A team examined explanations generated by a large language model (LLM) for its performance of a clinical prediction task. They had found that, after fine-tuning, the LLM, GPT-4o from San Francisco-based OpenAI, performed comparably to four more traditional types of machine learning (ML) for predicting which patients would discontinue their home cancer medications before planned treatment completion.
From the Department of Biomedical Informatics, research fellow Congning Ni, PhD, Associate Professor Zhijun Yin, PhD, and colleagues reported their findings in the e-book series “Studies in Health Technology and Informatics.” The team used electronic health records and pharmacy surveys from 2,364 cancer patients.
The LLM achieved an F1 score of 87%, while the closest ML model scored 83%. For interpreting the latter model, the team used SHAP, or Shapley additive explanations, a widely used method for exploring (among other things) the internal structure of ML models, revealing how features are weighed. For interpreting the much larger GPT-4o, they asked the LLM to explain its reasoning for individual predictions; to derive feature-importance scores from this output, they used a new method they call mimic-SHAP.
The two models were found to agree on top features — body mass index and age. For secondary features, the LLM was found to lean more on patients’ prior conditions, the ML model on drug exposures and health care procedures.
Many cancer patients discontinue medications taken at home early, for reasons ranging from side effects and lack of response to nonmedical issues such as costs. Predicting early discontinuation could aid efforts to improve treatment adherence.
Others on the study from Vanderbilt include Qingyuan Song, Qingxia Chen, PhD, Lijun Song, PhD, S. Trent Rosenbloom, MD, MPH, Autumn Zuckerman, PharmD, Bridget Lynch, PharmD, MS, and Bradley Malin, PhD. They were joined by Jeremy Warner, MD, MS, of Brown University. The study was supported by National Institutes of Health award R37CA237452.
Following the introduction of a surgical protocol that leveraged intraoperative imaging with a combination PET-CT scanner to assess the success of head and neck cancer resection, surgeons have used the technology for breast cancer.
Denise Garcia, MD, uses the Xeos Aura 10 scanner to image a recently excised breast tumor from a patient. The use of the Xeos Aura 10 device ensures the imaging and assessment can be done in the operating room rather than in the pathology lab. (photo by Kyrionna Golliday)
Investigators led by Michael Topf, MD, Associate Professor of Otolaryngology-Head and Neck Surgery, performed the nation’s first surgery using intraoperative PET-CT scanning in September 2025. Now, a surgical team led by Denise Garcia, MD, Assistant Professor of Surgery in the Division of Surgical Oncology and Endocrine Surgery, has applied the technology to successfully resect a breast cancer mass.
“This application of intraoperative PET-CT is proof that countless patients can benefit from the expansion of this novel imaging methodology,” said Garcia. “Our team is proud to apply it to a type of tumor that has not yet been imaged for the purposes of assessing margin status. As our institution expands treatment methodologies to more types of cancer, we can cure more patients and give them peace of mind that their surgery has been completed with precision. This technological advancement underscores the success we’ve had across multiple disciplines in working toward that goal.”
Rapid expansion of intraoperative PET-CT scanning boosts efficiency, offers peace of mind to surgeons and patients alike
With each new application, surgeons are demonstrating that an intraoperative PET-CT imaging protocol can help reduce wait time for results from several days to a matter of minutes and allow surgical teams to know immediately whether they need to continue operating.
During surgery, the patient receives a dose of a radioactive agent that illuminates the cancer tissue in the scanner. Once the tumor is excised, it is placed in a specialized mobile PET-CT scanner called an Aura 10 device, developed and supplied by Belgium-based surgical technology company Xeos. The scanner negates the need to send the specimen to the pathology lab, providing surgical teams with a real-time view and allowing them to quickly determine if the entire cancerous mass was removed.
If any mass remains, the operation continues. If the cancer has been successfully resected, the surgery concludes, and the patient is sent home with peace of mind, knowing they won’t need to return for a follow-up surgery, and with confidence that their surgeons have a precise, immediate look at the results of the surgery. Because patients receive the radioactive agent on the day of surgery rather than in advance, they also receive a lower dose of radiation.
The fifth annual Swim Across America-Nashville (SAA-Nashville), an annual team relay pool swim and charity event held at Ensworth Natatorium, celebrated a record-setting year: They raised more than $130,000 for cancer research and clinical trials at Vanderbilt-Ingram Cancer Center.
Ben Park, MD, PhD, Director of Vanderbilt-Ingram Cancer Center, kicked off the event with his annual cannonball splash. (submitted photo)
Ben Ho Park, MD, PhD, the Benjamin F. Byrd Jr. Professor of Oncology and Director of Vanderbilt-Ingram Cancer Center, kicked things off with his signature cannonball splash. Nearly 200 swimmers — including Olympians Missy Franklin Johnson, Paige Zemina Northcutt and Claire Donahue White — volunteers, supporters and sponsors participated this year, making it the largest and most successful Nashville swim to date.
The funds will be awarded to cancer researchers studying new approaches for the prevention, diagnosis and treatment of cancer. With this year’s proceeds, SAA-Nashville has now raised more than $500,000 to fund cancer research initiatives at Vanderbilt-Ingram since 2022.
Past grant recipients have used funds to investigate advancements in malignant pleural effusion (often caused by cancers such as breast cancer spreading to the lungs), early-stage lung cancer, surgical oncology and more.
Trying to find another fun way to support cancer research and exercise? Clip In 4 the Cure’s early bird registration closes on June 30.
Medical artificial intelligence (AI) faces a fundamental challenge: uncertainty quantification. Artificial neural networks are largely unaware of the limits of their training data and can become overconfident when confronted with unfamiliar inputs. Suppose you train a neural network to distinguish among African mammals. If you then present it with an image of a South American jaguar — an animal it has never encountered — the model cannot say “unknown.” Instead, it may confidently declare the jaguar to be a leopard.
Reported June 23 in Nature Biomedical Engineering, researchers at Vanderbilt Health and centers in Hong Kong have created a versatile uncertainty-aware AI framework broadly adaptable as a wrapper for digital pathology AI systems. (An AI wrapper acts as an interface layer that customizes, formats and automates how users interact with the underlying intelligence.) They demonstrate their wrapper, called TRUECAM, primarily with reference to non-small cell lung cancer (NSCLC) subtyping using whole-slide images.
TRUECAM is designed not only for identification of out-of-scope inputs, but also to filter out noninformative regions — normal or poorly stained tissue, for example — that could distort slide-level inference. According to the paper, these complementary capacities allow TRUECAM to provide customizable accuracy guarantees for cancer subtype classifications.
The team tested TRUECAM as a wrapper for a widely used AI architecture for NSCLC subtyping and four newer, more generalized digital pathology AI foundation models. Testing involved NSCLC whole-slide images from two geographically diverse cancer research consortia, a constructed set of clinically meaningful out-of-scope images, and a sequence of real-world images from Queen Mary Hospital in Hong Kong. Testing also extended to cancer tissue spanning multiple organs, such as breast, brain and kidney.
Compared to other solutions for trustworthy digital pathology AI, the authors say that TRUECAM performs not only with greater accuracy, but also relatively rapidly and efficiently, without adding substantial costs.
“Achieving trustworthy AI in the medical domain is requisite for realizing the potential of this transformative technology,” said one of the paper’s three corresponding authors, Bradley Malin, PhD, Professor of Biomedical Informatics, Biostatistics and Computer Science, and holder of the Accenture Chair. “It’s not only that a patient’s clinical profile can fall out of scope of your model’s training data, but other sources of variation, such as your institution’s method of collecting and staining specimens, or artifacts and irregularities that tend to arise in tissue preparation, can also prompt your model to arrive confidently at a mistaken conclusion. TRUECAM provides a thoroughgoing, versatile and efficient solution to these potentially unsafe shortcomings.”
The team reports that TRUECAM proved more accurate and efficient than existing approaches to digital pathology AI uncertainty quantification, reliably detected out-of-scope inputs, abstained from classifying challenging inputs (allowing deferral to pathologists), delivered error rates that reliably met prespecified accuracy targets, improved fairness across sex and race, and proved generalizable to datasets beyond lung cancer.
Chao Yan, PhD, MS, Research Instructor in Biomedical Informatics, is among the paper’s three lead authors.
“Perhaps our most striking finding,” Yan said, “was that, with ambiguous patches and normal regions often found to dominate a pathology slide, TRUECAM’s targeted elimination of this noise, and its resulting focus on sometimes comparatively small patches in an image, allows it to proceed efficiently to accurate and fairer cancer subtype classification, with the model focusing on the same regions pathologists identify as diagnostically relevant. This goes beyond current approaches, and the practical implications appear to have broad import.”
Chief authors from Hong Kong include, from Hong Kong Polytechnic University, lead author and corresponding author Xiaoge Zhang, PhD, who earned his doctorate from Vanderbilt University in 2019, and lead author Tao Wang, a PhD student, and, from the University of Hong Kong, corresponding author Maximus C.F. Yeung, MBBS, MSc. Also on the paper from Vanderbilt Health is Fedaa Najdawi, MBBS, Assistant Professor of Pathology, Microbiology and Immunology. The study was funded in part by the National Institutes of Health under award K99LM014428.
On Tuesday, June 23, Susan G. Komen, the internationally known nonprofit breast cancer organization, announced $15.4 million in grants to 35 leading breast cancer researchers across the United States. Three of the 35 grantees are Vanderbilt-Ingram Cancer Center members:
Tuya Pal, MD, Associate Director of Clinical Genomics and Ingram Professor of Cancer Research
Ben Ho Park, MD, PhD, Director of Vanderbilt-Ingram Cancer Center and Benjamin F. Byrd Jr. Professor of Oncology
Jennifer Pietenpol, PhD, Chief Scientific and Strategy Officer at Vanderbilt Health, Ingram Professor of Cancer Research, and former director of Vanderbilt-Ingram Cancer Center
Ben Ho Park, MD, PhD
“On behalf of Vanderbilt Health, we are deeply grateful to Susan G. Komen for its long-standing partnership and extraordinary commitment to advancing breast cancer research. Komen’s sustained investment in science and in researchers enables institutions like ours to pursue bold, collaborative work that ultimately improves outcomes for patients everywhere,” said Pietenpol, who holds the Brock Family Directorship in Career Development.
“I’m honored to receive a grant from Susan G. Komen alongside my Vanderbilt Health colleagues and fellow grantees advancing breast cancer discoveries,” she said.
According to Komen, the funded projects span some of the most promising areas of research and include support for long-term, well-established researchers who have made a profound impact in the field.
Jennifer Pietenpol, PhD
Pietenpol and her team’s Komen-funded research focuses on understanding the molecular drivers of triple-negative breast cancers, with the goal of identifying new vulnerabilities that can be targeted therapeutically. Her work integrates genomic and functional approaches to uncover mechanisms that influence tumor behavior and treatment response, helping to inform more precise and effective strategies for patients with high-risk disease.
Park’s work centers around how to expose new therapeutic “vulnerabilities” in breast cancers that have gene mutations that lead to alterations in RNA, or “missplicing.”
In simpler terms, Park is developing new therapies based on a specific type of gene mutation that “rewires” cancer cells. This rewiring is what gives the cells the ability to become cancerous. His work has uncovered an Achilles’ heel: These rewired circuits are found only in cancer cells, not in normal cells.
Park explained, “This creates a strong rationale for developing cancer-specific drugs, and in our study, we focus on antibodies that selectively kill cells with ‘rewired’ components.”
Pal’s research is focused on the intersection of tumor and germline genomics, including studies of inherited breast cancers. Pal said, “Our overall goals are to better understand the development and trajectory of breast cancers due to inherited genes across populations.”
Her work examines breast cancer tumor genomics among broad populations of women with hereditary breast cancer due to BRCA1, BRCA2, PALB2, ATM and CHEK2 mutations. These efforts encompass the evaluation of aggressive breast cancers among young Black women, who face higher risks of being diagnosed with and dying from breast cancer, yet are also less likely to receive genetic testing.
Komen is the largest nonprofit funder of breast cancer research outside of the U.S. government, having invested more than $1.1 billion in research since its founding.
In a new study published in JAMA, the diagnostic yield of transbronchial lung biopsy was significantly higher when using a cryoprobe versus forceps in a group of patients with pulmonary nodules or masses, recent lung transplant, and diffuse parenchymal lung disease.
Fabien Maldonado, MD, MSc
A transbronchial lung biopsy is a minimally invasive procedure in which a bronchoscope — a thin, lighted tube — is guided through the nose or mouth into the lungs. Tools are then passed through the scope to collect tissue for laboratory analysis to diagnose lung conditions. A cryoprobe is a medical instrument that uses localized freezing to extract tissue. Forceps are used to pinch off tissue for removal, which can be faster but also crushes a portion of the tissue sample.
The FROSTBITE-2 randomized trial showed diagnostic yield during transbronchial biopsy was nearly 10 percentage points higher when performed using a 1.1-millimeter cryoprobe rather than with 2.0-millimeter forceps (88.6% vs 78.8%). The difference was particularly great among patients with pulmonary nodules or masses (83.2% vs 70.1%). In a secondary safety analysis, there were four pneumothoraces (collapsed lungs) requiring chest tube placement in the forceps group (1.6%) compared to none in the cryoprobe group. No patients experienced significant bleeding or respiratory failure events.
“A structurally intact, sufficiently large tissue sample from a targeted area in the lung increases the likelihood of an accurate diagnosis, which is what we strive for every time we perform a transbronchial lung biopsy,” said interventional pulmonologist Fabien Maldonado, MD, MSc, Professor of Medicine and Thoracic Surgery, and Director of Interventional Pulmonology at the Vanderbilt Lung Institute.
“We’re continually investigating ways we can improve these procedures, as accurate diagnoses up-front save time, which may help get patients the treatment they need faster. Evaluating the tools we use, particularly as innovations in this area occur, is an important avenue of investigation.
“Individuals who have known or suspected lung issues deserve to have the best possible diagnostic procedures, so they and their clinical teams have clear evidence of what is occurring in their lungs so informed treatment decisions can be made.”
Previous studies using a 1.9-millimeter cryoprobe have yielded larger lung tissue specimens at higher quality without crushing the sample, but there were also more bleeding and pneumothorax events. The FROSTBITE-2 trial used the 1.1-millimeter cryoprobe which, unlike the larger probes, is small enough to remove the biopsy specimen through the working channel without having to remove the scope, which increases safety.
Certain lots of the cryoprobe went under a Food and Drug Administration Class I recall in March due to reports of rupturing or bursting during activation; none of these events were reported in this trial.
The study was conducted under the auspices of the Interventional Pulmonary Outcomes Group, an international collaborative of clinical experts dedicated to improving patient care in interventional pulmonology through multicenter clinical trials and research. Maldonado, who holds the Pierre Massion Directorship in Lung Cancer Research at Vanderbilt Health, is vice chair of this group.
The trial was completed at nine U.S. medical centers including Vanderbilt Health that perform at least 100 transbronchial biopsies annually and have affiliated institutional centers for lung cancer, lung transplant and interstitial lung disease. Patients enrolled were 18 or older and scheduled to undergo transbronchial biopsy for lung nodules or masses, lung transplant, or diffuse parenchymal lung disease. Five hundred individuals were randomly assigned to either the 1.1-millimeter cryoprobe or the 2.0-millimeter forceps for the biopsy.
“These promising results bring us one step closer to making these vital diagnostic procedures even more safe, accurate and effective,” said Vanderbilt Health interventional pulmonologist Robert Lentz, MD, Associate Professor of Medicine and Thoracic Surgery. “Our team is currently conducting FROSTBITE-3, a randomized controlled trial comparing the 1.1-millimeter cryoprobe with instruments for lymph node biopsies, to determine whether this novel tool may help with molecular testing in patients diagnosed with lung cancer.
The FROSTBITE-2 study is an investigator-initiated trial. It was funded by Erbe, an international business that develops, manufactures and markets surgical systems. The funder had no role in trial design, data collection, data analysis, manuscript preparation, or the decision to publish.
Vanderbilt-Ingram Cancer Center hosted its 27th Annual Scientific Symposium, themed “Cancer and Environment at Every Scale,” last month. More than 300 people attended, including faculty, trainees, staff, community advisory board members, and cancer survivors from across Vanderbilt, Meharry Medical College, Tennessee State University and the broader community.
This year’s event highlighted research examining the many factors that influence cancer development, progression and patient outcomes — from molecular mechanisms to neighborhood-level data that reveal patterns across communities.
For the second consecutive year, it was organized by a trainee-led steering committee and included four co-chairs: Yash Pershad, a student in the Medical Scientist Training Program; Michael Robinson, MD, MSCI, Instructor in Pediatrics; Molly Talman, MD, Pediatric Hematology Clinical Fellow; and Jared Rhodes, PhD candidate. The symposium is faculty-mentored by Christopher Williams, MD, PhD, Associate Director for Research Education at Vanderbilt-Ingram, and Kim Dahlman, PhD, Assistant Director for Research Education.
“Our goal is to build an environment where not only do our trainees participate in cutting-edge, impactful scientific research, but they actually help shape it,” said Williams, who holds the MSTP Directorship. “Watching this committee take full ownership of the planning for a second consecutive year has been extremely rewarding.”
Vanderbilt-Ingram Director Ben Ho Park, MD, PhD, the Benjamin F. Byrd Jr. Professor of Oncology, gave opening remarks and introduced the Mission Moment speaker, Roberta Casanova, a breast cancer patient and Research Advocate. Casanova shared her personal experience with breast cancer and highlighted both the challenges of treatment and the ongoing complexities of survivorship.
Attendees heard from two nationally recognized keynote speakers:
Mikala Egeblad, PhD, Bloomberg Distinguished Professor and Co-Director of the Johns Hopkins Kimmel Cancer Center Breast and Gynecologic Cancer Program, talked about how environmental stressors — such as microplastics — can trigger inflammation and influence cancer progression.
Scarlett Lin Gomez, PhD, MPH, Professor of Epidemiology and Biostatistics and Co-Leader of the Cancer Control Program at the University of California, San Francisco, discussed how neighborhood-level data can reveal differences in cancer incidence and outcomes, underscoring the role of nonmedical factors that impact health.
Another highlight was the presentation of annual scholar awards for exceptional contributions to cancer research and care:
Yash Pershad received the Graduate Student of the Year award for his work on the mutation-specific risk of clonal hematopoiesis in the laboratory of Alex Bick, MD, PhD, Associate Professor of Medicine, Director of the Division of Genetic Medicine and Clinical Pharmacology, and holder of the Edward Claiborne Stahlman Chair. Pershad’s research has significantly advanced understanding of the condition, its progression toward malignancy, and opportunities for cancer interception. He is the author of nearly a dozen first-author publications in journals including Blood, JAMA Oncology and the Journal of Clinical Investigation.
Youngmin Kwon, PhD, was named Postdoctoral Scholar of the Year. Recognized as an outstanding collaborator, mentor and educator, he authored 22 peer-reviewed publications in journals including Health Services Research and JAMA Health Forum. His research focuses on access to cancer care in Medicare, and he is mentored by Stacie Dusetzina, PhD, Professor of Health Policy and Ingram Professor of Cancer Research.
A cornerstone of the symposium, the poster session featured 106 presentations. Biochemistry PhD candidate Gabriela Gonzalez-Vasquez received the overall exceptional poster award for her research on ATR signaling in DNA replication.
Early clinical research by Vanderbilt Health and Cumberland Pharmaceuticals Inc. suggests that an investigational drug originally developed to treat cardiovascular disease may reduce the risk of metastasis — or spread — of breast, lung and other solid tumors.
The pilot clinical trial of 29 patients with solid tumors at high risk of early metastatic recurrence confirmed that ifetroban, a thromboxane A2 receptor antagonist, was safe and well tolerated, and supported further development of the drug to prevent cancer metastasis.
While not statistically powered for efficacy, the randomized, double-blind, and placebo-controlled Phase 2a clinical trial also compared the percentage of patients who experienced a distant metastatic recurrence 12 months after completion of the study.
Seventeen percent of participants who received ifetroban experienced a distant metastatic recurrence, compared to 50% of those who received an inactive placebo. No deaths due to distant metastatic disease occurred among those who received ifetroban, while three deaths occurred in the placebo group.
“We are encouraged that ifetroban demonstrated a favorable safety profile in this patient population and the potential efficacy trends are promising, supporting further clinical development,” said Cumberland Pharmaceuticals Chief Executive Officer A.J. Kazimi.
Cumberland Pharmaceuticals is a Nashville-based specialty pharmaceutical company focused on developing new products for rare diseases.
“A therapeutic intervention aimed at metastasis prevention for cancer patients with high risk of recurrence that is given during the period of ‘watchful waiting’ could be groundbreaking if proven beneficial in larger scale investigations,” said Ben Ho Park, MD, PhD, the Benjamin F. Byrd Jr. Professor of Oncology, professor of Medicine, and director of Vanderbilt-Ingram Cancer Center.
The study is a project of Vanderbilt Health’s Drug Repurposing program, which was established in 2016 under the Vanderbilt Institute for Clinical and Translational Research (VICTR).
The program uses human genetic data from BioVU, Vanderbilt Health’s DNA biobank, which is linked to de-identified electronic health records, to find new indications for drugs that are already approved or have passed Phase 1 and Phase 2 clinical safety studies. For example, the drug repurposing team has found that adding guanfacine, a drug used to treat high blood pressure, to routine trigeminal nerve block injections can enhance pain relief in patients with trigeminal neuralgia, intense, sudden facial pain.
Earlier this year, they reported that EG501, an investigational drug developed by Evergreen Therapeutics Inc. which targets a receptor in the brain involved in learning and memory, improved cognitive function in patients with lupus, an auto-immune disease.
For the past 20 years, Vanderbilt Health researchers have been studying ifetroban for its potential to treat conditions ranging from fibrotic lung disease to heart failure in patients with Duchene muscular dystrophy.
The thromboxane A2 receptor plays a variety of roles in different cell types throughout the body, including the activation and aggregation of platelets, a type of blood cell involved in clotting. In turn, malignant cells that escape cancer treatment can stick to platelets and “ride” to distant parts of the body.
A phenome-wide association study (PheWAS) of BioVU’s genetic and health records database conducted by Vanderbilt Health investigators linked a variant in the receptor gene to an increased risk of metastatic disease across multiple primary cancers.
Preclinical studies demonstrated that ifetroban reduced metastasis in several animal models without affecting tumor growth.
By blocking platelet activation and aggregation through its action on the thromboxane A2 receptor, ifetroban is thought to limit the ability of tumor cells to migrate across blood vessel walls, invade other organs, and evade detection by the immune system.
After completing cancer therapy, patients at high risk of recurrence who were enrolled in the clinical trial received daily oral doses of ifetroban or placebo for 12 months, then were followed for another 12 months.
Kazimi praised the contributions of the Vanderbilt Health research team, which he said, “have been essential to this advance in oncology patient care.”
Results of this study will be used to guide the design of larger human trials verifying efficacy and further demonstrating safety.
“We look forward to pursuing those pivotal studies as we relentlessly look for treatments to benefit patients living with cancer,” Park said.
Early bird registration is open for the 5th Annual Clip In 4 the Cure. Clip In 4 the Cure is a team cycling event that benefits cancer research and initiatives at Vanderbilt-Ingram Cancer Center and Monroe Carell Jr. Children’s Hospital at Vanderbilt.
This year’s event will be held on Saturday, Oct. 3, from 8 a.m.–noon at Geodis Park, home of the Nashville Soccer Club.
Early bird pricing offers a 50% discount on the registration fee and runs until Tuesday, June 30.
Led by some of Nashville’s top spin instructors, the high-energy, relay-style ride also has live DJs, vendors, and giveaways. Every dollar raised supports lifesaving cancer research and innovative patient care, helping move us closer to a world without cancer.
Gayle Knoop doesn’t post about her cancer on social media, so most people didn’t even know she had been diagnosed with Stage 4 colon cancer with liver metastases in October 2024, or that the cancer had returned after nine months, or that she was preparing for Christmas 2025 to be her last with her family.
She was trying to stay upbeat.
“I’m at home over the holidays thinking this is probably my last Christmas with my family,” said Knoop, who has a husband, 22-year-old daughter, three dogs, and an older brother. “It was miserable.”
After treatment, she had been cancer-free for nine months, but the cancer returned in her liver. Her hometown doctor told her the clinical team had met about her case, and she wasn’t a candidate for surgery. She could do Y90 radiation, which she did not want to do.
Knoop said she finally “dug deep” and started going down all the rabbit holes and doing her research.
It was different than the pressures she felt growing up playing volleyball, softball and basketball. This one was medical, and she felt hopeless, but she had a hunch there could be something out there for her.
“I want to be here for my daughter. I want to see her graduate from medical school. I want to see her get married,” she said. “And I’m like, OK, get up off your ***, start digging. You’ve done it before. You can do it again. And it led me to Vanderbilt. And, to me, that was my answered prayer for God to put the right people in my path, and he did.”
A better option than expected
With a little sleuthing and perseverance, she found something online with good reviews about Sekhar Padmanabhan, MD, just two-and-a-half hours away from her home in Louisville, Kentucky, at Vanderbilt-Ingram Cancer Center in Nashville. And it was in network for her insurance.
She came to Vanderbilt-Ingram in search of the histotripsy surgery she read about online, but Padmanabhan instead performed robotic-assisted laparoscopic surgery on Knoop to remove the left lobe of her liver and two tumors from the right lobe.
“The patient sheet just said she was there to discuss histotripsy, which she had read about online. Histotripsy was not what she needed; we had a better option than that,” said Padmanabhan, Assistant Professor of Surgery, who came to Vanderbilt-Ingram in 2021 to help build the robotic liver and pancreas program.
“Obviously she was shocked when I said, ‘I think we can remove these tumors and potentially put you on a path for a curative-intent option,’” he said.
Prior to 2022, there had not been a robotic liver resection done at Vanderbilt Health or in Nashville. There have now been more than 100 robotic liver resections at Vanderbilt Health.
A word no one says with Stage 4 cancer
Sekhar Padmanabhan, MD, and his patient Gayle Knoop, who traveled from Louisville, Ky., for treatment and found hope. (photo by Erin O. Smith)
Padmanabhan said Knoop’s story amplifies the importance of educating not only community oncologists but also patients about new therapies and technologies available to them.
“Gayle has a certain level of grit and is someone who will not be a defeatist … would not take ‘no’ for an answer. I am thankful that mentality is a part of her, because otherwise she wouldn’t have ended up here,” he said.
“As I was looking through her labs and her scans and her history, in my mind, I was saying, ‘What are we missing here? Why are we not operating on her? She has a chance at a curative option, and why are we not offering that?’”
Knoop required a couple of visits to Vanderbilt-Ingram to repeat scans, make sure her blood work looked good, and make sure her liver was healthy before she could have the robotic-assisted liver resection.
“He offered me a 20% chance of a cure. You know, nobody ever says ‘cure’ with Stage 4 cancer, and he offered me a 20% chance at a cure,” she said. “And, for the first time, I had hope, and it wasn’t false hope. I had hope, and I had confidence in the people that I was dealing with.”
The surgery also allowed her to go back to Louisville the next day instead of a more invasive surgery that would have included five days in an intensive care unit and a roughly 10-day hospital stay.
“These successes need to be shared with the world”
Padmanabhan said he saw her in the clinic two to three weeks after her surgery, and she looked great and was back to her usual day-to-day activities. At a later follow-up with Justin Lo, MD, PhD, Assistant Professor of Medicine, her scans and blood work continued to look great.
“When an institution and the people who make it up are this special, it deserves to be recognized,” Knoop said. “Tunnel vision is inevitable when this is your day-to-day life, but I truly believe Dr. Padmanabhan and his team at Vanderbilt-Ingram saved my life and could save the life of so many others. It is imperative that these successes are shared with the world.
“I was more than a patient or cancer case. I was a wife, mom and sister who needed his incredible knowledge of advanced technology and his surgical skills to spend more time in these roles with my family,” she said.
Padmanabhan said Vanderbilt-Ingram is “pushing the envelope” with new technologies like histotripsy and new programs like robotic liver surgery and robotic pancreas surgery, serving patients not only from Tennessee, but also parts of Kentucky, Alabama and Georgia.
“Gayle’s story is obviously unique to her and very personal for her but, unfortunately, that is the story that we hear a lot, especially in this area,” he said.
“Folks don’t necessarily have access to that care close to their home, so I would encourage people to see if there are newer drugs, treatments, surgeries, therapies and technologies that we can offer you that could extend your life, perhaps cure you in certain instances, but also ensure that we do all those things while maintaining your quality of life.”
