Answered Prayers: California Pastor Embraces Innovative Treatment with Dr. Chawla and Dr. Cameron to Tame Aggressive Biphasic Mesothelioma. Los Angeles, CA

Charles Van Kirk
February 2008

Pastor Charles Van Kirk enjoyed lifelong health. In the spring of 2007, however, he noticed shortness of breath when going on lunchtime mountain bike rides with a friend. His normal route, which he could easily do with minimal exertion, left him with a painful stitch in his side.

He decided to follow up with his family doctor for a check-up. A chest x-ray revealed scarring or thickening in the lung. , Dr. Elwood Cohen of Lake Arrowhead, California, then ordered a CT scan with contrast. Charles suffered an allergic reaction to the iodine and was hospitalized for over a week. The CT, however, confirmed the presence of an abnormality in the lung.

Charles was next referred to a pulmonologist, Dr. Jason Linn, in San Bernardino.

Dr. Linn diagnosed a pleural effusion and drained the fluid surrounding Charles's lung with a thoracentesis. The fluid returned, which required a second thoracentesis to remove it. Unbeknownst to Charles, this was the classic pattern for mesothelioma. Fortunately, his pulmonologist was concerned about the recurring fluid and referred him to a surgeon, Dr. Christopher Gibson.

Dr. Gibson decided to surgically remove the mass from Charles's lung, but when Dr. Gibson entered the chest cavity, he realized that the tumor was very big and actually encasing the lung. The planned procedure couldn't get the tumor, so he took the opportunity to cut off a slice of the tumor for lab analysis. Pathology analysis of the tissue resulted in a diagnosis of malignant pleural mesothelioma. That was the bad news. The worse news was that the cellular subtype of the tumor was biphasic, or a mixture of epithelial (40%) and sarcomatoid (60%) cells. This type of tumor is especially resistant to chemotherapy and to surgical treatment.

Surfing for a solution

Charles and Diane with their daughter Christa and her husband in Santa Monica, California.
May 2006

Fortunately, Pastor Van Kirk had a secret weapon: his two daughters and their use of the Internet. As they meticulously searched through the countless web sites purporting to provide medical options for mesothelioma patients, they finally located information about the best treater for pleural mesothelioma in California, Dr. Robert Cameron at UCLA's David Geffen School of Medicine and director of the UCLA mesothelioma program.

Dr. Cameron ordered a PET scan and requested that the UCLA pathologists be provided with the tissue slides in order to confirm the diagnosis. If the pathology report indicated that Charles's tumor was epithelial rather than biphasic, he would be able to perform the lung-sparing PD surgery.

Unfortunately, the UCLA lab confirmed the initial reading from San Bernardino. Charles had biphasic meso, and unless the tumor could be reduced with chemotherapy Dr. Cameron would be unable to perform the lung-sparing surgery. Given the refractory and aggressiveness of biphasic mesothelioma , the promise of chemo seemed dim.

Ace in the hole

Dr. Cameron recommended that Charles consult with the leading researcher and practitioner on the West Coast specializing in chemotherapy for sarcoma, Dr. Sant Chawla of the Sarcoma Oncology Center in Los Angeles. Dr. Chawla has treated several of Dr. Cameron's sarcomatoid mesothelioma patients with many of the same drugs that are used to treat sarcoma. Dr. Chawla is one of only two doctors nationwide who offers a clinical trial for mesothelioma using conventional Alimta and Cistplatin, plus an innovative anti-angiogenesis drug that has not been approved by the FDA.

Dr. Sant Chawla

Charles consulted with Dr. Chawla and enrolled in the Phase I/II trial. In order to enroll, Charles had to meet several criteria: he had confirmed biphasic pleural meso, with measurable disease greater than 20mm, staging greater than equal to stage II using the IMIG system, ECOT performance status less than or equal to 2, and an estimated survival time of at least three months.

The regimen produced an unexpected tumor response of sorts, although medically a "response" is defined by a uniform reduction of tumor by one centimeter or more. Though the tumor did not shrink, follow up scans performed by Dr. Chawla showed the tumor had not expanded, which itself is rare for such an aggressive tumor.

At the earlier examination in April, Charles's tumor measured 55 x 36mm in diameter. Rather than the expected growth and spread of such an aggressive tumor, the CT scan taken in late May showed that the tumor size in spots was 49 x 33mm, which the reading physician evaluated as "essentially no change in size since prior examination." As importantly, the physician noted that there were no new masses.

Although Charles's left hemithorax demonstrated a decrease in overall volume and a circumferential pleural thickening that was particularly prominent at the base of the left lung, a medical comeback of sorts was in progress: The lack of spread was enough to justify a second consultation with Dr. Cameron, who was pleased. "First, I was surprised by the lack of growth," said Dr. Cameron. "Second, I was pleased to learn that Dr. Chawla had a new protocol that incorporated an anti-angiogenic compound into the mix along with Cisplatin and Alimta. I had referred many sarcomatoid patients to Dr. Chawla before, but Pastor Van Kirk was the first to participate in this new protocol."

The best defense

Dr. Robert Cameron in surgery

Dr. Cameron decided to operate, another "first "of sorts. He scheduled Charles for the lung-sparing pleurectomy / decortication (P/D) surgery. The surgery was grueling, lasting over twelve hours. Once inside the chest cavity, Dr. Cameron found something even more promising than the "no growth" of the preliminary CT scan. He found extensive scar tissue surrounding the tumor, something he'd never before seen from a biphasic patient on a chemotherapy protocol. He couldn't be sure until after the pathologist reviewed the specimens later, but at the time Dr. Cameron's impression, in so many words, was "Wow, the chemotherapy regimen must have helped."

A week later, the pathologist issued his report, which further stimulated Dr. Cameron's interest. About 75% of the tissue was scar tissue and 25% was tumor. What did this mean? Did it mean that Dr. Chawla's cocktail had killed 75% of the cancerous mesothelioma cells?

Not necessarily. "We don't know if the treatment was solely responsible for the pathologic finding that only 25% of the tissue removed was tumor. The scar tissue could be a natural biologic result of the tumor itself. We need to follow up on this very intriguing clinical result," observed Dr. Cameron.

So much to live for

Shortly after the difficult surgery, the robust and hard charging pastor was back on his feet. The best defense had truly been an aggressive and innovative offense. A miracle? That depends on who you ask. For Pastor Van Kirk and his family, the remarkable response, and the successful surgery, was more than random luck. "There are all kinds of miracles," says Charles. "Mine happened to be the kind that comes from great science, lucky timing, and the best mesothelioma doctors on the West Coast."

Charles officiating at his daughter's Lindsey's wedding in June of 2006

Charles and his wife have three beautiful daughters who have given them three lovely grandchildren. Their happiness and rejoicing at seeing their family grow is a special kind of love and joy known only to grandparents. As Charles says, "Few moments compare to a father walking his daughter down the isle to give her to a deserving young man, and fewer moments still compare with the joy of being blessed with grandchildren."

For the last eighteen years, Charles has served as the pastor of the Rim of the World Community Church located in Running Springs, California. Running Springs is a mountain community located near Lake Arrowhead and Big Bear Lake. "As a mountain preacher, you wear a lot of hats," Charles says with a big grin. Charles has a congregation of approximately 130 and is involved in the church's men's group which performs home repairs, shovels snow, and chops wood for widows and others in need of assistance. Charles and his church provided extensive shelter and assistance to families who were displaced as a result of the wildfires which ravaged the area in 2006.

"I love my work and have kept up with my responsibilities as pastor despite the symptoms and the treatment. Of course, I've had lots of help from my family and congregation."

Charles has always lived the healthy and active lifestyle. As a veteran who served during the Vietnam War and as a state champion swimmer in high school, an excess of strength and energy have characterized his life. It's an excess he has always put back into the community and into the lives of people in need. Since moving to Running Springs in 1985, Charles has taken full advantage of the numerous recreational activities available in his mountain surroundings. Before the onset of his symptoms, he and his wife Diane would go for hikes virtually every morning. Charles was also fond of going out for exercise at lunch. In the winter this involved going snow shoeing and in the summer this involved going mountain biking or jogging. He and Diane also enjoyed skiing at many of the nearby ski resorts.

Charles Van Kirk family
June 2006

Charles is a man who is loved by his family and by the community which he serves. He is used to being the one that others turn to for strength and support in their time of need, and is grateful for the outpouring of love and support he has received since being diagnosed with mesothelioma. His optimism about the future has been tempered by concern for the well-being of those who have grown to rely upon him. "I put my faith in God, my love in my family, and my trust in my doctors. What we've been able to get as far as extended life from the treatments so far is more than we ever hoped for at first. We're not giving up."

He can't give up now. Charles is the poster boy for what hopes to be a breakthrough treatment plan for sarcomatoid mesothelioma patients.

*** POSTED NOVEMBER 20, 2008 ***

An Update -- 7/30/2009

Since undergoing the pleurectomy/decortication surgery with Dr. Robert Cameron at UCLA Medical Center in September 2008, Dr. Cameron has continued to monitor Charles closely. Charles has been seen once every three months and undergoes CT and PET scans before every visit so Dr. Cameron can determine whether the tumor is recurring. On January 9, 2009, Dr. Cameron found that the scans did not reveal any recurrence. Scans taken prior to an April 24, 2009 visit revealed some activity in the cells which Charles’s oncologist characterized as “suspicious” for recurrence, but Dr. Cameron concluded that the activity was part of the normal healing process from the surgery and post-surgical radiation treatments. The most recent visit with Dr. Cameron occurred on July 24, 2009, during which Dr. Cameron concluded that there was once again no evidence of recurrence!

Even with chemotherapy, surgery and radiation, it is impossible to remove all of the cancer cells from Charles’s chest. It is for this reason that Dr. Cameron will continue to monitor Charles’s condition closely so that prompt action can be taken at the first sign of recurrence.

For now, “Pastor Chuck” (as he is known to his parishioners at the Rim of the World Community Church) is healing from the effects of the cancer and all of the treatments needed to kill it. He remains encouraged by the continued good news and the answer to his prayers that his current status represents. He is now "back in the saddle" at Rim Church, giving the Sunday messages, attending or presiding at a full schedule of meetings, and doing counseling and administrative work.  

We join with Pastor Chuck’s family, friends and parishioners in asking for the Lord's continued grace in keeping the cancer from returning.