MedPage Today brought together three leaders in the field of liver cancer to discuss the latest research and clinical advances. In this last of four exclusive episodes, moderator Ghassan K. Abou-Alfa, MD, of Memorial Sloan Kettering Cancer Center in New York City, is joined by Amit Singal, MD, of UT Southwestern Medical Center in Dallas, and Peter R. Galle, MD, PhD, of Mainz University Medical Center in Germany, for a roundtable discussion on the global burden of hepatocellular carcinoma (HCC).
Following is a transcript of their remarks:
Abou-Alfa: Hello everybody, and thanks for joining us on this roundtable on liver cancer. It’s a great pleasure to have you on board. My name is Ghassan Abou-Alfa from Memorial Sloan Kettering Cancer Center, New York. I’m joined today by dear colleagues Dr. Peter Galle from University in Mainz, Germany, as well as Dr. Singal from University of Texas Southwestern in Dallas.
We did an effort which already many of you have seen looking into the accessibility in regard to therapy and interventions in the continent of Africa. Africa, as you know, has the highest incidence of liver cancer in the world. We know that also there’s a high incidence in Southeast Asia, but sadly in Sub-Saharan Africa and to some extent even in North Africa where there’s hepatitis C driven, especially in Egypt and sub-Saharan Africa where there’s quite a bit of hepatitis B-related HCC. We did the effort and 84% of the excess was only extending to sorafenib.
And the question is, we talk about those fancy things, but how does it translate to the world? Any thoughts about shall we stick to what we have and whatever’s accessible wherever they are in the world? And Africa is an example of many other parts of the world. Amit, your thoughts.
Singal: It’s a great point. And I mean think when we think of the science, the science is actually the first part, right? So we needed to demonstrate efficacy in these clinical trials, and then we need to think through effectiveness, how this works in clinical practice, and implementation. And I mean I think that this is an entire science and policy advocacy, et cetera that needs to also happen. The good thing is that there are people in the field such as yourself, Peter, myself, that are advocating for this to happen. And I think now the next thing that we need to do is work with people on the ground to actually see if we can increase access.
This is much harder. One can argue it’s actually equally hard as advancing the science itself, is to make sure that people have equal access. So I don’t know if I have the answer to this per se today, but I 100% reinforce what you said that this is important, because we know that these new therapies have increased efficacy versus the traditional therapies. And I think the next thing that we need to do is think about how we can disseminate this from a broader global perspective, particularly for these areas that are disproportionately impacted.
Abou-Alfa: No, by all means. Actually Peter, as you know and I were just chatting before we started our nice discussion over here, and I mentioned that I was in Berlin for the World Health Summit and there was a specific part of the meeting on noncommunicable diseases where cancer falls into play. And it was nice as Amit was saying to see actually governmental bodies, it was nice to see advocacy groups, and pharmaceutical companies as well, but clearly it’s very important to really put those acts together to get the access of the therapy to patients.
And my question is, do you have, especially that in your part of the world really you need all efforts of that nature of very noble high level value for patients around the world and for your whole humanity. Do you have any thoughts? How can we get access to atezolizumab [Tecentriq], for example, for patients in little bit more challenging parts of the world?
Galle: Well, we have to make it clear to the public and to politicians that in the case of hepatocellular carcinoma, we have a particular concern with respect to the regional differences worldwide. The disease burden is different, the availability of not just drugs but also surgery and interventional radiology is different, the approval status of drugs is different. And therefore guidelines just give an overview of what could possibly be done, like Amit said, you begin with the science, we define what is best.
But then, I think it’s quite clear we need to point out that what is best is unreachable for a large proportion of our worldwide population and in particular of course, sub-Saharan Africa.
So that is something which needs to be discussed. And this disparity, there needs to be awareness of it. I mean if you get started with liver awareness, it’s a disaster wherever you go. We detect this tumor even in developed countries at a late stage. We could be so much better if we would take care of our liver patients. It would increase liver awareness in patients, and doctors get the diagnosis early. Japan has demonstrated that 95% can be diagnosed at early stage disease. We get three-quarters in a situation where curative intent is not possible.
So there is so much to do in terms of politics and awareness, and we are just getting started on that. I will be next week in Ghana actually on a Ghana oncology conference. And I’m very curious what I’m learning there.
Abou-Alfa: If anything, to our colleagues, interestingly, all three of us come from different parts of the world. I mean our descents from India for Dr. Singal, for me from the Middle East from Lebanon, and for Dr. Galle from Germany, we represent — here I am in New York, and we really are kind of covering the whole world and we understand those perspectives and really are humbled and honored to be able to really read those kind of key elements per se for our colleagues wherever they are.
No doubt that I would say there’s a high potential. I like very much what Dr. Galle brought in is that this is not really only on a big scale of globality, this can happen even in our own specific areas. Like I live in New York City, which is one of the most diverse cities in the world. Even the effort to try to bring our patients from communities in the New York area to be having taking care of life, for example as we welcome them at my institution at Memorial Sloan Kettering, that’s very important to do.
And then of course we have to make sure that we help enhance the access. I was delighted, for example, that the first lady of Namibia who was actually on the podium during this meeting in Berlin, she was beyond delighted to hear about all what we were doing in that regard. And of course, we have to continue to do that effort. Of course, not on our own, but with our colleagues in Africa, as we just heard from Dr. Galle, whom we wish a very safe trip to Ghana and please enjoy as always.
So with this said, I thank you very much everybody for joining us and, of course, special thanks especially for my dear friends, Dr. Amit Singal and Dr. Peter Galle. Thank you.
Watch episode one in this series: Recent Advances in Systemic Therapy for Hepatocellular Carcinoma
Watch episode two in this series: Combination Treatment Approaches in Hepatocellular Carcinoma
Watch episode three in this series: The Role of TKIs in Hepatocellular Carcinoma
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