The Expert: Dr. John Maddox, a pathologist based in Newport News, Virginia, outlines plaintiff’s mesothelioma and his treatment.
Dr. John Maddox is an anatomic and clinical pathologist based out of Newport News, Virginia. He has helped author papers investigating the relationship between asbestosis and mesothelioma as well as lung cancer. Testifying as an expert in a 2018 Florida asbestos trial, Dr. Maddox addresses the plaintiff’s claim that exposure to asbestos in industrial talc caused his mesothelioma.
In this clip, the expert discusses the treatments that were tried and their results. The patient’s presentation to his treating physicians was classic for mesothelioma and investigations, including a PET scan, confirmed that there were abnormally metabolizing tumor cells present diffusely in his chest. The fluid that had accumulated in the patient’s chest cavity was removed for evaluation, and it rapidly reaccumulated, as would be expected with this disease. Once the diagnosis was made, the patient sought a second opinion from a well-known hospital in Boston. The physicians at that facility recommended that the disease process be surgically staged to see if there had been spread within mediastinum or to the opposite side.
The original surgery to determine the diagnosis had revealed a large tumor load encasing the right lung. This staging surgery then revealed that it had spread to the lymph nodes of the mediastinum in the center of the chest as well as to the opposite lung. His stage at that point was such that surgical intervention would be unproductive as the disease had spread too far. It also eliminated the possibility that he could take part in treatment protocols that mandate that one does not have advanced stage disease.
The patient went on standard chemotherapy for mesothelioma, which entailed administration of two agents simultaneously. After four months of treatment, he developed lung toxicity related to one of those drugs and it was discontinued. After completing treatments with the other drug, he was enrolled in an experimental protocol from the National Institute of Health in Maryland.
This new protocol used a specific antibody against the protein called mesothelin which exists on the surface of the mesothelioma tumor. This targeted approach did not seem to work and was abandoned after only two cycles of administration. The patient then returned to Florida and was initially started on “second line” chemotherapy, which demonstrated no response, before eventually starting on “third line” chemotherapy. This latter treatment is an immune system modulator that targets the PD-L1 [Programmed death-ligand 1] protein that is present on some tumor cells. PD-L1 helps the tumor to evade the body’s immune response. Attacking this protein would theoretically allow the patient’s immune system to fight the tumor more effectively.
There was a “partial response” to this therapy that was manifest as a decrease in pain as well as a decrease in the size of tumor load on both sides of the chest, but most of the tumor did remain at the time of litigation. At the end of this clip, Dr. Maddox plainly states that despite the slight improvement noted with the “third line” therapy, this patient “within a reasonable degree of medical probability” would die of his mesothelioma.
As the jury deliberated, an unpublished settlement was reached.
Gary Gansar, MD, is residency-trained in general surgery. He served as Chief of Surgery and Staff at Elmwood Medical Center and on the Medical Executive Committee at Touro Infirmary and Mercy Hospital in New Orleans, LA. Dr. Gansar was Board Certified in general surgery while in active practice. He joined AMFS in 2015 as a Physician Medical Director.
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