Cancer 2015: Liver cancer expert offers view from the front lines
December 24, 2014 | by Tami Dennis
Yuman Fong, M.D., is an internationally recognized expert in hepatobiliary cancer – that is liver cancer, pancreatic cancer, gallbladder cancer and cancer of the bile ducts. He's also renowned for his use of genetically modified viruses to combat malignant disease, is a pioneer in the operating room and the laboratory, is the author of more than 600 peer-reviewed articles and 11 textbooks, and is the chair of the Department of Surgery at City of Hope. All told, he’s uniquely qualified to offer an overview of cancer advances expected in 2015.
Liver cancer:When it comes to liver cancer, Fong says, ablation (burning tumors with needles) and resection (surgical removal of tumors) will continue to improve, offering better prognoses for people diagnosed with the disease.
“Ablations can produce long-term remissions and potential cures for liver cancer,” Fong said, pointing to a recent article published in Advances in Surgery. That article’s key points:
- Tumor ablation is a safe and easily performed treatment for hepatocellular carcinoma.
- Randomized trials have shown tumor ablation to be durable and potentially curative therapy for small hepatocellular carcinoma.
- Tumor ablation and minimally invasive therapies are changing the treatment paradigms for hepatocellular carcinoma.
- These minimally invasive therapies are good bridge therapies to transplant for patient with advanced cirrhosis.
Then there’s liver pump chemotherapy. A recent Current Oncology article, for which (like the others) Fong was a contributing author, details the conclusions of an expert panel convened to discuss the role of infusion pump chemotherapy in patients whose colorectal cancer has spread to the liver.
Among their conclusions was that such therapy should be offered with more traditional chemotherapy and that, for patients with inoperable tumors, it can even be a first-line treatment. The panel also stressed the importance of delivering such chemotherapy, especially when given with traditional chemotherapy, as part of a multidisciplinary program that includes expertise in hepatobiliary surgery, medical oncology, interventional radiology, nursing and nuclear medicine.
In short, because each patient is unique, each one needs a team of experts assessing and consulting with each other on the best possible treatment. That team-based care is a City of Hope specialty.
Viral gene therapyAlready, viruses are all around us. Increasingly, they’ll be used to our benefit.
“All viruses attack their hosts and introduce their genetic material into the host cell as part of their replication cycle. The host cell then produces additional copies of the virus, leading to more and more cells becoming infected. With viral vectors, we take certain viruses and genetically modify and design them to attack and destroy cancer cells only while sparing normal tissues. By exploiting some of the characteristics of cancer cells, these viruses only replicate in cancer cells, ultimately destroying them.”Recent research suggests that cancer-killing viruses can be effective against a host of cancers, including stomach cancer and triple-negative breast cancer.
Fong and his colleagues have found in laboratory experiments that a genetically modified vaccinia virus could even be used to make triple-negative cancer cells susceptible to a specific type of radioactive therapy. That’s no small accomplishment. Triple-negative breast cancers are among the most difficult to treat because they spread quickly and because they don’t respond to hormonal therapy.
As for gastric, or stomach, cancer, here too patients may benefit from the deft use of a modified vaccine virus. Fong and fellow researchers found that such treatment could be used to “effectively infect, replicate within and cause regression of gastric cancer.”
This type of viral gene therapy also shows immense promise for the treatment of liver cancers resistant to conventional therapy, Fong says.
In other words, expect to hear more about viral gene therapy.
Pancreatic cancerPatients with pancreatic cancer will not be left out of the positive news in the coming year. The drug pasireotide (Signifor) has recently been found to help prevent one of the most dreaded complications of pancreatic surgery, known as pancreatic fistulae.
An early summary of 2015All told, the future of cancer treatment is looking brighter every year.
“When I first started in medical school, most of these cancers I now treat were incurable and terminal. Now, we cure more than 50 percent of the people we take to surgery with these cancers. And when I say “cure,” I don’t just mean living longer. I mean living to an old age. And that’s gratifying. To witness during my lifetime a body of cancer change from incurable to more than half the people being cured who are operated upon is very, very gratifying. It’s a big change and it’s continuing.”In 2015, cancer researchers and physicians will take new steps in the right direction.
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