👉 Did My Lung Cancer Treatment Work? My PEF Ablation Results with Dr. Justin Thomas

Added: 2026-05-09

[00:00:03]It's the first word she says when coming out. I I should tell that joke on the air.

[00:00:08]I think we may be live. Hey everyone and welcome to Chef AJ Live. I'm your host Chef AJ and my guest today is Dr. Justin Thomas. He was on the show before talking about a novel, a relatively new procedure for advanced cancers called the PEF ablation. He is actually an interventional pulmonologist at the Eisenhower Medical Center in Rancho Mirage, California. And on January 2nd, he performed an ablation on me. And he's here today to reveal the results of whether or not this procedure was successful. Please welcome back Dr. Justin Thomas. Thank you so much for doing this. I know how busy you are and how hard it is.

[00:00:45]>> Thank you, Ad. Thanks for having me on.

[00:00:47]I appreciate it.

[00:00:49]>> The last episode was amazing because you actually got patience from it. Not that that's why you trying to do it, but people there are people that for whatever reason can't have the standard of care chemo surgery and radiation or choose not to. And to find out about this procedure for them could be life-changing.

[00:01:07]>> Yeah. No, absolutely. And in fact, actually, I think since since your show, I've had probably about five or six people reach out to um that were very interested and and came out. In fact, I've already treated a couple of them.

[00:01:20]Uh so uh even somebody from as far out as South Africa was interested in coming here and from a legalistic standpoint and everything, we couldn't get them out here, but you know, I hope they can find some help there. But anyway, it's been it's been great and you know, I I'm very excited today to kind of reveal u what we did for you. Well, I think it's great also because when I first heard of the PEF ablation and I put that into YouTube, really nothing came up except for a couple of doctor the that video will always be there for future people that have heard about this procedure and want to get it and because you explained it so beautifully.

[00:01:58]>> Oh, thank you.

[00:01:59]>> Yeah, before we go on, I just I wore a special shirt for you. I don't know if you've ever seen this one, but can you see what it says?

[00:02:06]>> Uh, I love that. lung cancer. You picked the wrong chick. I couldn't decide if I should wear that one or this one.

[00:02:15]>> Anyone with lung because I'm sure you know this just because I'm sure you treat or at least see a lot of lung cancer and I'm sure you know that it's probably the most stigmatized and least funded of pretty much all the cancers.

[00:02:27]>> That is right. And despite it being actually the number one cancer killer out there, you know, more than breast, uh, more than colon and prostate combined, actually. So, >> yeah, just just my luck. Right.

[00:02:41]>> Right.

[00:02:42]>> You know what's interesting is, um, I recently had Dr. Joel Ferman on my show.

[00:02:46]He's a plant-based doctor, has done multiple PBS specials and multiple New York Times bestselling books, and he said on the show that diet has absolutely nothing to do with lung cancer. That it cannot cause it. It cannot cure it. That it's basically environmental and genetic.

[00:03:01]>> Right. Exactly.

[00:03:03]>> Yeah.

[00:03:03]>> And yet there's still people write me every day that if only I had a healthier version of a vegan diet or started eating meat.

[00:03:11]>> Yeah.

[00:03:11]>> Go away.

[00:03:12]>> Yeah. No, not at all.

[00:03:15]>> Yeah. So, it is going to be really interesting to see you screen share with the results because as you know and you said I could talk about this. I got a call last night after having a wonderful uh virtual session with you on Monday where you showed me the measurements and appeared that I was either stable or improved in some areas. My oncologist who's very nice and I really respect and like Dr. Mayal from Stanford called me 6:00. Doctors, if you're watching this, please don't call patients on Friday night or in the evening because you just ruined the rest of our night. But he said basically that I'm actually not better, I'm worse. That my cancer has grown and spread. and that he presented my case to the tumor board at Stanford which consisted of five medical oncologists, two radiation oncologists, an interventional pulmonologist like yourself who does PEF ablations and god there was one more I don't know but there was nine of them and they all basically said that I you know think that that well you can talk about you talk to him so you know what he said but the the confusing thing is is why does one set of doctors say this and another it could be very confusing for the patient. I want to believe you. Well, not just because I like you, but because you're giving me good news.

[00:04:27]>> Right. Exactly. You know, part of part of the issue, too, is that um seeing seeing doctors in multiple different facilities can be confusing because not everybody has all of the information. Um for instance, um your PET CT that you had in April, um which actually I think we did your your ablation in It was January 22nd.

[00:04:52]>> 22nd. January 22nd. So you had a you had a PET CT sometime early April there and um I didn't have access to images um but I had access to the report and the report you know mentioned um that the lung nodule that I ablated and the lymph nodes that I ablated were still PEP positive um and that there were maybe some new activity in some other lymph nodes. When I did your broncoscopy back in uh the end of January, there were no other lymph nodes in there by ultrasound. And actually when we did a CAT scan here, um everything showed improvement. And our CAT scan though was almost what about a month or when was it about >> I had Eisenhower.

[00:05:39]>> When was it after your your PET CT?

[00:05:41]Actually, >> it was my Eisenhower a PET scan was on April 14th.

[00:05:45]>> April 14th scan here. But then you also had a PET CT earlier.

[00:05:49]>> Yeah. Around April 4th, about 10 days before.

[00:05:51]>> 10 days before. Okay. So, um I want to show you the images from our uh from our scans here in comparison to the scan right before the procedure. Um so, let me let me share that with you.

[00:06:04]Um there we go.

[00:06:08]>> You know, you're the first person that really showed me my images and what really astounded me was how close this thing is to my heart.

[00:06:15]>> Yes. Exactly. So let's let's actually go to the the mass itself. So um this scan on the left is from January and the scan on the right is from um April. And so you can see actually almost three three months exactly apart. Um so what we're looking at here is uh you lying on a table. The table's down here. Um and um your head is at the far end and your feet are at our end. And we're looking up through your body from your feet to your head. And um we're chopping you like you're on a magician's table. So that makes this your left side and this is your right side. These little dots over here are just blood vessels. This is your heart. This is your spine and these are ribs. Um so the black is the lung. Um so this is your left lung. And you can see here on this left lung there's this mass right here. And that mass is abudding the aorta which is right here. This is the descending aorta. And the mass here, um, I made the numbers a little bit bigger here. 27, I'm sorry, 21.7 by 27.1 millimeters. Okay, so that's right about an inch. 22 mm is an inch. Um, and then the scan here on April 14th, measuring exactly in the same dimensions, uh, was 19.9x 24.9.

[00:07:35]So you can see clearly based on those numbers. And then even these ones here, this is a different view. Like we're looking straight on at you and you're facing us. This again, your left lung, right lung. Here's the mass. Taking those same measurements or different measurements, different planes. Um you can see the mass actually is shrunk a little bit from from the last scan. The other thing that we did is we um treated some lymph nodes. So here's the lymph nodes that we treated right in here. You can see kind of this brighter area right here. um those lymph nodes we treated with the PF right here. This darker area is the esophagus and there's your aorta again. So it's just a different cut.

[00:08:16]We're not seeing the mass here in this cut, but and you can see on the followup the exact same cut. No lymph nodes.

[00:08:22]There's just your esophagus there now.

[00:08:24]No lymph nodes are gone. So we we actually had a very favorable pretty much I would call that a complete response on the lymph nodes themselves.

[00:08:33]Okay. Um, and so that that's a very favorable response. And the thing is that I do want to point out as well is going back to the mass, every scan that you've had done along the way has shown growth of this mass. So all the scans last year, every scan that was done showed continued progression. Um, and so I did want to point that out. But now this is the only scan that you have ever had done that shows actually if anything a slight bit of shrinkage but if nothing else uh if you can argue measurements and that sort of thing by a millimeter or two. If nothing else it definitely did not progress. Okay. Um now when they're talking about the PET scan that was done 10 days before this scan let me come out let me come out of this uh shared screen. Here we go. When we talk about the PET scan that was done April uh 4th, um all they had to compare to was a PET scan from a year before, so in May of uh 2025, and we know that you had progression between those two times. I just mentioned that to you. You know, every scan all last year was showing progression. Um and so we don't have the benefit, unfortunately, of seeing what things look like right before the ablation. So, if we had a PET scan right before the ablation, that would have been been nice. It's not something I generally do, though. Um, and I don't I don't typically need it. If I've got a scan that's showing progression, then I just go after the the masses that progress. But, um, anyway, so we don't have that benefit of seeing really exactly what things were right before.

[00:10:13]Um, so it's it's interesting. I mean, I mean, our our plan at this point is is to go in. We do want to make sure that those little spots that are lighting up on the new scan are truly progression and not just reactive areas. Um there was also an issue with that scan where everything was like turned up for whatever reason. It was a different scanner than the one that was done in May of last year and all of the brightness, you know, what we call FDG aidity um was turned up and they made a specific comment about that on that scan. So that does make it a little bit more difficult to compare to the prior scan in May as well. So um I'm actually advocating that um we go in and and the tumor board said this as well that they want to get some biopsies to confirm that this is true progression. So we'll go in there, we'll ultrasound, we'll take a look and see if there's any nodes that are large enough to sample. I mean I can sample things that are as small as 5 millimeters. So if there's anything that size, I will sample it. Um, and while I'm there, um, I feel that we might as well go ahead if we do see anything that's looking concerning to go ahead and treat it with ablation. Again, the, uh, the, uh, tumor board that you mentioned had recommended radiation. Um, and now would go back to again the standard of care.

[00:11:35]And you know standard of care in this case and somebody who's not a surgical candidate, somebody who doesn't want to do or is not really a good candidate for even systemic therapy. You know the imunotherapy, the katruda that you had so much trouble with in the past. Um radiation is really the only next thing that's the only thing left that's in the standard of care. However, you have flatout refused radiation in the past.

[00:12:01]And you know, I I I actually lean a lot on my tumor board. And you know, there's a lot of smart people out there. And um I I do not I mean, I I would support whatever that tumor board says. If they feel radiation is is the right thing to do, then by all means, you you need to give that a very, you know, strong thought and uh discuss it with the radiation oncologist who you already know. Um and discuss the risks and benefits of that by all means. And u I I think that you should you certainly explore it. Um I don't think that ablation competes with that in any way.

[00:12:38]I think that while I'm in there anyway, might as well ablate it. It's not going to hurt you. You tolerate it very well.

[00:12:44]It's a very safe procedure. Uh and we it's not like we need to ablate and then wait and see what that shows before you decide you want to do radiation. I think you know if if they recommend radiation then you know you do it now. Um but anyway, it's that all of course is up to you and and when you have those discussions with radiation oncology, you know, talks real specifically about what are the risks, you know, what is how is this going to benefit me, you know, at this point in time. If this is truly progression, I've got lymph nodes all up and down here. Um then, you know, is this really going to uh make me feel better? First of all, you feel great right now that you don't have any symptoms. uh is it going to extend your life, you know, uh to any significant degree that would be worth the potential risks of that treatment. So >> yeah, so far I really can't see the data where radiation is going to extend my life, you know, because extending your life by four or seven months doesn't seem much extension. Plus the fact like I don't know anybody that's really had radiation that down the road didn't get some serious side effects, including needing a heart transplant. somebody personally, not just not speculative, people I know, friends and neighbors had really bad cardiac problems afterwards or memory problems. My friend that had radiation to his brain, it doesn't seem all that benign. And >> I mean, I've been refusing it for like they've been wanting to do it for 4 years and it just it doesn't sound so scary to me the actual having of it, but the side effects like the because they when they read those side effects with the esophagus and things like that, it's just it's it's I'm I'm actually quite scared of it to be honest. So, it's not like I want it anyway, you know, and I don't understand why I can't have I don't want the thoracic surgery, but why can't I have it now? Why is it too late now? But it wasn't too late in January.

[00:14:31]Uh now it's because I mean you do have evidence that there may be progression to even other areas. So uh and we also know that you've had um progression to lymph node that I already treated which I I showed you on those images there. So that that's a level two what's called a a station seven lymph node subcorinal and it's an in node. So lymph node stations are are uh uh staged by one two and three. three being worst, one being kind of the least. Well, zero would be the least, but um when you get to N2, um that that makes this minimally a 3A lung cancer. And um if there are other lymph nodes involved, such as the contraateral nodes, you're then starting to look at um 3B, 3C even. And so th in those cases lung one can or I'm sorry surgery is not indicated.

[00:15:26]>> Okay. But >> cat's out of the bag in other words. And so cutting out you know just a part of the lung you're not cutting out all these other lymph nodes really doesn't uh pretend a better survival for you.

[00:15:37]>> But the spread is still in my lung. I'm I'm not any it's not going anywhere yet outside the lung. Right.

[00:15:44]>> The spread is in the mediainum which is this middle area of the chest. Um there's the main mass which is in the left lower lobe and then the spread is in the lymph nodes here.

[00:15:54]>> Geez.

[00:15:55]>> Yeah.

[00:15:56]>> So I don't understand how doing the biopsy is going to differentiate true progression from whatever else it could be.

[00:16:04]>> Well, I mean whatever else it could be is just be reactive lymph nodes. You know when we when we do ablation we do see uh reactivity. We see um particularly we do it too soon. I'm not saying this is necessarily too soon, but I have seen more activity in the first scan that I do. If we do a PET CT on followup, usually I don't do a PET CT on followup, but if we do, particularly if it's done too early, you will see um significant increase in activity in the areas that we've abladed and even sometimes in areas we haven't. Um because, you know, this this type of treatment does ramp up the immune system to start fighting the cancer. And so is that what we're seeing? It could be. It could be that we're just seeing, you know, the immune system starting to ramp up its its its own treatment of your cancer. So, um, but I think going in and biopsying and if we see cancer in those areas, then that's that's of concern and that that does prove at least that this is not just reaction, it's actual tumor.

[00:17:07]>> But it would be the same can if you see it, it's the same cancer. It's not like a new cancer, right?

[00:17:12]Mostly >> it's still lung cancer. So you know one of the reasons and I don't mean to be a difficult patient but I've as you know I'm anxious and I'm working with Dr. Kesler has helped me so much overcome so much of my anxiety is that I've never had symptoms you know up until now and now I have this thing called a plural eusion and puricy and uh what's it pneumonitis and so it's not terrible I don't have terrible pain but I do have some pain when I take a deep breath and shortness of breath when I exercise and so that scares me a little bit because it is the first time I've been symptomatic.

[00:17:47]Yeah, the, you know, the ablation can stir up a lot of stuff and cause inflammation. That being said, I mean, your scan that you had done here showed really no pneuminitis whatsoever. Uh, the one that was done April 14th, 3 months after. So, I don't, you know, I don't think there's much going on there.

[00:18:03]And the eusion also, the plural eusion, that fluid collection around the lung doesn't look any worse than it did back in January.

[00:18:10]>> Do you ever uh do a biopsy of the fluid when you're in there?

[00:18:14]Uh well can't do it through the broncoscopy but uh yes we can we can sample fluid. Uh the amount of fluid that you have though at least on your CT scan here is minuscule. It's really hardly anything and and would not be uh it would be too risky to to drain that fluid.

[00:18:30]>> Got it. Thank you. A lot of the live viewers are saying does biopsy itself proliferate the cancer and cause it to spread?

[00:18:38]>> No. Um there's no evidence that that would happen in lung cancer. There are a few cancers where we do see that potentially happen. Um and some of those are one is testicular and that's why you know we don't even biopsy the testicle.

[00:18:51]We cut it out if there's concern for cancer. Um misotheloma is another one.

[00:18:57]Um there are some instances where excuse me um there are some instances where um uh let's say somebody has uh breast cancer for instance and they got fluid around their lung and they've got you know plural metastases and everything and we put in a catheter uh to drain that fluid and we leave that catheter in so the patient can drain it at home.

[00:19:21]It's called a plurex catheter or tunnled plural catheter. Uh sometimes there can be tumor that grows in the tract of that catheter um because we've you know gone in and there's tumor cells kind of encroach into that area. So um but no um biopsy of cancer does not not this type of cancer anyway does not tend to spread it.

[00:19:44]>> Right. And I even remember when I had my perccutaneous one. He showed me they had this like clever little thing that was in a thing and you know like was kind of cool. So you know I I really apologize Dr. Matt Letterman really wanted to be here today and ask you a few questions.

[00:19:58]So if you don't mind I'll ask the doctor questions and one of them I I also wondered myself and he said what is the expected timeline for the full therapeutic effect of PEF on a tumor the size of AJ's?

[00:20:11]>> Yeah. So, it's it's a very good question and one that we're still really trying to elucidate for sure. Um, generally speaking, we will see response within 3 to six months.

[00:20:24]>> Wow.

[00:20:25]>> Mhm.

[00:20:26]>> And and you can repeat and I just want people to know that, >> you know, even if I do and not even I am scheduled already for another ablation with you, that doesn't ne that doesn't mean I still can't do radiation if >> I choose. I just don't really really want to. So >> yeah, >> for a variety.

[00:20:43]>> One of the things too with radiation, you know, because one of the one of the indications for this type of of ablation would be somebody who's had already radiation and then they're having recurrence in that radiation field um and they can't get radiation anymore because, you know, a certain amount of tissue can only take so much radiation.

[00:21:01]And so um in those situations, I have treated those patients. Um it can be a lot more difficult to treat with the ablation when you've had radiation. So, because it scars everything. All the radiation scars it. And scar is like hard as a rock when you're trying to get into it with a needle.

[00:21:18]>> Yeah. So, this is so new. You've been doing them about a year, right? A little over >> uh two years now, actually.

[00:21:23]>> Two years. Yeah. So, this will really be interesting when you really gather up all the data from the studies of all the patients that you're following. So, >> well, actually, it's funny you should say that. Um, I just published this week. So, yeah. uh on Monday in cancer's journal um Dr. Reparia who is actually one of my residents here and I published um and so you can look that up. You just do cancer's journal Justin Thomas postlectric field ablation and you'll see it right there. Um and so and then we're also part of the Propel Registry here too. So we keep track of patients uh on a national level uh who are having these procedures done and there's a few other centers out there that are part of that registry as well.

[00:22:05]>> Oh, I can't thank you. I'm going to look that up. I'm going to link it to the chat and the show notes. So, you know, I I I really want this to work because it seems like it's so much lower risk than anything else that's been offered to me.

[00:22:18]I mean, the only side effect that I see with the ablation is the possible side effect of any surgical procedure, which could be a risk with anesthesia, which can happen, but the actual procedure, it doesn't seem like >> very low risk. Yeah, very low risk. Um that's that's the beauty of this procedure really and it it's really is the amazing thing about it because you know all the other ablations have a lot of risk you know there's a lot of bleed bleeding risk there's risk of you know eroding into other structures and such this wouldn't be a a tumor because of how close it is to that aorta it would not be a tumor that we do a thermal ablation on because I mean you'd probably bleed out you know it would not be good.

[00:22:56]>> Yeah. Well, I'm I I don't want to say I'm actually looking forward to having it again, but I'm I'm willing. And uh you know, uh audience, if you have any questions for Dr. Thomas, I want to respect his time. Please quickly put them in the chat. So, how like how often can you repeat an ablation on a person?

[00:23:12]I mean, I would imagine if you got no response, you would never probably think to do it again, >> right? Exactly. So, that's the only reason we're considering even doing it again with you. Um but um you we don't know. Um, you know, I've I've treated uh patients uh a couple patients now three times, you know, and uh they've gone well and the only reason I've treated them again is because several months go by, they had a nice response and then several more months go by and they end up progressing again and then we'll go in and treat that or we'll treat a different tumor. Um or there's some patients who have just a whole bunch of tumors and so I can't treat every one, you know, uh in one session.

[00:23:54]So I might treat more in another session. So >> just if you could quickly explain because not all the viewers saw your first episode which I'll link to. What does the ablation actually do to the cancer? How >> Yeah. So it uh what it is is it's a it's a done through a needle and this needle gets guided into the tumor using a lot of different imaging techniques including CT scan and uh the needle delivers very high voltage energy and very short bursts. um like micro bursts and uh there's a 100 packets of that energy that are delivered per ablation zone. And what the energy does is it actually destabilizes the tumor cell membranes and uh causes a process called electroporation. And what happens is the basically um the tumor cell membrane becomes very leaky and it loses its homeostasis. So it loses all its balance of you know chemicals, electrolytes and all that sort of stuff. And what that does is it actually triggers apoptosis or programmed cell death. So the tumors just off themselves and they burst and they release all of their tumor antigens into that little micro environment there and the immune system comes in starts grabbing on to those little bits of tumor and saying, "Oh, this is not us.

[00:25:13]We need to start fighting it." And so it starts presenting those little tumor antigens to other T- cells B cells and they start to ramp up the immune response. And so that's why we can see like in my paper you'll see that there's about a 27% um abscopal response that we were seeing. So offtarget effects. So those who responded about 27% of them actually had um or those in the uh more advanced disease who had other tumors to actually be able to see uh that weren't treated those shrunk down about 27% of patients.

[00:25:45]So um that's that's a very fascinating and exciting part of this technology and we do see also a very augmented response when patients are on things like Kruda or other targeted imunotherapies where you're you're trying to use the immune system to fight the tumor. Well, if you can burst some of those tumor cells and cause them to release intact tumor antigen, then you can get a really more robust response. And indeed, we are seeing a much more augmented response in patients on those types of medications.

[00:26:16]>> Wow. I wish I had met you when I was on it, you know. So, I don't think I can go back to it because based on the response. Who invented the PEF ablation?

[00:26:25]>> Um, that is a good question. I used to know the answer to that. I cannot remember. the the uh the company is called Galvanized Therapeutics who uh has come up with this and and actually it was a a treatment for um other cancers um from a uh external standpoint. So they'd actually put like pads on people uh that that would you know shock them essentially uh to to help with with treatments uh of cancers things like misotheloma and such in the past. So that's how the idea came about.

[00:26:58]>> Yeah. So, uh, Stacy's asking, "What am I going to do since the cancer spread?"

[00:27:01]Well, what I'm going to do is I' I've been offered radiation as I've been offered for many years, but I'm going to do another, uh, PEF ablation with Dr. Thomas sometime between May 22nd and June 4th. We're picking a date. And while he's there, he will biopsy, uh, things to show to the tumor board, whether it's progression or, I guess, inflammation in this case. And, uh, just hope for the best cuz I'm actually moving. So, Exactly. I mean, I think the first answer to that question is we got to make sure that it is progression and not just >> that would be cool. That would be so cool if it's not. And how long will it take? Will it still take three months after the ablation to know whether it's progression not or just till the biopsy?

[00:27:44]>> Oh, no. Just the biopsy results. Yeah.

[00:27:45]Yeah. So, three to five business days typically. Yeah.

[00:27:48]>> Wow. That's all. Well, >> yeah.

[00:27:51]>> Okay. Well, Dr. Thomas, thank you. I think you're just really um really kind and really smart and u thank you for you know doing this. I mean I'm sure everybody is wishing their doctor would do this for them because a lot of people are saying my doctor never even showed me my images. So I really appreciate it and u I look forward to seeing you. Uh well last time I was asleep I didn't see you at all. So >> you did you probably just don't remember it.

[00:28:15]>> I don't I don't remember at all. So, so thank thank you for all you've done for me and coming on