West Coast Medical Expert Update: Dr. David Jablons, San Francisco, CA

We are frequently contacted by patients and relatives who are searching for qualified doctors. Until recently, we were hard pressed to recommend any thoracic surgeons or oncologists who were on the same level with East Coast surgeons such as Dr. David Sugarbaker (Brigham and Women's in Boston) and Dr. Valeri Rusch (Memorial-Sloan Kettering in New York).

However, we were recently contacted by Carolyn Clarymacy, a registered nurse with USCF/Mt. Zion Medical Center in San Francisco. She was grateful enough to advise us that "there ARE surgeons and oncologists on the West Coast, who are on the forefront of treatment of Mesothelioma." She provided us with the resume of Dr. David Jablons, a thoracic surgeon at UCSF/MT.Zion Medical Center. Dr. Jablons was trained under Dr.David Sugarbaker and Valeri Rusch. His resume is very impressive. He is involved in protocols involving multi-modality treatment of Mesothelioma, as well as actively developing immunotoxin therapies.

I asked Ms. Clarymacy to provide a profile on Dr. Jablons. Here is his background:

Dr. David Jablons is a board-certified cardiothoracic surgeon, whose specialty is thoracic oncology. He received his surgical oncology training at the surgical branch of the National Cancer Institute and the National Institute of Health. His cardiothoracic surgery training was completed at the New York Hospital- Cornell University Medical Center, and the Memorial-Sloan Kettering Cancer Center. He has a particular interest in mesothelioma, and is actively researching possible immunotherapies for the treatment of mesothelioma. He utilizes a multimodality approach in the surgical treatment of mesothelioma, including radical pleurectomy / decortication,or extrapleural pneumonectomy, intraoperative radiotherapy (in the patients who undergo pleurectomy / decortication), and adjuvant chemotherapy and three dimentional conformal radiotherapy. Early studies show enhanced quality of life and improved median survival utilizing this approach.

Dr. Jablons can be reached at:
UCSF/Mt.Zion Medical Center Section of General Thoracic Surgery
San Francisco, CA 94143-1674
(415) 885-3882

Dr. Jablons has never testified for the asbestos companies. For more information on Dr. Jablons, please contact us at 800-831-9399 or check out their webpage at: http://mzweb.his.ucsf.edu/clin_departments/surgery/thoracic

Ms. Clarymacy was kind enough to provide us with a few medical article abstracts co-authored by Dr. Jablons.
Please see below:

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Resection and Intraoperative Radiotherapy (IORT) followed by Three Dimensional Conformal Radiotherapy +/- Adjuvant Chemotherapy for Malignant Mesothelioma

David M. Jablons, M.D. (Division of Thoracic Surgery)
Mack Roach III, M.D. (Department of Radiation Oncology)
Thierry M. Jahan, M.D. (Medical Oncology)
Robert B. Cameron, M.D. (Division of Thoracic Surgery)

All of UCSF/Mt. Zion Cancer Center

Malignant mesothelioma is a tumor arising out of the pleura related to asbestos exposure which carries a dismal prognosis. Median survivals for patients range from 9-12 months. Recent series have explored the role of combined modality therapy to attempt to achieve local control and enhance disease-free survival for these patients. Multi-modality therapy employing pleurectomy / decortication (P/D) or extrapleural pneumonectomy (EPP), external beam irradiation (XRT) and chemotherapy (Cytoxan, Adriamycin and Cisplatin (CAP) has, in select patients, achieved median survivals of 22 months.

We report here our early experience, using an aggressive combined multi-modality approach for the treatment of malignant mesothelioma. The purpose of this program is to assess: (1) the feasibility of routinely incorporating IORT with PD; (2) adjuvant three-dimensional conformal radiotherapy (3DCRT); and (3) adjuvant CAP chemotherapy on local control and survival.

Four patients have been entered into our study to date. Three-fourths (75%) have completed the full course of therapy; one patient opted not to take chemotherapy. All patients had histologically confirmed thoracoscopically staged (Butchart II) epithelial predominant mesotheliomas. There have been no treatment related deaths and minimal morbidity. Hospital stays for radical pleurectomy / decortication/IORT have averaged 8 days (range 7-9 days). Median disease-free survival is presently 7 months (range 5-9 months, mean f/u 7.5 months.) All patients have had definitive control of their pleural effusions and resolution of corresponding dyspnea. No patient has recurred nor developed radiation pneumonitis within this brief follow-up period. One patient developed a delayed post-operative empyema which resolved with tube thoracostomy and antibiotics.

We conclude that this aggressive combined multi-modality approach for treating mesotheliomas appears to be safe and well-tolerated thus far. While long-term follow-up is required to determine the potential for an impact on survival, it seems that this regimen can be administered safely with minimal morbidity and comparable hospital stays to standard pleurectomy and decortication.

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In vitro and in vivo expression of IL-4 receptors on human malignant mesothelioma: implications for therapy.

Jablons, D., Cameron, R., Xia, W., Leland, P., Varricchio, F., and Puri, R. Section of General Thoracic Surgery, University of California at San Francisco, San Francisco, CA 94143 (D.J., R.C., W.X.); Center for Biologics Evaluation and Research, FDA, Bethesda, MD 20892, USA (P.L., F.V., R.P.)

Malignant mesothelioma is a uniformly fatal disease of the pleura which afflicts nearly 4,000 Americans yearly and whose incidence is on the rise. Typically, patients with mesothelioma succumb due to progressive local disease rather than distant metastases. Despite efforts at combined modality therapy, response rates have been limited and survival rates dismal. Additional novel therapies are needed to improve prognosis of these patients. Previously, it has been reported that multiple human solid tumors express IL-4 receptors (IL-4R) on their cell surface and that these receptors could be targeted by IL-4 toxin. In this study, we have demonstrated that 8/8 samples of human malignant mesotheliomas (collected at the time of resection) consistently express IL-4 receptors as detected by immunohistochemistry using a monoclonal antibody to IL-4R p140 protein (M57). Background staining was minimal and appropriate controls failed to demonstrate non-specific staining. Additionally, using radiolabelled IL-4, we demonstrated that MS-1, a human mesothelioma cell line, expressed relatively high density of high affinity IL-4R. These studies suggest that IL-4R on malignant mesothelioma may serve as a novel target for IL-4 toxin-based cytotoxic therapy and that further studies should be performed in this direction.