The Meso Foundation recently hosted a Meet the Mesothelioma Experts session with Dr. Raphael Bueno, the chief of thoracic surgery at Brigham and Women’s Hospital in Boston, MA. He was interviewed by Mary Hesdorffer, the Meso Foundation’s executive director and nurse practitioner, and discussed his work and the future of his mesothelioma program.
When asked about his vision for the mesothelioma program at Brigham and Women’s Hospital, Dr. Bueno expressed the need for a more targeted approach to mesothelioma treatment. In the past, every patient with mesothelioma at any stage was treated the same. This is changing, and Dr. Bueno explained his program’s use of clinical window trials to help determine which drugs are best for which patients.
With a clinical window trial, patients are given the opportunity to have a biopsy and a specific biological therapy for 2-6 weeks followed by another biopsy. The biopsies are then compared to measure response. By looking at people who respond, people who stay the same, and people who progress, they then have more insight into the biomarkers that can predict who will respond well to the drug.
Mary moved on to ask Dr. Bueno about the significance of molecular testing for mesothelioma. In his response, Dr. Bueno explained that he recently published the results of a study in which he sequenced 260 mesothelioma tumors and identified all the mutations present. The results showed that there are many novel mutations and biological pathways that are repeatedly altered in mesothelioma. Through this research, there is an opportunity to find clues as to what targets should be selected for new drugs and to see if any existing drugs can potentially work for mesothelioma.
When asked about the treatment that his patients currently receive, Dr. Bueno explained that it depends on the patient and for what they may be a candidate. Some patients will first receive biological therapy to test its effectiveness. They may then have surgery followed by intrapleural heated chemotherapy with cisplatin to remove all of the cancer cells. He is looking to use more targeted therapy based on molecular diagnosis, but it is only in the planning stages.
Dr. Bueno believes that “in order to beat a disease like mesothelioma, you need to combine different platforms,” which would include surgery, heated chemotherapy, biological therapy, and immunotherapy. He stressed that one end-all cure is unlikely, but a combination of various treatment types could be the key.
Dr. Bueno joined the faculty at Brigham and Women’s Hospital in 1996 after completing his residency in thoracic and cardiac surgery at Massachusetts General Hospital. His main research interests center on the molecular events that lead to malignancy in mesothelioma and lung cancer, the development of prognostic tests and identification of biomarkers. Dr. Bueno’s clinical research efforts center on developing new technologies for thoracic surgery.
Listen to the full interview with Dr. Bueno below:
Visit curemeso.org/experts to listen to all past Meet the Mesothelioma Experts sessions.
