As we honor liver cancer awareness month, what do you want our patients and families to pause and remember?
Liver cancer is a leading cause of death worldwide, accounting for over 700,000 deaths each year. In the United States, it remains as both the fastest increasing cause of cancer and the fastest increasing cause of cancer-related death. The landscape of liver cancer is starting to change as new diseases such as obesity, diabetes, and the metabolic syndrome continue to rise. It is imperative for patients and providers to understand that liver cancer is preventable, and understanding the risk factors for this disease and treating them early on should be the primary focus. The field of liver cancer treatment has also made marked advances over the last few years and the plethora of clinical trials, many which are in advanced stages of research, is truly inspiring. We continue to anticipate improvements in our approach to management of this lethal complication, and we should feel privileged to be amongst some of the most innovative and experienced researchers and physicians and to have such generous patients who have helped pave the way to finding a cure.
How do you collaborate with the Liver Cancer team at Smilow Cancer Hospital to care for your patients?
The backbone of the Liver Cancer Program is our multi-disciplinary and highly collaborative team approach to the care of each of our patients. Our program has a dedicated weekly conference in which our patients are discussed amongst a group of highly specialized physicians that include hepatologists, radiologists, medical oncologists, interventional radiologists, hepatobiliary/transplant surgeons, surgical oncologists, pathologists and radiation oncologists. Even though as the hepatologists we are the primary caretakers of these patients to diagnose and manage underlying liver disease, prevent and treat complications and provide long-term term follow up to monitor for recurrence and maintain liver function, we are constantly in collaboration with the aforementioned providers to coordinate treatments and optimize the care of our patients.
What advances have made the biggest impact in the treatment of patients with liver cancer over the last 5 years?
Treatments including liver resection, liver transplant, ablation and trans-arterial therapies have made significant advancements from a technical perspective and through introduction of minimally invasive approaches. These improvements have not only expanded the candidates who may undergo curative treatment, but have also improved the safety and efficacy of our therapies. However, the most marked advances have been made in the field of systemic therapy which is used to treat patients with more advanced stages of liver cancer. Over the last few years, multiple new medications have been approved – 10 currently FDA approved to be exact - and as of May 2020 a new combination therapy of Atezolizumab, which is an immune-checkpoint inhibitor, and Bevacizumab, which is a vascular-endothelial growth factor inhibitor, became the new first line agent showing significant improvement in prolonging survival in our patients. There is an abundance of phase 3 trials ongoing, exploring the role of immunotherapy for the treatment of liver cancer and I anticipate further modifications in our treatment approaches in the near future.
Clinical trials can often be the best option for therapy, how do you explain this to patients who may be hesitant?
Clinical trials are necessary to not only advance our understanding of the disease but also to advance and improve care. I think knowledge is power and I do my best to explain the rationale behind trials, to review what the trials entail, to provide adequate material for patients to review on their own and to leave extended time to answer any questions that may arise.
Is there a piece of advice or support you try to extend to all your patients and their families? Words of hope?
This is an extremely exciting time for the field of liver cancer. We have only just begun to scrape the surface to a better understanding of this disease. We have made significant advancements not only in the treatment of liver cancer, now with the ability to extend meaningful options to patients who present with all stages of this disease, but also in our ability to modify and even eradicate major risk factors for the development of both chronic liver disease and liver cancer. The medical field is dedicated to improving outcomes and the abundance of advanced trials dedicated to liver cancer makes me optimistic that our approaches to care and outcomes will only continue to improve.