New Treatments For Liver Cancer

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http://www.ksat.com/health/27084113/detail.html

New Treatments For Liver Cancer

POSTED: Friday, March 4, 2011

UPDATED: 5:51 pm CST March 4, 2011

BACKGROUND: According to the Mayo Clinic, liver cancer is one of the most common

forms of cancer in the world. However, liver cancer is uncommon in the United

States. Most cancer that occurs in the liver in the United States begins in

another area of the body such as the colon, breast, or lung. Doctors call this

metastatic cancer, rather than primary liver cancer. This type of cancer is

named after the organ in which it began. According to the National Cancer

Institute, about 15,000 men and 6,000 women are diagnosed with primary liver

cancer in the United States each year. Most of these people are over age 64.

TREATMENTS: There are a variety of treatment options for patients with liver

cancer. Some of these include:

Surgery -- Doctors remove the cancer and part of the healthy tissue that

surrounds the tumor.

Liver transplant surgery -- A patient's diseased liver is removed and replaced

with a healthy liver from a donor.

Freezing cancer cells -- Cryoablation uses extreme cold to destroy cancer cells.

Heating cancer cells -- In a procedure called radiofrequency ablation, electric

current is used to heat and destroy cancer cells.

Injecting Alcohol -- Pure alcohol is injected directly into tumors either

through the skin or during an operation.

Chemotherapy -- Chemoembolization is a type of chemotherapy that supplies strong

anti-cancer drugs directly to the liver.

Radiation -- High-powered energy beams destroy cancer cells and shrink tumors.

Targeted Drug Therapy -- Sorafenib (Nexavar) is a targeted drug designed to

interfere with a tumor's ability to generate new blood vessels.

TRANSPLANT SOLUTION: While liver transplants may be a good option for some

patients, the cancer cells still in the body may eventually attack the new,

transplanted liver. This happens in about 20 percent of cases. Now, researchers

at the University of Miami School of Medicine are testing a revolutionary

new procedure that uses the body's own natural killers to keep liver cancer from

coming back. The treatment utilizes specialized cells in the body known as

natural killer cells. After a liver transplant, these natural killers can attack

any liver cancer cells remaining in the body. Natural killer cells are extracted

from a donor liver, cultured in the lab so they multiple, and are injected into

the patient's bloodstream. These cells act like " smart bombs, " honing in and

destroying any lingering cancer cells. They also have the added bonus of being

10-times more aggressive against the hepatitis C virus.

s Tzakis, MD, Professor of Surgery, Director of Liver and Gastrointestinal

Transplant Program at U of Miami/ Memorial Hospital., tells us about a

new procedure that uses the body's own natural killer cells to fight liver

cancer.

Tell me about this particular type of liver cancer. Where does it come from and

what happens to it. It originates as hepatitis?

s Tzakis, M.D.: The underlying disease is hepatitis. Hepatitis is a very

common infection. It’s a major health problem. And it was a huge problem in the

1970’s when there was no testing to tell who had Hepatitis and who didn’t. So,

transmission of Hepatitis happened through blood transfusions, through

contaminated needles. A lot of people got it during this time.

What are we doing now with these patients down the road?

s Tzakis, M.D.: Now down the road…there’s one problem: a lot of patients.

The second problem is: the treatment that is available is not universally

effective. It is thought that maybe 15 or 20% of the patients can clear the

virus themselves. The other 80% of the patients cannot clear the virus. And of

this group, the treatments that we’ve had have been effective for roughly half

of them. So half the patients altogether, maybe with the best treatment, clear

the virus. For the remaining, it stays with the patient and creates a chronic

form of hepatitis. This hepatitis scars the liver at the end and causes what we

call Cirrhosis. And, it has been found, once the liver is Cirrhosis every year

there is a 3 to 4% chance it might develop a cancer. So, if somebody has

Cirrhosis from Hepatitis C, 15 years later there is a 50% chance of having a

tumor. It’s a very high percentage. Remember in the United States there are

about 4 million people who have Hepatitis C.

So, it’s a major problem. It’s an epidemic.

What did the advent of liver transplants do as far as the curability,

treatability for liver cancers?

s Tzakis, M.D.: There are three components when you treat a patient with

liver cancer from hepatitis C. One is the tumor itself; how big it is, where it

is located, how aggressive it is? The second component is the liver as an organ

itself. How well can it perform? Is it very damaged, not too damaged? Then the

third component is the general condition of the patient. How much can the

patient take in terms of treatment? And there is a percentage of these tumors

that can be simply cut out because the liver is not too damaged, the patient is

strong enough to take the resection and that is the most practical thing. And,

if it’s possible, that’s probably the first choice. In the majority of the

patients the combination of the characteristics, the features of the tumor, the

size, the aggressiveness, the location and the condition of the liver do not

allow the tumor to be resected, to be cut out. For these cases it has been shown

that the liver transplant is the most effective way to handle it, remove the

liver. That’s the good news. What’s the bad news? The bad news is that the liver

transplant requires medication, immunosuppressive drugs to prevent it from

rejecting, that sort of fuels the hepatitis. So, that is not so good for the

patient and it also fuels tumor growth. One has to be careful whom to transplant

because if there is anything left behind the tumor will come back and come back

in a worse form than when it started. So, there are now national guidelines

about what we can transplant and what we cannot transplant in order to use these

scarce resource, the livers, in the best possible way.

What is this new treatment with the NK cells? First of all what do you do?

s Tzakis, M.D.: The second part of the bad news is the tumor can come

back. And even with all the precautions and following the national guidelines

there are about 15 or 20% of the patients who will develop a recurrence of the

tumor. The tumor comes back although we think we took care of it. So, this is

what we are addressing with the NK cells. We first heard about them at the

national meeting here where researchers from the University of Hiroshima

presented their findings. They had discovered cells within a healthy liver that,

if cultured properly, can attack the tumor like smart bombs. So, they have this

characteristic but not as strong naturally, but when properly treated they

become four times smarter in attacking tumor cells.

So what do you do to these cells and how do they become a smart bomb?

s Tzakis, M.D.: They are smart to start with, but they become very smart

after we culture them outside the body. What we do when we recover a liver to

transplant it, we cool it. That’s what we normally do in order to preserve it.

We cool it with a solution that we flush it with. Now we take that solution and

we isolate the NK cells from the many cells that have been flushed out from the

new liver. We isolate the NK cells and then Dr. Ohira and Dr. Nishida and our

collaborators at the diabetes research institute where we do all this work

outside the body, treat these cells in a way that they make them a lot smarter,

four times smarter actually to attack these tumors. They home into the tumor

cells that may be still in the body that may be still circulating. Now they also

found that these same cells have activity against the hepatitis C virus, which

is an extra gift that these patients get, because they found that these cells

block the propagation of hepatitis C and after the treatment they become 10

times more potent in blocking the propagation of hepatitis C.

So, give me the steps. You take the cells out, you transplant the liver and then

you infuse?

s Tzakis, M.D.: Right. So, here is how it works time wise. We recover the

liver, we cool it down, the same time we cool it down we take the perfusion

fluid. We take the flush that we cool it down with, take it to the lab. We put

this solution through a process and separate the NK cells. During the same time

another team transplants the liver so the patient gets the transplant right

there and then. Then our team in the lab, after they isolate the cells, makes

sure we have the correct type of cells, puts them through the special cultures

and that lasts several hours, almost a day. Then we keep these cells and do some

special tests to make sure we don’t transmit any bacteria, and that we don’t do

anything wrong to the best of our knowledge, making sure it’s absolutely perfect

for infusion. Then, four or five days after the transplant and while the patient

is recovering, we give the cells intravenously. After we give them

intravenously, if there are any tumor cells that circulate in the body, the NK

cells home into these cells and go and kill them. And that’s how this works.

Tell me what the NK stands for and tell me what they do when they get inside the

body to that cancer that may have been left in the body.

s Tzakis, M.D.: NK cells stands for Natural Killer Cells and what they do

is they home in on the tumor cells like smart bombs, like guided missiles. They

home in on the tumor cells and kill them.

How big a breakthrough is this in the treatment of liver cancer? It’s obviously

still experimental.

s Tzakis, M.D.: It is experimental so I wouldn’t want to guess how big a

breakthrough it is. Obviously, it is a very novel approach. It hasn’t been done

before. It was tested successfully with living donors in the University of

Hiroshima. I think the basic research that Dr. Ohira and his collaborators have

done is very exciting and it looks very promising. The early results from

Hiroshima are very encouraging and we hope we are going to have very good

results in preventing tumor recurrence.

One more thing, how aggressive was Mr. Miranda's cancer?

s Tzakis, M.D.: Before he was treated with radiologic procedures by Dr.

Narayanan, it seemed to be inoperable. It appeared to be very aggressive, but

with the chemotherapy and the special procedures that were done for him, it was

brought down to within range that we could do the transplant for him. So, to

answer your question I think it was a very aggressive tumor and thankfully it

was brought under some control with the procedures that we did. And, hopefully,

it is under complete control now. We will need to follow him over the next three

to five years to know exactly how successful we have been.

But in Japan?

s Tzakis, M.D.: The Japanese experience with 24 patients, the follow up is

more than three years, average follow up. Twenty-two of the twenty-four patients

are alive and well and without tumor recurrence. And, some of them had very

large tumors. And our Japanese collaborators compared them with a group that

they had transplanted previous to that with comparable tumors and the results

are significantly better now than they were before. So, the early experience is

very promising.

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