Medical oncologists with specific expertise in primary liver tumors (including hepatocellular carcinoma and cholangiocarcinoma) provide expertise regarding when and how to incorporate systemic therapy into treatment planning. Systemic therapy can include chemotherapy, targeted inhibitors blocking growth signals relevant to liver tumors, or immunotherapy treatments designed to stimulate the immune system to attack cancer cells.
Medical oncologists in CAMILOT work closely with our colleagues in surgery, interventional radiology, radiation oncology as well as other providers to develop a treatment plan for each patient evaluated in the Liver Tumor Clinic at UW Medical Center. Our medical oncologists specialize specifically in gastrointestinal medical oncology and have substantial expertise in treating patients with primary liver malignancies. By combining the joint resources and regional expertise of UW Medical Center, Fred Hutchinson Cancer Research Center, and the Seattle Cancer Care Alliance, we share the goal of helping patients develop an optimal treatment plan, providing access to promising clinical research options when applicable, and furthering medical science to improve outcomes both locally and globally for patients with liver cancer.
Meet our Team
William P. Harris, M.D.
Kaylyn Wong, M.D.Supriya Saha, M.D.
Treatment of patients with hepatobiliary tumors (including tumors arising within the liver and biliary systems such as hepatocellular carcinoma and cholangiocarcinoma) requires a broad understanding of the role of local interventions and systemic therapy. Our gastrointestinal oncologists have extensive experience in both state-of-the-art standard therapy and experimental approaches. Medical oncologists specialize in treatment with systemic therapeutics--agents given either in pill form or by intravenous administration--to treat cancer. This can be effective whether the cancer is confined to the liver or if it has spread to other regions of the body. Often, after discussion with our multidisciplinary liver team, systemic agents are reserved for later use if localized therapy is felt to provide the most benefit. In the case of more advanced disease, commonly accepted FDA-approved systemic therapy may often be the best choice. However, some patients with either a new diagnosis or disease resistant to standard therapy may be eligible for promising new approaches. For this reason, our Medical Oncology group is highly involved in a wide range of clinical trials for treatment of patients with hepatobiliary cancers and tumors involving the liver.
General Areas of Clinical Investigation
Our center is one of the most active clinical trial sites in the United States for patients with liver tumors. This allows us to open a broad range of trials for various diseases and circumstances. Given our experience with clinical trials and our high patient volume; our medical oncologists are able to select the most promising and exciting trials for our patients. While not all patients are eligible for such studies, those who are will be offered the option to participate.
Clinical trials involve the investigation of experimental treatments (or combining two standard interventions) in hopes of improving outcomes for our patients. Such trials vary dramatically in terms of who is eligible for enrollment. To enter a clinical trial, patients must meet stringent criteria often relating to extent of tumor involvement, degree of liver dysfunction, and other medical problems to ensure safe conduct of the trial. Typically, patients with severe liver dysfunction are unfortunately not eligible for clinical trials due to safety concerns. Patients are typically assessed for candidacy as part of the multidisciplinary assessment and if such trials are felt to apply, our team will discuss these among the possible treatment options. Clinical trials often change given the rapid pace of medical advances. For this purpose, please see the link in our Clinical Trials/Research section to view current liver tumor clinical trials.
Combination Trials of Local and Systemic Therapy
Many of our trials focus upon investigating whether a combination of local and systemic therapy may improve upon our current standard of care. For example, in hepatocellular carcinoma, we are investigating whether standard oral chemotherapy can be combined with either radioembolization or external beam radiation to provide optimal control of the dominant liver tumor and any disease that has escaped into the bloodstream or distant sites of disease. Similarly, we are investigating the role of drugs that stimulate the immune system, and are investigating whether combinations with local interventions can be safely used to improve outcomes.
Recent advances in medical science have demonstrated the power of harnessing the immune system to combat cancer. Some immunotherapy drugs have already been FDA approved for other cancers such as lung cancer and melanoma, but require further investigation in primary liver cancers. While the role of drugs that “turn on” the immune system against cancer is not fully understood in hepatobiliary tumors to date, this approach is both rational and promising based upon early observations. Immunotherapy is being studied predominantly in advanced hepatocellular carcinoma although occasionally trials are available for patients with cholangiocarcinoma.
Just as the term "liver cancer" refers to a variety of different tumor types, even among specific tumors, significant variability exists in the genetics of an individual tumor. Certain tumors may harbor a mutation that can be targeted with a more selective drug. This approach is often referred to as "personalized medicine." If a mutation is detected in a tumor for which the medical oncology community has a promising targeted drug, this is referred to as an "actionable mutation." Certain tumor types harbor actionable mutations more frequently than others. For example, cholangiocarcinoma that arises within the liver may harbor a specific mutation leading to overactive signaling leading to more rapid tumor growth. Due to our active clinical trial program and the large number of patients we treat at our center, our hepatobiliary team actively seeks out trials for patients with specific mutational profiles to retain promising options for our patients.
See a list of
clinical trials related to liver tumors here.
Patient and Family Resources