting a specialized team, what other steps can one take?

That's a very good question. So, I think, today people are more educated and the information is easily accessible internet. So, I think patients need to search for centers that may treat mesothelioma, or centers that are engaged in a multi-modality, multi-specialty treatment.

What do I mean by that?

Well, I'll give a classic example. If you come to Chicago for one reason or the other it's not really surgically driven mesothelioma treatment. What I mean by that, most of the economic centers will not be aggressive in the surgery [inaudible 00:01:16]. Therefore, you're more inclined to get chemotherapy as probably the only therapy than if you went to another center, in which you can get chemo, surgery, and the chemo/radiation [inaudible 00:01:33]

So patients need to say, "okay, if there's a doctor in Maryland who has this trial and sounds like a great idea. But is not talking about anything else about the trial. I'll say wait a minute, everybody's telling me that's it's written in literature and published. But the best therapies multi-modality therapy; chemo, radiation and surgery. If the best results are with combined therapy why should I just go and get the latest or the sexiest therapy, and no one's talking about the other modalities up there. Just because you don't have anything else? Just because there's of interest behind that. The trial?

So, I say this to patients, " look for the best place to get treated and that has to be in multi-modality center. In which they offer you all the subspecialties.

Thank you, well, how about Ali and Lisa and do you have thoughts on that.....

He's right. Definitely right.

I guess, Dr. DeSilva, what do you see for about interrupt pedi/chemo [00:02:54]? Do you think that's the future totally? What do you think?

You know, I think, I don't think that is the future, I think that is the present. The future, we just acquired a mind-boggling inter operative radiation therapy. So now we have a radiation machine that will open the chest or abdominal cavity and we write in a protocol with our radiation oncologist. Se we do the surgery, whatever we think it's too bulky or too invasive, [inaudible 00:03:28] or whatever, we gonna bring the probe into the chest and just deliver local radiation. Never been done before, very excited about that.

Is that a clinical trial?

Well, within a protocol. So [inaudible 00:03:43] chemotherapy still is heated chemotherapy from my point of view. See the list of best results for what we call local control after surgery. Not in place of surgery. Another words, if you open the chest, [inaudible 00:03:58] chemotherapy there, take out the tumor, I'm afraid nothing is going to change. The heated chemotherapy is really to control what's left around that we can't see. And if the question is margins, or depth of penetration, because the chemotherapy has a depth at which it would stop working. Not radiation. Radiation can bust through it. So, maybe the diffuse will be inter operative radiation. Maybe the future could be something different. You need a therapy, but as it stands now, the present, I think it is surgery, chemotherapy, inter operative chemotherapy.

Now, the inter operative chemotherapy, you do inter op and then you follow it up later, like you...

Protocols are being written right now, and then I get very excited about this, we got the machine and we're gonna start with lung and then mesothelioma is gonna be next to it. So we are writing two protocols, one for one.

Wow.

The whole idea is you can have lung cancer, but we really can't take cancer, can we remove part of it and just buzz it with radiation? So when we wrote the protocol, I said why can't we do this for Mesothelioma? Has anyone done it yet for Mesothelioma? And we looked up and no, no one has done it, so we are very excited to part of [inaudible 00:05:17] for that.

Now, let's just, I jumped to everything else we would be doing.

Yeah, wow.

So, [inaudible 00:05:28], I think one of the tracking temptations in everything, one of the things, I think a lot of people have the impression that it's [inaudible 00:05:39] platinum and just platinum.

[crosstalk 00:05:44] platinum based. So within a protocol, this is platinum based chemotherapy, we're just redeeming a book tracker that we wrote is coming out next year about that. This platinum base, it works that good for everybody. So it's not an ideal drug, but it's been time and time, over and over again, proven to be a safe based drug, has good penetration, good killing of the cells. So what we have done is add different drugs to the platinum base, so the platinum will be the base of your house, no the foundation, because what is really what is across the border for cancer. You know, talk of that foundation with different blocks of chemotherapy. Gemzar is one of them, Ellipta is something were looking to do intro op, no one is doing it.

If you look at most of the research done in that area, really triple chemotherapy will be ideal, but the best results for cancer in general across the border, whether it is GI, lung, Mesothelioma, is with triple therapy. So it would based carbon based or carbon toxic based chemotherapy, followed by two other drugs on top of it.

Wow. Impressive. So that's what we're saying. So that's what we're saying. There's so much going on that you have to give yourself a chance.

That's right. So and [inaudible 00:07:11] target therapy, I want to make a point that patients really and patient advocates need to understand that most of the trials, they are trials. They are not to be used in place of, or to replace the current therapy that we know it works. Which is chemo, surgery, surgery plus chemo and radiation. Because if you self replace it, especially early stage disease. If you start replacing the Multi-modality therapy that we know works, by a single trial, then you are setting yourself up for, I'm gonna have to take this call, I guess. Some of our bosses just called me, I wanted to [inaudible 00:07:59]

Not me!

I can't even pronounce his name, 'cause it's one of those foreigner names. Anyway, so joking apart, all I'm saying is you shouldn't be lured into doing a trial, [inaudible 00:08:18] a trial. A patient should go to a trial after the standard of care has been applied to that patient. So a lot of patients come and ask questions, well we wanted to see you, but you said surgery, chemo, but Doctor XYZ in California has this new drug, its a trial. You know I say well, it's not the standard therapy, I would not suggest you do that. If you want to pursue that, it's fine, it's your life, it's your choice. As a physician, surgeon, i can't really suggest that. You've got to go through the steps.

If those treatments fail, which as we all know, eventually they fail because there is disease progression, and so forth and so on. Then you go into a trial, because there is nothing else. Now if you into a trial, you may have burned bridges, no, the trial doctors are brilliant doctors and they want to make sure their trial works really well. With support help, and, of course, and we have trials here too. Colon cancer, not Mesothelioma at this point, but for one cancer.

They put barriers, in which to say, if patient gets XYZ, he can't qualify for my trial. They almost want to replace everything out for the trial. I think the trial is reserved for those patients in which multi-modality therapy is not really indicated. Or multi modality therapy has been applied but failed and your looking at early recurrence, and then yes, I think you should go into a trial.