As we honor liver cancer awareness month, what do you want our patients and families to pause and remember?
Liver cancer is a global health problem that affects more than 900,000 people worldwide and it is preventable by recognizing risk factors, such as chronic viral hepatitis C and B, alcohol, smoking, obesity, diabetes, and health care inequalities. It is important the public and physicians recognize individuals at risk, because, when liver cancer is diagnosed at an early stage, there is a lot we can do to control it and even to cure it. Mortality due to liver cancer is still increasing, but a lot has been accomplished in the last 20 years. Small, incremental advances, when delivered through a multidisciplinary approach can make a big difference. So in this month dedicated to cancer awareness I wish that we physicians, along with our patients and their families, remember the dedication of the researchers trying to crack the code of tumorigenesis, the generosity of the patients that have participated in the clinical studies, and the donors that enable top class research and patient care. And most of all, let us pledge to do all we can so that every patient can access the best possible care.
How do you collaborate with the Liver Cancer team at Smilow Cancer Hospital to care for your patients?
The Liver Cancer Program at Smilow Cancer Hospital is a highly integrated multidisciplinary team that includes surgical oncologists, transplant surgeons, interventional oncologists, hepatologists, medical oncologists, radiologists, and pathologists. We hepatologists specialize in the care of the liver disease present in most patients with liver cancer. Therefore, in collaboration with the above specialists we are involved in all aspects of liver cancer care and provide the much needed follow-up of the patient. We also moderate a weekly Tumor Board, so that each patient is reviewed simultaneously by all specialists involved.
What advances have made the biggest impact in the treatment of patients with liver cancer over the last 5 years?
Advances are being made in all fronts of the multidisciplinary care of liver cancer. The most recent advance is the treatment of hepatocellular carcinoma with a combination of drugs: one targeting the vascular endothelial growth factor and the other one targeting PD-L1, a receptor that blocks the immune response. This trial is changing the approach to the cure of patients with intermediate stage HCC and also represents a seminal biological observation.
Clinical trials can often be the best option for therapy, how do you explain this to patients who may be hesitant?
Depending on the design of the study, by participating in a clinical trial a patient can be treated with the standard of care for that cancer or receive new treatments otherwise not yet available. I often tell the patient to go to our website and read the inspirational stories shared by the patients that participated in our studies.
Is there a piece of advice or support you try to extend to all your patients and their families? Words of hope?
I am quite optimistic, as we are getting there. Better control of the risk factors, better treatment of the underlying liver disease, expansion of the criteria for liver transplant, minimally invasive surgical techniques, progresses in interventional oncology and radiotherapy, and a series of new drugs targeting specific cellular pathways increasing the immune response against the tumor, are all contributing in improving the prognosis of patients with liver cancer. The road is still long, but now we understand the direction and the need for teamwork.