Dr. Hassan Khalil has learned from some of the best mesothelioma specialists in the world.
He completed two thoracic surgery fellowships at Brigham and Women’s Hospital, where he received training from Dr. Abraham “Avi” Lebenthal, Dr. Marcelo DaSilva (now at AdventHealth in Orlando, Florida), and Dr. Raphael Bueno. He also completed a surgery residency at the UCLA Medical Center, which has one of the world’s best mesothelioma programs.
With this much training and tutelage, Dr. Khalil is well-positioned to help people affected by this rare cancer.
Dr. Khalil is the newest associate thoracic surgeon at Brigham and Women’s Hospital in Boston, Massachusetts. His focus includes mesothelioma, specifically pleural mesothelioma. He’s working with Dr. Lebenthal and Dr. Bueno, two of the most highly respected thoracic surgeons in the world.
“It’s a sad disease and a lot of people don’t want to deal with diseases with poor survival,” he said of his clinical focus on mesothelioma. “I think that’s where I can make the most impact. In situations where patients would otherwise have a terrible prognosis, I can help them.”
Dr. Khalil is also the new head of the Boston VA mesothelioma program, taking over leadership after Dr. Lebenthal ran it for 10 years. The Boston VA has partnered with Brigham and Women’s since its inception in 2010. Dr. Khalil will usher in the second era of helping veterans with mesothelioma who wish to receive treatment through the VA health care system.
Mesothelioma Guide had the privilege of conducting a one-on-one interview with Dr. Khalil. The conversation covered a range of topics, including his:
- Experience with mesothelioma surgeries
- Views regarding specific types of therapies
- Goals for the Boston VA program
If you’d like to see Dr. Khalil for your mesothelioma, contact our veterans patient advocate Carl Jewett. He’s available at firstname.lastname@example.org.
Mesothelioma Guide: Why do you have a clinical interest/focus on mesothelioma?
Dr. Khalil: I think mesothelioma is a terrible disease. It’s one of those diseases where patients do poorly without therapy. Their survival is dismal. So I think that’s why I and several other specialists want to focus on mesothelioma. I believe any incremental improvement in therapy adds a lot to the patient’s lifespan and quality of life.
MG: There’s an ongoing debate between the two surgeries for pleural mesothelioma: pleurectomy with decortication (P/D) versus extrapleural pneumonectomy (EPP). P/D spares the lung while EPP removes the lung (and other areas). What is your stance on this?
Dr. Khalil: In some ways, it is (case by case). It’s also about experience. EPP is certainly a technically easier operation. … With P/D, you have to peel the visceral pleura off the lung. It can cause complications like bleeding and prolonged air leaks.
EPP is a quicker operation. Some argue it’s potentially a better cancer operation, although the survival is equivalent. My preference is to leave the lung behind and not do an EPP when technically possible.
MG: What is your stance on performing surgery during stage 3 or stage 4 of mesothelioma? Are you more cautious in your treatment approach with these cases?
Dr. Khalil: I think down-staging patients with neoadjuvant therapy makes sense to me in most cases. Reassessing patients for potential surgery after getting neoadjuvant therapy also makes a lot of sense.
Surgery itself can be a diagnostic procedure in some patients. In a subset of patients who are otherwise healthy and can tolerate surgery, if there is a good response to neoadjuvant therapy, I would advocate for them to get surgery (regardless of stage). I think some of those patients are resectable.
MG: Which other therapies do you prefer along with surgery (chemotherapy, radiation, immunotherapy, etc.)?
Dr. Khalil: The fact we have several modalities of treatment tells me there isn’t any one excellent therapy. I think all of these modalities work together. I don’t see them as individual therapies; I see surgery as one part of the treatment. Patients, most of the time, need neoadjuvant treatment or adjuvant treatment.
Does one work better than the other all the time? Not consistently. They each target the tumor in a different way. In my mind, they all go hand in hand. Immunotherapy sounds good because it’s the new kid on the block, but not everyone responds to it. I think it’s wonderful we have this new treatment, but I see it as another instrument that works with these other therapies.
MG: Do you use intraoperative chemotherapy for mesothelioma? (Note for readers: Intraoperative chemotherapy delivers a liquid form of the drug at the tumor site rather than injecting it into the bloodstream.)
Dr. Khalil: I think it’s a sensitive question depending on who you ask. A lot of people don’t do it and don’t believe in it. For a patient whose gross disease is removed (during surgery) and who has adequate kidney function, I think (intraoperative chemotherapy) is one of the tools I use.
MG: Do you perform surgery on patients with a biphasic or sarcomatoid cell type or just epithelioid cell type?
Dr. Khalil: I think it’s nice we have these classifications. It allows us to study and research the disease better. I do believe in the prognostic benefits of knowing what kind of tumor we’re dealing with. However, I don’t believe in outright saying whether someone can have surgery based on a classification. I’ve seen epithelioid mesothelioma cases, that are supposedly better for surgery, that have been unresectable. I’ve seen sarcomatoid tumors that are resectable.
MG: You’ll be leading the VA’s mesothelioma program. Why did that interest you, and how will that transition work?
Dr. Khalil: My predecessor Dr. Avi Lebenthal did a great job starting the program. We have patients, veterans, who follow up at the VA after having undergone surgery. I think these patients should continue to get excellent care. I’ve worked with many of them already.
MG: Will you perform surgeries at the Boston VA or have veterans come to Brigham and Women’s Hospital for operations?
Dr. Khalil: We will perform them at the Boston VA campus.
MG: Do you have a lot of experience helping veterans with mesothelioma?
Dr. Khalil: As part of my advanced thoracic training, I trained at the Boston VA. I’ve already met a lot of mesothelioma patients in the pipeline. I think that’s also a big plus because I bring expertise from Brigham and Women’s Hospital.
MG: How do you see the VA’s mesothelioma program growing in the next few years under your supervision?
Dr. Khalil: I think where we are now is pretty good. I think we need to make ourselves more known to the veterans, so they know there is a Boston VA with a mesothelioma program.
I think a lot of them like the VA and want to stay within the VA health care system. So I want to put the word out that we have a mesothelioma program, and our outcomes are very good. It’s a multidisciplinary team, so you won’t come and be cared for by one surgeon. It’s a whole team.
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