What Do You Feel Is the Best Approach to Treating Mesothelioma?

[MUSIC PLAYING] I feel that surgery first, followed by chemotherapy, is the best multimodality approach for mesothelioma due to the fact that we know only 20% to 40% of patients will actually have somewhat of a radiologic or clinical response to chemotherapy. So patients that will opt for chemotherapy first-- which is still done in certain places because right now there currently is a clinical trial looking at whether or not to get the chemotherapy prior or after surgery. And we still don't have those results. So in the meantime, it's done depending on what institution you're at. And so the idea-- why I believe that the chemotherapy-- two reasons, first, is an issue is that 20% to 30% of the time it may be helpful, but it never shrinks it completely. It never gets rid of it. And then there's a 60% to 80% chance that the tumor will progress and that you missed your window to operate. They're getting sicker on the chemo, and the tumor is growing. And that's a 60% to 80% chance the tumor will progress and grow. So rather than take that chance, I'd rather get it out first and then have-- and we know that 80% of patients, after we take it out, can still make it to surgery because we do a pleurectomy and decortication. And so it's not as aggressive or not as morbid. So patients will be able to do the chemotherapy afterwards. It was originally thought that do the chemo first because patients were getting an extrapleural pneumonectomy, and they were never able to make it because they were too sick to get chemotherapy afterwards. So you missed that window. But now that we do pleurectomy decortication, chemo afterwards is better because, like I said, chemo is going to react better to a patient that has less disease in the body. The other reason why I don't necessarily think it's a great idea to get chemotherapy first is that those patients with symptoms and signs of mesothelioma are already weak. They're already in pain. They're already having a lot of pleural fluid. The chemo doesn't get rid of any of that. It may shrink something a little bit, tiny bit, but it doesn't get the patient clinically better. So not only does it not help, but these patients are already sick, and then they start to lose even more weight just based on the chemotherapy alone. So those patients are essentially not doing well during that time period. And so what we found in previous studies is that 50% to 65% of patients that get the neoadjuvant or get chemotherapy first never actually make it to surgery. They're too sick to even make it to surgery. Whereas when you first see them, you catch it early, you haven't had to give them toxic agents or anything, and then we first caught it hopefully early enough, we operate on them first. So I think those are the two big reasons why I really favor the surgery first, followed by chemotherapy afterwards. [MUSIC PLAYING]