After 30 successful space missions, this retired NASA medical director takes on chronic lymphocytic leukemia with the help of MD Anderson's Geriatric Clinic.
Fall 2019 : Combating an epidemic
Combating an epidemic
Rising obesity rates spike increase in liver cancer diagnoses
Photo: iStock
First, the good news: The American Cancer Society reports the overall cancer death rate in the United States has been dropping steadily for 25 years. Now, the bad: Liver cancer isn¡¯t included in this downward trend. Liver cancer rates have more than tripled since the mid-1970s, making it the country¡¯s fastest-growing cause of cancer deaths today.
Why the climactic rise?
¡°In the past, liver cancer has been associated with hepatitis B and C virus infections, but that¡¯s changing,¡± says Darren Sigal, M.D., program director of Gastrointestinal Oncology at ¨C a member of the MD Anderson Cancer Network?.
Today, fewer than 5% of liver cancer cases in the United States are caused by hepatitis B, primarily because children have routinely been vaccinated against the virus since 1982. And although there¡¯s no vaccine for hepatitis C, powerful new drugs are curing 90% of patients.
¡°Viral hepatitis is becoming less important as a cause of liver cancer in the U.S.,¡± Sigal says.
Obesity-driven disease
Instead, a major culprit behind today¡¯s skyrocketing liver cancer rates is a condition known as non-alcoholic fatty liver disease. Characterized by a buildup of excess fat in the liver, the disease strikes people who drink minimally or not at all (hence ¡°non-alcoholic¡±). It¡¯s distinctly separate from another type of fatty liver disease caused by alcohol abuse.
Non-alcoholic fatty liver disease is linked to a high-calorie, low-exercise lifestyle.
¡°Because 70% of American adults are overweight or obese, the nation is experiencing a ¡°tidal wave¡± of non-alcoholic fatty liver disease cases,¡± Sigal says, ¡°which in turn is causing record numbers of liver cancer diagnoses.
According to the National Cancer Institute, 30% of Americans have some form of fatty liver disease. That number is poised to reach 50% by 2030.
¡°In 10 years, half of all Americans will have fatty liver disease,¡± Sigal explains. ¡°Up to 27% of those fatty liver disease cases will progress to liver cancer.¡±
Two-drug combination
To combat this epidemic, Sigal is leading a study of a new liver cancer drug that is derived from ocean algae and enlists a patient¡¯s own immune system to attack tumor cells. Developed at Scripps Research in collaboration with the biotechnology company Abivax, the drug, named ABX196, stimulates a type of white blood cell called an invariant natural killer T cell. These cells exist in extremely small numbers in the blood stream, and kill on contact by binding to tumor cells, then releasing a lethal burst of potent chemicals.
¡°ABX196 is a very unique immune treatment,¡± Sigal says. ¡°It¡¯s available nowhere else outside this study.¡±
Participants may enroll at the main trial site at Scripps MD Anderson Cancer Center in San Diego, or at the trial¡¯s secondary site at MD Anderson Cancer Center in Houston.
In the clinical trial, patients receive ABX196 in combination with an existing drug named nivolumab (brand name Opdivo).
¡°Sometimes, cancer cells are able to disguise themselves from cancer-killing T cells. If this happens, the cancer cells inactivate the T cells to prevent them from attacking,¡± explains , associate professor of GI Medical Oncology at MD Anderson in Houston and leader of the Houston study site. ¡°Opdivo blocks cancer¡¯s ability to disguise itself, which allows T cells to be active and attack.¡±
Opdivo alone is highly effective in combating some cancers, particularly lung cancer. But the drug works in only about 15% of liver cancer patients, and even then, only lasts about four months.
¡°By adding ABX196 to the treatment mix along with Opdivo, this new clinical trial is designed to make Opdivo more effective,¡± Kaseb explains. ¡°The goal is to see if the synergy between these two drugs can lead to improved outcomes for patients with this deadly cancer.¡±
Helping those who need it most
Previous tests over the last two years confirmed the therapy worked to activate the immune systems of mice and healthy humans. Now the two-drug regimen is being tested in patients with liver cancer, which carries a particularly grim prognosis.
The five-year survival rate for people with localized liver cancer is 30%, and for those with advanced disease, it¡¯s a dismal 3%.
¡°Liver cancer is not often found early, because signs and symptoms usually don¡¯t appear until the disease is in its later stages,¡± Kaseb says. ¡°We very much need a treatment that works.¡±
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