Liver Transplantation for the Treatment of Liver Cancer
December 01, 2021Information
November 28, 2021
Yale Cancer Center
visit: http://www.yalecancercenter.org
email: canceranswers@yale.edu
call: 203-785-4095
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- 00:00Funding for Yale Cancer Answers
- 00:02is provided by Smilow Cancer
- 00:04Hospital and AstraZeneca.
- 00:08Welcome to Yale Cancer Answers with
- 00:10your host doctor Anees Chagpar.
- 00:12Yale Cancer Answers features the
- 00:14latest information on cancer care by
- 00:16welcoming oncologists and specialists
- 00:17who are on the forefront of the
- 00:20battle to fight cancer. This week,
- 00:21it's a conversation about the care of
- 00:23patients with liver cancer with doctor
- 00:25Ariel Jaffe. Dr. Jaffe is an assistant
- 00:27professor of medicine and the section of
- 00:30digestive diseases at the Yale School
- 00:32of Medicine where Doctor Chagpar is
- 00:34a professor of surgical oncology.
- 00:37Ariel, maybe we can start off by
- 00:38you telling us a little bit about
- 00:40yourself and what exactly you do.
- 00:43Sure, so basically I specialize
- 00:45in the care of patients that have
- 00:48advanced liver disease and I work
- 00:50both in the transplant program,
- 00:53so patients who need to go on
- 00:55to have a liver transplant,
- 00:56and also patients
- 00:58that develop liver cancer,
- 00:59which is an extremely common
- 01:01complication in patients that
- 01:03have chronic liver disease.
- 01:05So let's talk a little bit about that.
- 01:08So when you're talking about
- 01:11patients who require transplant,
- 01:13what kinds of conditions
- 01:15require liver transplants?
- 01:17I mean, are these patients who
- 01:21have hepatitis, cirrhosis, tell
- 01:23us a little bit more about what
- 01:25kinds of conditions will lead
- 01:27you down the path of transplant?
- 01:31Most commonly, patients that develop
- 01:33end stage liver disease, which is
- 01:35what we commonly know
- 01:37as cirrhosis are the ones that we
- 01:39do evaluate for liver transplant,
- 01:41and that could be from a variety
- 01:43of different causes.
- 01:43Some which you alluded to.
- 01:45You know patients that
- 01:47have chronic viral disease.
- 01:49Certain toxins, like alcohol use,
- 01:51certain genetic disorders,
- 01:53patients with obesity and diabetes which
- 01:56can lead to fatty liver and
- 01:59go on to develop
- 02:00end stage liver disease.
- 02:02Once you start to have
- 02:03complications from that,
- 02:04we generally start to consider
- 02:06you for transplant.
- 02:08There are a subset of patients who may
- 02:10actually have really well preserved
- 02:12liver function and look and feel well,
- 02:15but in patients that develop liver cancer,
- 02:17which sort of as I mentioned,
- 02:18is an extremely common complication,
- 02:218 to 10% of patients with
- 02:23cirrhosis will develop cancer each year.
- 02:26That's another indication in which we
- 02:28go on to consider them for transplant.
- 02:31Because
- 02:31transplant will not only cure the cancer,
- 02:33but it will actually cure their
- 02:35underlying liver disease,
- 02:36which is the major risk factor
- 02:38for their cancer development.
- 02:41So tell us a little bit more
- 02:43about that in terms of cancer.
- 02:46Are all patients with liver cancer
- 02:48candidates for
- 02:51transplant or is it only those
- 02:53who have that underlying chronic
- 02:55liver disease that would make them
- 02:58potentially a candidate anyways?
- 03:01So not all patients are
- 03:04candidates for transplant.
- 03:05The majority of patients who
- 03:07develop liver cancer will have some
- 03:09form of chronic liver disease,
- 03:11but interestingly, we're actually
- 03:12seeing a unique population who don't
- 03:15have underlying advanced liver disease
- 03:17go on to develop liver cancer and it's
- 03:20a little bit of a controversial field
- 03:21if those patients should be
- 03:25considered for transplant or not.
- 03:27But in terms of those that
- 03:29may have chronic liver disease
- 03:30and develop liver cancer,
- 03:32there are certain criteria that need
- 03:33to be met for patients to be considered
- 03:36for transplant and some of that includes
- 03:38how extensive their liver cancer is.
- 03:41So for example,
- 03:42if it's spread outside of the liver,
- 03:45they would not be good
- 03:46candidates for transplant,
- 03:47or if they have a large amount
- 03:50of tumors within the liver,
- 03:52they would not be considered
- 03:54good candidates.
- 03:55We also sometimes like to look at
- 03:57patients if they have recurrent cancer.
- 04:01We're more likely to consider them
- 04:03for transplant or if their underlying
- 04:05liver is really very very sick so
- 04:07that they have other complications of
- 04:09liver disease in addition to cancer,
- 04:12then you know,
- 04:13we're more likely to want to pursue
- 04:15transplant in those patients.
- 04:18One of the things that
- 04:20people might be thinking about when
- 04:22we think about transplant is that
- 04:25oftentimes people
- 04:27may be under the impression
- 04:29that patients who have cancers,
- 04:31for example, may not be a potential
- 04:36recipient of organs,
- 04:39but it sounds like for liver cancer,
- 04:42that's not the case, that
- 04:44if you have liver cancer,
- 04:46even if it's recurrent liver cancer,
- 04:49you can still be on the organ
- 04:53recipient list.
- 04:54Is that right?
- 04:55Yes, actually
- 04:56it's a really unique cancer and
- 04:58you're very spot on with that.
- 05:00In that transplant is
- 05:02considered one of the curative therapies,
- 05:06and it really can't have spread outside
- 05:07of the liver or you can't have
- 05:09such an extensive tumor burden.
- 05:11But because you're really
- 05:13replacing the liver,
- 05:15you're not only treating the cancer,
- 05:16but you're sort of getting rid of
- 05:18the damaged organ because we like
- 05:20to think of liver cancer in
- 05:23particular as sort of a complication
- 05:25of a failing organ.
- 05:27I think it's an important perspective to have.
- 05:32Yeah, it does not mean that
- 05:34you're not a candidate.
- 05:34It's actually one of the most
- 05:36curative therapies and really
- 05:38currently in the United States,
- 05:39honestly,
- 05:40about a quarter of transplants
- 05:41are done for the indication
- 05:43of having liver cancer.
- 05:45Wow, so the other thing that we often
- 05:48think about when we think about transplant
- 05:52is the universal shortage of organs.
- 05:55Liver is one of those nice organs that there
- 05:59is a potential for a living related donor.
- 06:02How often is that used in
- 06:05patients who have liver cancer?
- 06:07Can you talk a little bit more about that?
- 06:09Definitely so the liver is
- 06:13just one of the most remarkable
- 06:15organs, and its ability to regenerate.
- 06:17So in certain patients who are
- 06:20candidates for a living donor organ,
- 06:23meaning that a part of the liver is taken
- 06:25from a donor and put into the recipient and
- 06:28it will actually grow to a normal size,
- 06:30usually in about 12 weeks time.
- 06:34To determine if someone is
- 06:36a candidate for a living donor,
- 06:37there's a few factors that we
- 06:39have to take into account.
- 06:41One is the size of the patient
- 06:43because there's a certain sort of
- 06:47massive liver that you would need
- 06:49to sufficiently
- 06:52do its job in a person.
- 06:54So if you're a really really
- 06:57big guy or big girl,
- 06:59your candidates might be limited.
- 07:01You would really need someone who is
- 07:03equally as tall or as large as you.
- 07:05The second thing is,
- 07:07if you're really incredibly sick and have a
- 07:10lot of complications from your liver disease,
- 07:12there's concern that you may not be able
- 07:14to tolerate just a piece of an organ.
- 07:16So it's actually something
- 07:18that we use quite often,
- 07:22and it varies based on programs and
- 07:24how large the programs are,
- 07:26but we definitely do a lot of
- 07:28living donors in our center here,
- 07:31and it's a really a great option
- 07:33for a certain subset of patients.
- 07:36And tell us a little
- 07:38bit more about how that works,
- 07:40because I think that for many people
- 07:43just the thought of having a relative
- 07:47or a loved one being diagnosed with
- 07:50a potentially treatable cancer,
- 07:52but that you can help with,
- 07:54you can help give them a new life,
- 08:01is really awesome in terms of the actual
- 08:04benefit that you can provide,
- 08:07but people may have some
- 08:09questions about that.
- 08:10Yes, so it's definitely a pretty
- 08:14grueling process
- 08:16and the way that it works
- 08:19is once we determine that someone
- 08:21is ineligible as a transplant candidate,
- 08:23they're then open to have either relatives
- 08:25or even just altruistic
- 08:28donors that can call in and be screened
- 08:31to see if they're compatible and
- 08:33usually it starts with
- 08:34just looking at blood typing to
- 08:36see if there is a compatibility.
- 08:38The rejection is a little bit different
- 08:40in the liver compared to other organs,
- 08:43so it's nice in that there's not
- 08:46so many factors that have to be
- 08:48directly matched to be
- 08:51considered a compatible donor.
- 08:52But once we think that there's
- 08:54not going to be overt rejection,
- 08:56and that really comes down a lot of
- 08:58times to compatibility and blood typing.
- 09:01We have a very strict process
- 09:03to make sure that the donor itself
- 09:05is someone who would do very well
- 09:07going to surgery, that they have
- 09:09no underlying liver disease,
- 09:11and that ultimately we
- 09:13feel would essentially come out
- 09:15unscathed should they decide to go
- 09:18forth with donating their liver.
- 09:20It's extremely rare in general to have any
- 09:24type of rejection from incompatibility.
- 09:26Just because our ability to screen
- 09:28and make sure that blood types and
- 09:30things match is so great now,
- 09:32so that's not generally a major
- 09:35major concern,
- 09:35but there's a lot of strict processes
- 09:38in terms of making sure the size is
- 09:41appropriate that the recipient,
- 09:43whatever portion was donated,
- 09:45that that would be enough for the patient
- 09:48not to have what we call post operative
- 09:50liver failure or liver insufficiency.
- 09:54So I would say technology and our
- 09:56screening strategies are just so
- 09:58remarkable now that those
- 10:00factors are really very well detailed
- 10:03before we would proceed with any
- 10:05type of living donor liver transplant.
- 10:09And then after the transplant,
- 10:11does the recipient stay on
- 10:14immunosuppressive therapy for life?
- 10:16Or how does that work?
- 10:18Yeah, so there's variations
- 10:21in the quantity of immunosuppression
- 10:24in liver transplant recipients.
- 10:26Generally within a year after transplant
- 10:29you can get patients down to an extremely
- 10:31low level of immunosuppression which
- 10:34again is slightly different than
- 10:36other organs where rejection rates
- 10:37are much higher and it's interesting
- 10:40because there are certain reports
- 10:43of patients being able to completely
- 10:45come off of immunosuppression.
- 10:48And we've actually had a few patients
- 10:50within our center that we've done that on.
- 10:52It's a little bit higher risk,
- 10:54and it requires some more close monitoring,
- 10:56but I would say the vast majority of
- 10:59patients are usually on at least one
- 11:01medication for the duration of their life,
- 11:04but it's again incredibly low
- 11:07dose compared to the majority of
- 11:09other organ transplant recipients.
- 11:12And they quote cured?
- 11:16Yeah, so that's
- 11:17exactly the hope is
- 11:20that from liver transplant,
- 11:23you're essentially replacing the
- 11:25entire organ, and so whatever the
- 11:28etiology of that patients,
- 11:30liver diseases is essentially cured.
- 11:33Of course, there's a risk if
- 11:36patients redevelop viral infections,
- 11:38or if some of the risk factors
- 11:40that led initially to their
- 11:42liver disease are still present.
- 11:44And I think a lot in our population
- 11:46the common things are patients
- 11:49who develop fatty liver disease
- 11:51in the post transplant setting,
- 11:53if they continue to
- 11:55have diabetes or obesity,
- 11:57you can develop recurrent
- 11:58disease in the organ.
- 11:59But if patients mitigate their risk
- 12:03factors and go on to live a healthy life,
- 12:06then yes, liver transplant is
- 12:08curative not only for the cancer,
- 12:10but again for the initial
- 12:12cause of their cirrhosis.
- 12:14And so for patients who have liver cancer
- 12:18is transplant one of the things that
- 12:20you think of first or do people have
- 12:23to kind of go through chemotherapy?
- 12:25At least in assessment of
- 12:27surgical resection and so on?
- 12:29Kind of the more commonplace
- 12:31cancer therapies before you think
- 12:33about transplant or is transplant
- 12:35something that is now first line?
- 12:39So it definitely is extremely
- 12:41independent on each patient's case.
- 12:44If we see a patient who has a single tumor,
- 12:48that's very small in size,
- 12:50and we think that we can cure them
- 12:52with a local resection, meaning,
- 12:54just cutting out a portion of that liver,
- 12:57that's generally the first line
- 12:59therapy that we would actually go to.
- 13:01In patients that have more
- 13:03advanced liver disease and other
- 13:05complications from their liver,
- 13:07if they develop a cancer
- 13:08on top of that, we know that a transplant
- 13:10would cure both of those aspects,
- 13:12so I would not say it's often firstline,
- 13:15but it's a curative approach that we
- 13:18definitely have in the back of our heads
- 13:20for a subset of patients that
- 13:21would be good candidates.
- 13:23Terrific, we're going to learn
- 13:25a lot more about liver cancer and
- 13:28transplant hepatology right after we
- 13:30take a short break for a medical minute.
- 13:33Please stay tuned to learn more
- 13:34with my guest doctor Ariel Jaffe.
- 13:37Funding for Yale Cancer Answers
- 13:39comes from AstraZeneca, dedicated
- 13:41to advancing options and providing
- 13:43hope for people living with cancer.
- 13:45More information at AstraZeneca Dash us.com.
- 13:51Genetic testing can be useful for
- 13:53people with certain types of cancer
- 13:55that seem to run in their families.
- 13:56Genetic counseling is a process that
- 13:59includes collecting a detailed personal
- 14:01and family history or risk assessment and
- 14:04a discussion of genetic testing options.
- 14:06Only about 5 to 10% of all cancers
- 14:09are inherited, and genetic testing
- 14:11is not recommended for everyone.
- 14:13Individuals who have a personal and
- 14:15or family history that includes
- 14:17cancer at unusually early ages,
- 14:20multiple relatives
- 14:20on the same side of the family
- 14:23with the same cancer,
- 14:24more than one diagnosis of
- 14:26cancer in the same individual,
- 14:28rare cancers or a family history of a
- 14:31known altered cancer predisposing gene
- 14:33could be candidates for genetic testing.
- 14:36Resources for genetic counseling and
- 14:38testing are available at federally
- 14:40designated comprehensive cancer
- 14:41centers such as Yale Cancer Center
- 14:44and at Smilow Cancer Hospital.
- 14:46More information is available at
- 14:49yalecancercenter.org. You're listening
- 14:51to Connecticut Public Radio.
- 14:53Welcome
- 14:53back to Yale Cancer Answers.
- 14:55This is doctor Anees Chagpar and I'm joined
- 14:58tonight by my guest doctor Ariel Jaffe.
- 15:00We're talking about patients with liver
- 15:03cancer, and before the break we talked
- 15:06about the whole aspect of transplant
- 15:09as a potential curative modality for
- 15:12patients with liver cancer. But Ariel,
- 15:14just as we were heading to the break,
- 15:16you mentioned that there are a
- 15:18lot of other things that go into
- 15:20thinking about liver cancer as well,
- 15:22so I wanted to take a step back
- 15:24and talk a little bit about
- 15:26how common is liver cancer?
- 15:30Primary liver cancer is actually
- 15:33a quite significant global burden.
- 15:35There's over 800,000 new
- 15:37cases diagnosed each year,
- 15:39and actually in the US in particular,
- 15:41it's the fastest increasing cause
- 15:43of cancer and the fastest increasing
- 15:45cause of cancer related death.
- 15:48When we talk about
- 15:50primary liver cancer we mean cancer
- 15:52that has originated and developed
- 15:54in the liver from the beginning.
- 15:56There are two main types that we think about,
- 15:59so hepatocellular carcinoma,
- 16:00probably accounts for 80 to
- 16:0490% of primary liver cancer,
- 16:06but another common type that we see
- 16:08that often develops in patients with
- 16:10chronic liver disease is something
- 16:13called cholangiocarcinoma and
- 16:14that arises in the biliary cells,
- 16:16and these are the cells that line
- 16:18the little lakes
- 16:20and channels within the liver
- 16:22that sort of drain and modify the
- 16:24substance that the liver makes,
- 16:25called bile.
- 16:26When you think about
- 16:28secondary liver cancer,
- 16:30a lot of times what we're talking
- 16:31about is metastatic disease,
- 16:33so cancer that may have spread to the liver,
- 16:36but that's really treated and
- 16:38managed extremely differently
- 16:39than primary liver cancer.
- 16:42And so that's really fascinating.
- 16:44I didn't realize that liver
- 16:46cancer in the United States was the
- 16:48the fastest growing in terms of
- 16:50incidence and mortality. Why is that?
- 16:53What are the risk factors that
- 16:55predispose to liver cancer that
- 16:58are factoring into this equation?
- 17:00Or is it the risk factors?
- 17:03Yes, so there's definitely been a shift
- 17:05sort of in the risk factors globally where
- 17:08prior the major causes of liver disease
- 17:10used to really be chronic viral disease.
- 17:13And mainly we're talking about
- 17:15chronic hepatitis B and hepatitis C,
- 17:18but with the ability to treat
- 17:20hepatitis C and control hepatitis B,
- 17:23and even prevent that with vaccinations
- 17:27really in the Western world,
- 17:28what we're seeing as the major cause of
- 17:31liver disease is definitely what we call
- 17:33Fatty liver disease or non-alcoholic
- 17:36fatty liver disease, and
- 17:38as we see a rise in the obesity epidemic,
- 17:42we're seeing more and more patients that
- 17:45develop complications such as diabetes,
- 17:47high cholesterol,
- 17:50central adiposity,
- 17:52meaning
- 17:53a lot of belly fat, which is inflammatory
- 17:55bad fat that the body does not like,
- 17:58and high blood pressure.
- 18:01As we're seeing more patients
- 18:03develop those complications,
- 18:04we're seeing a rise in the
- 18:06incidence of fatty liver disease.
- 18:08It is certainly true that there's just
- 18:11this exponential rise in obesity in
- 18:14America and in the world quite frankly.
- 18:17So let me ask you this, is it possible
- 18:21to reverse that, if you lose weight,
- 18:24do you reduce your risk of fatty
- 18:27liver and therefore reduce your
- 18:30risk of hepatocellular carcinoma?
- 18:33Absolutely,
- 18:34generally when patients have
- 18:36developed cirrhosis which is really
- 18:38advanced scarring within the liver,
- 18:40we do say that you can't
- 18:43reverse completely to having
- 18:44a normal healthy liver,
- 18:45but for a lot of patients who
- 18:47are not quite yet cirrhotic,
- 18:49or who may be cirrhotic but have active,
- 18:52ongoing inflammation, which is a
- 18:54big risk factor for
- 18:56the development of cancer,
- 18:57you can absolutely reduce the risk of
- 19:00developing complications from liver disease,
- 19:03and the development of liver cancer.
- 19:05So in particular for fatty liver disease,
- 19:08really the only kind of approved
- 19:11therapy at this time is the
- 19:13recommendation to lose weight.
- 19:15And generally we say 5 to 10% of
- 19:18weight loss has been associated
- 19:20with reduction in inflammation
- 19:22reduction in scarring of the liver,
- 19:25and even reduction in the
- 19:27potential to develop liver cancer.
- 19:28And it's why we like to really tell
- 19:31patients that a lot of the risk factors
- 19:33to develop liver disease and liver
- 19:35cancer are really preventable.
- 19:36And you see and
- 19:40treat patients with liver disease who may
- 19:44be at risk of developing liver cancer,
- 19:47and you also see patients who
- 19:49have developed liver cancer.
- 19:51You know if you tell them to lose weight,
- 19:53that's often easier said than done.
- 19:57Are there any specific recommendations
- 19:59that you give patients?
- 20:01I'm just thinking that our listeners
- 20:03might be thinking, yeah,
- 20:04I'd love to lose 5 to 10% of my body weight.
- 20:08How exactly do I do that?
- 20:10Yeah, so it is definitely
- 20:12easier said than done,
- 20:14and I think especially in the COVID era
- 20:16where a lot of people were really
- 20:18confined to their home,
- 20:20it's been an even bigger challenge,
- 20:22so oftentimes what I say to patients is,
- 20:24we kind of go through what
- 20:26they're eating and their physical activity.
- 20:28And sometimes their food choices.
- 20:30They may think that they're eating healthy,
- 20:32but when we actually breakdown the calories
- 20:34or the amount of sugar they're eating,
- 20:37it's a lot more than they're aware of so
- 20:39off the bat,
- 20:40I always offer patients to speak with
- 20:43nutrition because I think to have someone
- 20:45hold you accountable and really go through
- 20:48the target of each food
- 20:51group and macro and micro nutrients
- 20:53you should be hitting is very helpful.
- 20:56We also have specific fatty liver
- 20:58clinics and weight loss clinics here,
- 21:00so there are definitely patients
- 21:02even if they're dieting or exercising,
- 21:05they're just really stuck in this
- 21:07challenging place and they can't
- 21:09get to an ideal body weight.
- 21:10And in that situation there are
- 21:12medications that are available to
- 21:14sort of assist in weight loss.
- 21:16So we have a lot of programs
- 21:18and a lot of
- 21:20ancillary help for patients that
- 21:21really struggle.
- 21:22Alright, so the news flash
- 21:24there is talk to your doctor,
- 21:27because there likely is
- 21:29help available and we can
- 21:31all get through this
- 21:33and hopefully reduce our risk.
- 21:35But Ariel, I want to just kind
- 21:37of switch gears a little bit.
- 21:39Let's suppose it's a little too late.
- 21:41And we develop liver cancer.
- 21:45How do you know that you
- 21:47have developed liver cancer?
- 21:49So how is that diagnosis made?
- 21:51Are you going to have signs and symptoms?
- 21:54Are you going to go yellow or is this
- 21:56something that is picked up
- 21:58incidentally?
- 22:00That's a great question.
- 22:01You know, the majority of patients
- 22:04that develop liver cancer are really
- 22:06asymptomatic until it becomes very advanced.
- 22:09So at the time that someone may have
- 22:11pain or start to have
- 22:14some vague symptoms like weight
- 22:16loss or significant fatigue or even
- 22:18jaundice or yellowing of the eyes,
- 22:21which suggests that there's either a
- 22:23blockage in the liver or that the tumor
- 22:26has spread so much in the liver that it's
- 22:28just kind of taken over any remaining
- 22:31normal tissue, that's often too late.
- 22:32So really, what's incredibly important is
- 22:35to identify patients that have chronic liver
- 22:39disease or risk factors for liver cancer.
- 22:42Some which include
- 22:44poorly controlled diabetes,
- 22:45heavy alcohol use, obesity,
- 22:47and make sure that we're
- 22:49screening those patients.
- 22:51So really all major societies recommend
- 22:53in patients with chronic liver disease
- 22:56that every six months you're actually
- 22:58screened for liver cancer with the
- 23:00hopes that if you develop a cancer,
- 23:02you can actually pick it up early.
- 23:05And it's interesting because liver
- 23:07cancer is the only solid organ tumor
- 23:10that could actually be diagnosed
- 23:12based on imaging alone,
- 23:14so it has very unique features when we
- 23:18do a CAT scan or an MRI that basically
- 23:20allow us to definitively tell if this
- 23:23is a hepatocellular carcinoma and
- 23:25oftentimes we don't even have to do
- 23:28a biopsy to confirm the diagnosis.
- 23:31So people who have those risk factors
- 23:34should have a CT or MRI every six months.
- 23:38So we always recommend an ultrasound.
- 23:40That's the first
- 23:42step for screening,
- 23:45and that's really just based
- 23:46on sort of cost effectiveness,
- 23:48and you know the fact that it is
- 23:50fairly sensitive, but in some patients,
- 23:52if their liver is very scarred down,
- 23:55so you can't get a good look at that tissue,
- 23:57or if there's a lot of obesity, because
- 24:00a lot of fat in the belly can limit how
- 24:02good of a look you can get.
- 24:05In those cases,
- 24:05you may then need to do more advanced
- 24:08imaging, but generally once we see
- 24:10something abnormal on an ultrasound,
- 24:13the next step is to do a cross sectional
- 24:16scan with either a CT or an MRI.
- 24:19And so it's interesting
- 24:21that liver cancers are one of
- 24:24the few where you don't need a
- 24:26biopsy to make that diagnosis.
- 24:28So let's suppose you see that,
- 24:31tell us about some of
- 24:33the medical management,
- 24:34some of the things that are coming
- 24:36down the Pike short of transplant
- 24:37that might be helpful in these patients.
- 24:42Whenever someone has a new
- 24:44diagnosis of liver cancer,
- 24:45we always want to make sure that
- 24:47it hasn't spread outside the liver.
- 24:48So that's a big step,
- 24:49because once it has spread,
- 24:51your treatment is a little bit different,
- 24:54and it's very important to look at a
- 24:56patient's underlying liver function,
- 24:58because that plays a major role in
- 25:00understanding if they're eligible or
- 25:02would tolerate certain treatments.
- 25:04And outside of transplant,
- 25:05we really do think of
- 25:08liver cancer treatment in either
- 25:10a curative approach or what's
- 25:12called a palliative approach, and
- 25:14transplant is one of the curative therapies,
- 25:18but other curative therapies include
- 25:20local resection and that's
- 25:22when we cut out a small
- 25:24piece where that tumor is
- 25:26and of course,
- 25:27someone has to be a good candidate
- 25:29to undergo surgery and so if
- 25:31they have really advanced liver
- 25:32disease that would not be
- 25:34an ideal treatment choice,
- 25:36but other curative therapies
- 25:39include something called ablation which
- 25:42is really where you destroy the tumor and
- 25:45that can be either through
- 25:47thermal techniques,
- 25:48radiation techniques,
- 25:49electrical injury,
- 25:50and then we think of some of our
- 25:55palliative treatments which include
- 25:57what we call local regional
- 26:00therapies or transarterial therapies,
- 26:02and that's basically where you can
- 26:05either induce radiation damage
- 26:07or locally give chemotherapy to
- 26:10the tumor to kind of cut off the
- 26:13blood supply and kill that tumor,
- 26:15and then for patients
- 26:16that either are just not responding
- 26:18to those or where the cancer has
- 26:20spread outside of the liver,
- 26:21we start to think about systemic
- 26:24therapy or chemotherapy.
- 26:27And so you know,
- 26:28I can imagine that no patient wants
- 26:31to go through chemotherapy and
- 26:33everybody has heard horror stories
- 26:36about what chemotherapy is like.
- 26:38But very often on this show we've been
- 26:41talking about some of the newer advances,
- 26:43especially in systemic therapy,
- 26:45where we really are looking
- 26:48towards personalized medicine,
- 26:50sometimes immunotherapies.
- 26:51Is there anything like that
- 26:54going on in primary liver cancer?
- 26:57Absolutely, so I think probably the
- 27:00management for patients with liver cancer
- 27:02that's more advanced has been one of the
- 27:06most innovative
- 27:08fields within liver cancer.
- 27:10And that's because there have been so many
- 27:13new advancements in systemic therapies.
- 27:14Just a few years ago,
- 27:17we just had one or two medications,
- 27:20and now we have 10 FDA approved therapies.
- 27:23And as of May 2020, so just a
- 27:27little over a year ago,
- 27:29a new combination therapy.
- 27:32One of the components
- 27:34was an immune checkpoint inhibitor,
- 27:36which is one of our immunotherapy
- 27:39medications that actually proved to
- 27:41be the best first line therapy,
- 27:42so it had improvement in overall
- 27:45survival and disease
- 27:46free progression compared to what our
- 27:49prior first line was and is actually
- 27:52now what we try to use for our patients.
- 27:55And I think it's also important to know that
- 27:58oftentimes,
- 27:58when our patients hear that they're going
- 28:01to go on systemic therapy or chemotherapy,
- 28:04they kind of think of
- 28:06the movies or loved ones that they've
- 28:09seen have gotten really very sick.
- 28:11Or their hair has fallen out or their
- 28:13immune system is completely wiped out,
- 28:16and the medications that we use to
- 28:18treat liver cancer are definitely
- 28:20much more tolerable
- 28:22with significantly reduced side
- 28:24effects compared to
- 28:25what a lot of patients think about
- 28:28for sort of standard chemotherapy
- 28:29for other tumors.
- 28:31Doctor Ariel Jaffe is an assistant
- 28:33professor of medicine in the
- 28:35section of digestive diseases
- 28:36at the Yale School of Medicine.
- 28:38If you have questions,
- 28:40the address is cancer answers at
- 28:42yale.edu and past editions of the
- 28:44program are available in audio and
- 28:47written form at yalecancercenter.org.
- 28:48We hope you'll join us next week to
- 28:51learn more about the fight against
- 28:53cancer here on Connecticut Public Radio.
- 28:54Funding for Yale Cancer
- 28:56Answers is provided by Smilow
- 28:57Cancer Hospital and AstraZeneca.