Professor Lang-Lazdunski was particularly involved in several landmark surgical trials in pleural mesothelioma:

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• The MARS trial which suggested EPP might be detrimental to patients and prompted a reconsideration of EPP as the surgical procedure of choice in pleural mesothelioma.

• The MesoVATS trial which compared patients’ outcomes after VATS pleurectomy and talc pleurodesis.

• Several early-phase trials testing new drugs in mesothelioma.

• He was involved in the conception and design of the EORTC L1205 trial comparing different chemotherapy administration schedules together with P/D in pleural mesothelioma.

• He did not take part in the MARS2 trial as his opinion was that it was unethical to not offer surgery to mesothelioma patients whose tumour could be removed by pleurectomy / decortication. In addition, he did not support the idea of removing the diaphragm (and pericardium) routinely in all patients.

 

Professor Lang-Lazdunski reported his 10-year experience of a multi-modality regimen involving radical pleurectomy/decortication and hyperthermic pleural lavage with povidone-iodine, together with systemic chemotherapy, at the annual meeting of the American Association of Thoracic Surgery in Toronto in April 2014. After more than 100 consecutive operations for pleural mesothelioma, there was no hospital mortality and there was a median overall survival of 32 months - one of the best ever reported in the field at the time. He showed that the cell type was a very important prognostic factor; patients with epithelioid mesothelioma lived significantly longer (median survival just under 36 months) than those with biphasic or sarcomatoid type (median survival 15 months) following multi-modality therapy. After five years, more than a third of patients with epithelioid mesothelioma was still alive. Another important finding in that study was that complete macroscopic resection was significantly associated with survival: patients in whom the surgeon could remove all visible tumours lived longer than those who had any tumour left behind. This is a very important point as mesothelioma surgery is technically demanding and there is a long learning curve for surgeons. It is thought that surgical mortality, complications rates, and long-term survival are better at specialist centres dealing with a large number of mesothelioma operations. Thus doctors, nurses and other team members are used to treat mesothelioma patients and know better how to prevent and deal with common and rare complications.

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Professor Lang-Lazdunski and colleagues published several scientific articles on the role and importance of PET-CT in the diagnosis, prognosis and follow-up of malignant pleural mesothelioma.

In 2008, he was the first to use Cyberknife, a new stereotactic radiotherapy tool, in a patient who presented with a localised relapse of malignant pleural mesothelioma following multimodality therapy. The patient was still alive and well 13 years after surgery.

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In 2019, Prof. Lang-Lazdunski presented his extended experience at the IASLC World Lung Cancer Conference in Barcelona, Spain. Again, he reported the lowest mortality so far for this kind of surgery in a series of more than 150 consecutive patients, with excellent long-term survival (35 months median survival for epithelioid mesothelioma). Patients were able to receive many more therapies with his lung-saving procedure and patients’ quality of life remained good. During the same meeting, he reported the largest experience of patients receiving pembrolizumab or Nivolumab as second or third-line therapy after trimodality therapy, with encouraging results.

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Together with colleagues from the Royal Marsden Hospital, London, Prof. Lang-Lazdunski reported the first use of Vismodegib (pharmacologic agent targeting the Hedgehog pathway) in a patient harbouring a rare pathogenic mutation in his DNA. The patient responded well and remained on the same treatment for approximately 2 years.