Spotlight on Sylvester’s Liver Cancer Research
Article Summary
- Researchers at Sylvester Comprehensive Cancer Center are at the forefront of understanding liver cancer and its causes.
- A major focus is studying health disparities and how to overcome them.
- Hepatocellular carcinoma has a five-year survival rate of only 18% in the U.S., with about 25,000 new cases diagnosed annually.
Things have changed in the liver cancer field since Patricia D. Jones, M.D., joined Sylvester Comprehensive Cancer Center, part of the University of Miami Miller School of Medicine, almost 10 years ago.
The first drugs against the hepatitis C virus, a major risk factor for liver cancer, were then just coming online. Now, there is a diverse arsenal of treatments and costs are coming down. And last year the U.S. Centers for Disease Control and Prevention released guidelines calling for universal screening for hepatitis B virus, another key risk factor.
However, hepatitis C medications are not reaching everyone, and people are only beginning to learn about hepatitis B screening, said Dr. Jones, an associate professor of clinical medicine at the Miller School. Mortality rates from primary liver cancer are still high, she noted.
“We often we see very young patients who didn’t even know that they had hepatitis B until they were diagnosed with liver cancer,” said Dr. Jones.
Dr. Jones and other Sylvester researchers reflected on advances in the field, Sylvester’s role and their hopes for the future.
Uncovering Disparities
Much of Dr. Jones’ research has been devoted to understanding why some groups have a higher risk for liver cancer. That information leads to targeted health interventions.
Dr. Jones and corresponding author Paulo Pinheiro, M.D., Ph.D., a Sylvester cancer epidemiologist, published a study showing how race and ethnicity affect the risk for developing hepatocellular carcinoma (HCC), the most common form of primary liver cancer.
Fatty liver and alcohol-related HCC were more prevalent among the Hispanics than white people, for instance. However, within the Hispanic population, Puerto Rican men had a three-fold higher risk of developing HCC than Cuban men, highlighting the value of digging deeper into demographic data. Socio-economic factors also played a role.
More recently, Dr. Pinheiro and his colleagues presented data from an ongoing study showing how the causes of the disease, from hepatitis B and C virus to alcohol-related liver disease, affect HCC survival outcomes.
Addressing Disparities
Stopping liver cancer before it develops is the best way to save lives. HCC has a five-year survival rate of only 18% in the U.S., with about 25,000 new cases diagnosed annually. Incidence has soared 48% since 2000.
Dr. Jones and her team are now focused on understanding the basis for disparities in HCC risk. They are following people who have chronic liver disease to trace who eventually develops cancer and understand why, assessing a range of lifestyle and genetic factors.
“We’re trying to understand people more holistically,” said Dr. Jones.
Dr. Jones is also involved in a project to increase hepatitis B screening in the community.
“One of the barriers is being able to see a health care provider,” said Dr. Jones. “We aim to circumvent that barrier by going right in the community and saying, ‘You can get tested, just like for HIV.’”
People would then be linked to care, including hepatitis B treatments and vaccination.
The screening initiative is led by Erin Kobetz, Ph.D., M.P.H., associate director, community outreach and engagement at Sylvester and the John K. and Judy H. Schulte Senior Endowed Chair in Cancer Research. Dr. Kobetz leads multiple projects focused on breaking down health disparities.
Dr. Jones says the diversity of the population in the Miami area helps dissect the various risk factors for disease by race and ethnicity. Collaborations with researchers in California and elsewhere build on that advantage.
Dr. Jones also appreciates Sylvester’s commitment to better understanding and addressing health disparities in liver cancer. The institution has funded many of her preliminary studies, she said, enabling her to obtain later grant funding from sources such as the National Institutes of Health.
Changing Access
Over the last several years, the proportion of liver cancer cases linked to hepatitis viruses has shrunk compared to cases linked to the other key risk factors of fatty liver and alcohol use, noted Sylvester researcher David S. Goldberg, M.D., a Miller School associate professor of medicine in the Division of Digestive Health and Liver Diseases.
New drugs to better treat liver cancer, such as emerging immunotherapies, are also increasingly reaching patients, he said.
In 2022, Dr. Goldberg and his colleagues developed and validated a risk score tool to predict long-term survival probabilities for patients with cirrhosis. They will soon release a prediction model specifically for individuals with cirrhosis with liver cancer prior to liver transplantation.
Dr. Goldberg and his colleagues also are helping to lead a national study examining disparities in access to liver transplantation, referral, selection and care for alcohol-associated liver disease. He’s also involved in effecting transplantation policy and has shown how a shift in transplant allocation guidelines increased health disparities.
Hope for the Future
There’s a lot more to do to decrease the health disparities that can lead to liver cancer, said Dr. Jones.
“We still have terrible cases and we still have poor outcomes,” said Dr. Jones. “Most of the work that you see about disparities is descriptive.”
She explained that it doesn’t show why one group does worse than another. Moreover, solutions are still being discovered.
Open questions include why some people are diagnosed so late and why some people with insurance and easy access to treatment are still not getting the care they need.
“I’m optimistic that this research will bring to light some of the barriers. I think we will be better off in 10 years,” said Dr. Jones.
Tags: cancer research, cancer screening, Dr. David Goldberg, Dr. Erin Kobetz, Dr. Patricia Jones, Dr. Paulo Pinheiro, hepatitis, liver cancer, liver transplant, Sylvester Comprehensive Cancer Center