Dr. Sai Yendamuri is a cardiothoracic surgeon who specializes in general thoracic surgery. “Within the realm of general thoracic surgery,” Dr. Yendamuri recently told the Mesothelioma + Asbestos Awareness Center, “my clinical focus is almost exclusively on thoracic cancers, or cancers that occur in the chest. These include those of the pleura (such as mesothelioma), lung and esophagus, or food pipe.”
Dr. Yendamuri is Professor and Chair of the Department of Thoracic Surgery at Roswell Park Cancer Institute, a National Cancer Institute-designated comprehensive cancer center in Buffalo, NY. As such, his day-to-day work involves the evaluation and care of patients with thoracic malignancies. But his responsibilities don’t end there.
“I also conduct clinical trials for patients with lung, esophageal and pleural tumors as well as perform translational research — that is, working to advance our laboratory findings to the clinic so they can benefit patients.”
Although Dr. Yendamuri cares for patients with many different cancers of the chest, he has a particular fascination with mesothelioma.
“Mesothelioma is an unusual tumor,” Dr. Yendamuri explained, “both in its genesis as well as its clinical presentation. In addition, the fact that the therapeutic armamentarium available for treating patients with this disease is limited means that strides in treatment are of urgent need.”
One of the treatments he is excited about is immunotherapy, a type of treatment that focuses on improving the body’s immune system response in order to fight cancer and other diseases. “The biggest advance for mesothelioma patients is the development of immunotherapeutic options,” Dr. Yendamuri stated. “Early studies have demonstrated promising results that may change the outlook for patients with this disease dramatically.”
Dr. Yendamuri is not only interested in emerging and experimental mesothelioma treatments, however. Conventional therapies, including surgery, are an important part of today’s care options. “The surgeries performed for these cases are technically challenging,” he said. “All these elements make it worthwhile to devote a substantial portion of my career to focus on this malignancy.”
The Future of Mesothelioma Research
“As mesothelioma is a relatively rare disease, it tends to get little attention from research funding agencies as well as researchers,” Dr. Yendamuri said. “Therefore, the kind of extensive investigation done in many other cancers has not been performed with mesothelioma. However, despite these limitations, a lot more is known about mesothelioma today than 10 years ago, and this information is being translated to clinical trials.”
Even with that increase in knowledge about the disease, Dr. Yendamuri sees a number of current challenges in mesothelioma research.
Disagreement Among Specialists
Foremost, there’s a variance in expert opinions regarding the extent of surgery that will be most beneficial for patients. “Extrapleural pneumonectomy (EPP) — an aggressive surgery that includes removal and reconstruction of the entire lung, parietal pleura, diaphragm, pericardium — was once considered the standard surgery for mesothelioma,” Dr. Yendamuri explained. “Recently, this practice has been challenged, and radical pleurectomy and decortication, in which the lung is not taken out, has emerged as a viable alternative.”
The latter option allows patients to keep their lung, meaning that they generally have a better quality of life after the surgery. “In addition, intraoperative adjuncts to treatment are also being investigated. These include photodynamic therapy and intrapleural heated chemotherapy,” Dr. Yendamuri continued. “The optimal combination of these various treatment options is yet to be determined.”
Limitless Possibilities for Immunotherapy
Immunotherapy provides a lot of potential for the development of a cure – or at least a much more effective treatment – of mesothelioma than current drugs and techniques provide. However, this approach is so new, with so many promising potentialities, that it actually is difficult to know which direction to take the research.
“Immunotherapy for thoracic malignancy has burst onto the scene with the promise of durable responses,” Dr. Yendamuri said. “The timing and kind of immunotherapy that will most benefit those with mesothelioma is a challenging but promising area of research.”
Increase in Radiation Therapy
“Radiation therapy is being used more aggressively in mesothelioma than in past years,” Dr. Yendamuri said. “Whether radiation should be given before surgery or can be given safely with the lung left in place is an interesting area of research.”
However, as with surgery, there can still be some disagreement among mesothelioma specialists as to the best approach to take. As improvements in technique and technology continue, this area of conventional cancer treatment has an opportunity to undergo a revolution.
Improving Awareness, Detection, and Treatment
In addition to the medical and research problems associated with mesothelioma, there are also issues related to lack of awareness. “Unfortunately, both the public and healthcare professionals are not very aware of this disease,” Dr. Yendamuri said. “This is partly due to the rarity of this disease as well as the insidious nature of its presentation.
“Also, there is a long latency period between a patient’s exposure to asbestos and the presentation of the disease (approximately 40 years, on average), which means patients can often forget that they were exposed to asbestos. However, in my practice, I am seeing this disease diagnosed earlier than I used to, suggesting increasing consideration of this diagnosis earlier on in the evaluation of the patient.”
How to improve such early detection, however, is something of a problem. “Lung cancer screening is currently standard of care for specific target populations, but screening for mesothelioma is not yet a proven paradigm,” Dr. Yendamuri explained. “However, being aware of this diagnosis during the evaluation of a pleural effusion so that mesothelioma is diagnosed earlier should hopefully make available more therapeutic options.”
As for his own practice, Dr. Yendamuri plans to keep looking into better ways to treat the disease. “My goal is to continue to explore combinations of current treatment options with surgery, chemotherapy, radiation and intraoperative adjuvants to maximize survival while preserving quality of life.”
“The fact is that patients are running out of options faster than we can create them,” Dr. Yendamuri declared. “Clinical research is time-consuming, and time is often the one thing that many of our patients do not have.”