What inspires you to work with patients who have liver cancer?
Liver cancer is one of the deadliest cancers worldwide and it is often diagnosed in late stages. Until recently, patients with liver cancer had few treatment options. However, with the advent of image-guided minimally invasive techniques, Interventional Radiologists now have the opportunity to have a major impact on patient care with improving survival outcomes and quality of life metrics. Patients who years ago would have needed major hepatic resection or liver transplantation for cure can now be treated on an outpatient basis.
Liver cancer, based on the organs physiology, is one of the cancers types that can be treated by percutaneous and/or transcatheter routes. It is a great feeling to be able to cure cancer with such a poor prognosis. Unfortunately, due to the stigma of some of its causes, the liver cancer patient population is tremendously underserved. Therefore, I look forward to the opportunity to address many current unmet needs in the field.
How has treatment improved for patients with liver cancer, and in your opinion, what is the outlook for liver cancer in the next five years?
The field of liver cancer management is rapidly evolving and in recent years, there have been significant improvements in locoregional and systemic therapies. Furthermore, comprehensive screening programs and advanced imaging techniques have enabled physicians to diagnose patients at earlier stages when treatments have increased effectiveness. Over the next five years, I envision the liver cancer treatment paradigm shifting towards personalized care with increasing use of targeted immunotherapies that will often be given in combination with image-guided locoregional therapies. In addition, AI-based prediction modeling will be incorporated into staging systems such that patients will be better selected towards more appropriate therapies. In this way, we will be able to determine which patients will respond to a specific therapy and which patients won’t. Since time is of the essence when treating cancer, it is critical to be able to predict those for success versus those who should first try an alternative approach. Lastly, there will be improved tumor targeting and navigation with the development of augmented reality, virtual reality and robotics. Ultimately, all of these advances will lead to overall survival outcomes and quality of life benefits.
What are some of the biggest challenges you face in caring for patients with liver cancer?
There are a number of challenges faced when treating patients with liver cancer. From a purely biological perspective, many patients have some evidence underlying liver dysfunction (e.g., cirrhosis, steatohepatitis, etc) that makes treating the liver difficult. One may be able to treat the tumor but the physicians can run the risk of putting patients into liver failure. Therefore, when caring for patients with liver cancer, an elevated level of expertise and experience is needed.
Other challenges we face include the relative lack of established awareness groups that advocate for liver cancer management of the national level. Given the demographics and etiology of many forms of liver cancer, there has been less federal and foundational grant funding to understand this disease than many other forms of cancer (e.g., breast, prostate, lung, colorectal, etc.). Hopefully, given the current interest in health care equity research, more inroads will be made into diagnosing and treating this deadly disease.