Wednesday, 16 September 2026 10:00 AM
Partnerships
In separate interviews, Dr. Raja Flores and Dr. Rachel Sanborn describe the same principle from different sides of mesothelioma care: who a patient is matters as much as which treatment they get
CHESTNUT HILL, MA / ACCESS Newswire / September 16, 2026 / Mesothelioma Hope, a leading online resource providing education, patient advocacy, and support for those diagnosed with mesothelioma, has published two exclusive interviews with leading mesothelioma specialists that together address one of the most confusing questions patients face: why two people with the same diagnosis can be offered entirely different treatments.
Dr. Raja Flores, Chairman of the Department of Thoracic Surgery at Mount Sinai Health System, argues that recent research questioning the value of mesothelioma surgery is being misapplied to patients who could benefit from it. Dr. Rachel Sanborn, Medical Director of the Thoracic Oncology Program and of the Phase I Clinical Trials Program at Providence Cancer Institute in Portland, Oregon, explains how she matches patients to chemotherapy, immunotherapy, or a clinical trial.
Dr. Flores on Surgery and the MARS2 Trial
The trial did not test what patients think it tested. Every patient in both arms of MARS2 received chemotherapy first - a scenario Dr. Flores describes as fundamentally different from current practice. His team stopped giving chemotherapy before mesothelioma surgery roughly 15 years ago because patients did better with surgery first.
A 9% surgical mortality rate. Dr. Flores points to the mortality rate in the trial's surgery group as evidence that patient selection was a key issue. "There's no treatment where that would be considered acceptable," he said. He notes the group included patients with more advanced disease than he would normally operate on, and that all patients received the same extended operation rather than an approach matched to their disease.
One of the trial's own investigators raised the same concern. According to Dr. Flores, an investigator on the study later reviewed roughly half of the surgical patients and concluded he would not have operated on two-thirds of them.
A defined screening protocol. Dr. Flores uses what he calls the "Flores five" to assess surgical candidacy: a CT scan, a PET scan, a pulmonary function test, a cardiac stress test, and a review of the biopsy slides to confirm both the diagnosis and the cell type.
Age is not a disqualifier. "Age alone won't rule a patient out for surgery," Dr. Flores said, noting he has operated on a 97-year-old patient who lived to 100. He distinguishes between chronological age and overall fitness.
Realistic expectations. Roughly one in five patients he operates on lives five, eight, or ten years - a rate he describes as consistent over time. He does not use the word "cure" with patients.
"We still offer surgery, but it has to be the right patient, and they can do very well," Dr. Flores said.
Dr. Sanborn on Matching Patients to Treatment
Fitness comes before cell type. The first thing Dr. Sanborn assesses is performance status - how active and functional a patient is day to day. Patients who are up and moving tend to tolerate treatment more safely and benefit more from it, while patients spending most of the day in bed can be harmed by the same regimens.
Cell type then drives the choice. Patients with epithelioid mesothelioma tend to benefit from platinum-based chemotherapy, sometimes combined with a VEGF inhibitor such as bevacizumab. Patients with sarcomatoid or biphasic mesothelioma generally get less benefit from chemotherapy and tend to do better on combination immunotherapy.
Practical support is a clinical factor. Dr. Sanborn also assesses whether a patient has enough support to get through treatment safely, including reliable transportation to appointments.
Stability counts as a good outcome. On imaging, she looks for either shrinkage or stability and treats both as good results - while emphasizing that imaging and symptoms do not always tell the same story and must be read together.
Clinical trials are not a last resort. Dr. Sanborn notes that combination immunotherapy became standard for certain patients only because research showed it outperformed chemotherapy for a group whose average survival had been measured in months. She also addresses a common fear directly: "Placebo-controlled trials generally aren't used in this setting."
"Without continually asking how we can do better, we never will," Dr. Sanborn said.
Context for Patients and Families
Both specialists independently raised the problem of getting to the right care in the first place. Dr. Flores noted that many of his patients come from rural areas where mesothelioma was initially identified as adenocarcinoma because local providers may not have seen a case in years. He also described a counterintuitive finding from his own research: patients with a longer lag between diagnosis and treatment tended to do better because the delay reflected time spent reaching a specialized mesothelioma center. Dr. Sanborn described a similar diagnostic path, in which fluid may be drained several times before cancer is found and a surgical biopsy is needed to confirm the type.
How Mesothelioma Hope Supports Patients
Mesothelioma Hope's Patient Advocates are available 24/7 to help patients and families:
- Request a second opinion on a mesothelioma diagnosis
- Connect with surgeons and oncologists who treat mesothelioma specifically
- Understand surgical, chemotherapy, and immunotherapy options
- Explore clinical trials and access support groups and financial assistance
The full interviews with Dr. Raja Flores and Dr. Rachel Sanborn are both available at MesotheliomaHope.com.
About Mesothelioma Hope
Mesothelioma Hope is a comprehensive patient support resource dedicated to helping individuals diagnosed with mesothelioma and their families access the information, specialists, and support they need. Through its team of Patient Advocates, the organization provides free guidance on treatment options, clinical trials, financial assistance, and legal resources. Mesothelioma Hope can be reached 24/7 by calling (866) 608-8933 or by visiting www.mesotheliomahope.com.
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SOURCE: Mesothelioma Hope