Duke Health interventional pulmonologist Dr. Kamran Mahmood, MD, MPH and the Duke Interventional Pulmonology Team are offering a ground-breaking, promising new treatment procedure for advanced lung cancer patients— pulsed electric field (PEF) ablation.
Dr. Mahmood is among the first physicians to perform the procedure bronchoscopically, the first at a North Carolina academic medical center.
The procedure is performed under general anesthesia. Robotic bronchoscope is introduced through an endotracheal tube via mouth. A needle at the distal end of a catheter is inserted into the tumor and high voltage, high-frequency electric current is passed into the lesion.
This ablates the tumor and makes it immunogenic, enhancing the body’s immune response against the cancer. Because of the immune response, even the untreated cancer sometimes shrinks, a phenomenon known as abscopal effect.
“While the electric current causes ablation of the tumor, more importantly — based on early-stage studies — it also revs up the body's immunity,” said Dr. Mahmood, associate professor in the Division of Pulmonary, Allergy, and Critical Care Medicine. “In other words, the body's immune system, including the T cells and other immune cells, start recognizing the tumor and start attacking it more effectively.”
Dr. Mahmood is leading research studies at Duke to further assess the safety and efficacy of the treatment. The data is evolving, but early results are promising, he said.
A “Game Changer”
“We’ve seen tumors that have shrunken as well as others that have remained stable,” he said. “Some cancers do not respond; unfortunately, this is what the landscape of cancer treatment looks like.”
The procedure, he said, has the potential to be “a game changer” in moving the field of thoracic oncology forward.
Lung cancer treatment has come a long way in the last 15 to 20 years, but it is still the leading cause of cancer deaths despite the best treatments available. Lung cancer mortality is higher than the mortality of the next three common cancers — including breast, prostate, and colon. Lung cancer is the second most common cancer in both men and women.
“We have a lot of hope and excitement tied to this technology. It can be a game changer and provide a safe and effective therapeutic option to our patients whose cancer is progressing despite the standard of care,” Dr. Mahmood said. “We hope this technology will find a place in the armamentarium available to treat cancer and improve the survival and the quality of life of our patients.”
The U.S. Food and Drug Administration last spring cleared the treatment modality of pulsed electric field ablation for bronchoscopic use, which has been used in interventional radiology for a while now to approach lesions or tumors in the lung percutaneously.
Depending on the number of treatments that are applied, the process takes from 60 to 90 minutes. Treatment is currently reserved for patients with lung cancer and other cancers metastasized to lungs, who have failed the standard of care.
“Taking care of very sick patients and offering them hope is what excites me and my colleagues at Duke,” he said. “My message is don't lose hope, keep fighting, and keep participating in the trials so we can move the field forward and find an effective way of treating cancer.”