Speaker 1: We’re so glad that you’re joining us today for the conversation with Dr. Ali Kasraeian. I’m Brian Middleton, and it’s a rainy day outside, but inside we’ve dried off just a bit. It’s a full house.
Before we go any further in today’s show, just a quick reminder. If you’re listening in, and at any point in today’s show you have a question for Dr. Kasraeian, you can call in to our phone lines, 904-304-1045. That’s 904-340-1045. Dr. Kasraeian, who do we have joining us in studio, and what are we talking about today?
Ali Kasraeian: Today we are going to talk about a disease process that is actually quite heartbreaking and has been brought to attention unfortunately for a repeated time in the political venue. Many years ago, Ted Kennedy suffered from this disease and unfortunately passed from it. Beau Biden, the son of our former vice president, suffered from this and passed from it, and most recently Senator McCain was diagnosed with this, and it’s glioblastoma, which is a fairly aggressive brain malignancy, a brain cancer.
Today we’re going to talk about that today. It’s interesting. According to the [inaudible 00:01:15] Intelligence, which is a marketing research company, there are about 87 experimental therapies ranging from vaccines to monoclonal antibodies which are an amazing new direction in terms of precision medicine, in terms of targeted therapies and things of that nature, that are in clinical trials right now for glioblastoma.
Most of these are probably not going to be approved, but some are, so it’s a very exciting time for medicine, in general. The interesting thing is some of these newest tools in the modern oncologist and surgeons’ tools in their medicine bag may actually be beneficial and may actually help someone like John McCain.
It’s interesting to think about that, that over the very recent past, some of the things that we had thought not possible, could potentially be possible. They may not help someone today, but they could potentially be applied to someone today and make impactful changes in the quality of their life and potentially the length of their life in small steps that could potentially be impactful further and further in the days to come and the years to come.
Today we’re going to talk about that, and to help us explore and understand this disease and talk about some of the things that may contribute to a better future for people with glioblastoma, are the scientists and the physicians and the surgeons that help us do that and try to understand this heartbreaking disease from the frontline.
To help us do that, ladies first, I’m very very excited to introduce our first guest who’s joining us from Atlanta. It’s Dr. Erin Dunbar, who actually was one of the first people I met when I walked into medical school. Erin is probably the most compassionate warm-hearted person I have probably ever known, and I’m very excited that after a number of years, we have kind of crossed paths in my almost stalker-like attempts to find her over the past few days.
She is in Atlanta, Georgia, at the Piedmont Hospital system as a neuro-oncologist, so she’s a medical oncologist that specializes in malignancies of the brain. After finishing her medical school at the University of Florida, and a hematology-oncology fellowship after a medicine residency at the University of Florida, she actually did a specific neuro-oncology fellowship at Johns Hopkins, after which she also recently finished a palliative medicine fellowship to further complement how she [inaudible 00:03:52].
It’s interesting when talking to her, she talks about tumor-directed therapy and symptom-directed therapy, which is very insightful in managing a disease that has about a 14-month survival. When dealing with a disease like that, it’s fairly interesting to think about the perspective of someone, and she’s one of the most open-minded and open-hearted people in talking about disease in general and people in general.
First person, ladies first, I want to thank you, Erin, for joining us here today on the conversation.
Dr. Dunbar: Thank you very much. It’s an absolute pleasure and a privilege to be on this show. I always start off my conversations with patients and their families by saying, “I realize you didn’t want to meet me, and I didn’t want to meet you,” but I think of every person’s journey in their cancer journey, as being one of a novel, and I want every patient to write their longest most beautiful novel, and I see myself as one of the instrumental characters in that novel, but that I want to add as many pages to each chapter and as many chapters as I possibly can.
It is a humbling opportunity to take care of this very formidable adversary disease, so thank you for allowing me to be a part of this show.
Ali Kasraeian: Let me ask you this before I start introducing our renowned panel that talks about the breadth of this disease from surgical management to oncological management. When we were in medical school and you did just a hematology-oncology fellowship, and then you decided to become a specialized oncologist dealing with this disease. Then you were instrumental actually at the University of Florida, which has a renowned neuroscience center in putting together one of the first centers for brain tumor therapy that was putting a multidisciplinary team dedicated to the management of brain malignancies.
How did you, from a medical student, where we’re kinda of just figuring out what to do, decide to pursue this entire path and deal with this field of oncology specifically?
Dr. Dunbar: I’ll share with you that my father was a hospital pharmacist, and my mom was an educator. So I often thought about medicine as the keys and locks of medicine, and I thought of the nervous system as being a final frontier that legitimately, a lot of patients and families, but even physicians were very fearful of, and I was one of them. I really felt a special calling to combine all of those sort of traits or desires into one profession, and I felt that there was a lot of nihilism in neuro-oncology. If was, “You have brain metastasis, get your affairs in order. Go to hospice,” or, “You have a primary brain tumor. There’s not much we can do.”
I really deeply believed that there was evidence-based hope if we just applied ourselves to the incremental advancements that we would wind of making significant improvements in folks’ length of life and quality of life. So that’s what I dedicated my medical vocation to do. It was a very natural fit combining all those interests and passions.
Ali Kasraeian: Talking about frontiers: As a surgeon, obviously we have to assume that frontiers cannot be navigated and explored without having a surgical exploratory team to move forward and lead the way, so joining this conversation has to include a surgeon. To help us, is Eric Sauvageau, who is an innovative neurosurgeon in the Baptist Medical Center here in Jacksonville, Florida. You’re very cutting edge in endovascular surgery, and the things, and I look forward to bringing you back on the show to talk about the amazing things that you guys are doing towards completely revolutionizing how we manage strokes.
In terms of the discussions with this disease today, looking at the frontiers in the future for brain malignancies, for example, as a medical student looking towards what to do, how does someone decide to become a neurosurgeon looking at the fact that the diseases of the brain sometimes are very challenging and, as an anatomist, for us doing abdominal [inaudible 00:08:24], I’m a urologist, everything kind of makes sense, anatomically function meets structure and anatomy fairly easily. With the brain is very difficult to just look at something that looks fairly homogenous and it’s so important to doing so many different things both in terms of neuro function but also the psychological and psychiatric aspect of things.
When you were trying to figure out what to do, what was the thing that drew you to the next frontier, which everyone … That’s the big thing that people talk about, the brain.
Dr. Sauvageau: Again, thanks for the invitation.
Ali Kasraeian: Again, [inaudible 00:08:56] Eric’s going to sound smarter than all of us here today no matter what he says because of his accent. I’ll disclaimer that, then he can probably say nothing wrong today, so that puts us all at a profound disadvantage today. So, Erin, sorry for putting you in this situation.
Dr. Sauvageau: As Erin mentioned, I think it’s humbling. Early on in my medical training, I had the opportunity to work with a neurosurgeon who was really a great role model. I think what attract me to the field is the fact that by the nature of the pathology, what people have, the disease that they have, those diseases are frequently life-changing, so early on, you have deep interaction with those people to try to help them navigate through those big life-changing events, so this was something early on that was appealing to me and the fact, as you pointed out, that technology, the surgical aspect with the technology in all the …