A New Center of Excellence Takes Aim at South Texas Liver Cancer Problem

Wednesday, December 7, 2016

The Texas Liver Tumor Center provides a one-stop location to serve patients with liver cancer and their families.

South Texas has some of the highest rates of liver cancer in the nation. In the San Antonio metro area, the incidence of liver cancer is 14 percent higher than the state average, and 60 percent higher than the United States as a whole. While the exact reasons for these higher rates are a mystery, hepatitis C and fatty liver disease — a complication of obesity and diabetes — are major causes.

To address this problem, the Texas Liver Tumor Center was created. The center is a partnership between University Health System, University Health San Antonio — the physician practice of The University of Texas Health Science Center — and the Texas Liver Institute.

It is a one-stop destination, located at the UT Health Science Center’s Cancer Therapy & Research Center, where patients with liver disease can get a diagnosis, treatment plan and expert care. With some of the top researchers in the field taking part, the new center will offer patients the earliest access to new and promising treatments.

But perhaps the most welcome and unusual element of the Texas Liver Tumor Center is that the entire prelude to treatment — often the most uncertain and frightening period for patients — takes place in a single day.

When patients arrive, they typically have blood drawn and undergo an MRI or CT scan. Both lab and imaging results are available to physicians that morning. The patient then meets with a variety of specialists, a registered dietician and a social worker. When the patient goes to lunch, the Tumor Board — made up of the various physician specialists (oncologists, hepatologists, liver surgeons and interventional radiologists)­­ — meets to discuss the best course of action. By the time the patient leaves for the day, a treatment plan is in place and given to the patient and family.

Fred Poordad, MD, Medical Director of the Texas Liver Tumor Center and Clinical Professor of Medicine at The University of Texas Health Science Center

“The Texas Liver Tumor Center is really unique,” says Fred Poordad, MD, hepatologist and Medical Director of the center. “It takes an experience that from a patient’s perspective might span weeks or even months and condenses it to one day. What I can’t stress enough is how amazed the patients are. By the time they leave, they’ve had an experience that’s really unparalleled.”

Dr. Poordad, Clinical Professor of Medicine at the Health Science Center, arrived in San Antonio in 2012 from Los Angeles, where he was chief of hepatology at Cedars-Sinai Medical Center and professor of medicine at University of California, Los Angeles. He joined with Eric Lawitz, MD, to launch the Texas Liver Institute, a center focused on liver diseases of all kinds, working in concert with the UT Health Science Center.

Dr. Poordad and Dr. Lawitz have led a series of global studies that brought a revolutionary new class of hepatitis C treatments to market in recent years. Those drugs have made more than 90 percent of hepatitis C infections curable for the first time.

“I’ve been doing research in this field since 1998,” Dr. Poordad says. “It’s been a great time — hepatitis research, liver cancer research, research in cirrhotic patients. Just recently, we have expanded a fatty liver research program because we realized that’s the next big wave in liver disease.”

Surgical Options

Francisco Cigarroa, MD, Director of the Pediatric Transplant Program at University Hospital and Professor of Surgery at The University of Texas Health Science Center San Antonio

Patients requiring surgery are in very good hands. University Transplant Center, a partnership between University Health System and the UT Health Science Center, is led by Glenn Halff, MD, a liver transplant surgeon. Dr. Halff launched the liver transplant program in 1992, and its patient and graft survival rates have been among the highest in the state.

Dr. Halff, along with Francisco Cigarroa, MD, performed the region’s first split-liver transplant in 1997. Dr. Cigarroa, a pediatric liver transplant surgeon, returned last year after a six-year stint as chancellor of The University of Texas System to rejoin University Transplant Center. He now heads both the Division of Liver Transplantation and the Division of Pediatric Transplantation.

But these highly skilled liver surgeons also perform liver tumor surgery and work in concert with a large team of specialists to offer the best therapy options for patients. And while liver cancer is rare in children, it does occur. Dr. Cigarroa and his colleagues have the experience to manage these young patients.

Glenn Halff, MD, Director of University Transplant Center and Professor of Surgery at The University of Texas Health Science Center San Antonio

“There are many facets of care of liver disease,” says Dr. Halff, Director of University Transplant Center and Professor of Surgery in the School of Medicine at the UT Health Science Center. “Our goal is to prevent people from getting sick enough to need a transplant. We now offer a comprehensive, holistic program. Liver cancers frequently benefit from a combination of treatments—interventional radiology, oncology, and surgery or transplant. All are available in one integrated program, along with hepatology to manage the underlying liver disease.”

If a transplant is required, the program is one of only two active living donor liver transplant programs in Texas. Livers are unique in their ability to regenerate in the body after being split, making such transplants possible.

The team also includes a group of interventional radiologists led by Jorge Lopera, MD, Professor of Radiology at the UT Health Science Center.

“They are unbelievable at what they do,” Dr. Poordad says. “They are able to offer therapies with minimal invasiveness that really change the lives of these patients. I’m very proud to be affiliated with a center that offers this type of care. This is something that is not offered at too many places.”

The Texas Liver Tumor Center team includes medical oncologists, hepatologists, radiation oncologists and interventional radiologists—along with a registered dietician, a social worker, and ancillary and support staff members experienced with liver disease.

A variety of specialists comprise the Tumor Board at the Texas Liver Tumor Center and meet to discusses each patient’s case and develop a treatment plan.

The entire team is committed to working closely with referring physicians, who are kept abreast of their patient’s treatment plan and progress. The center is working on technology to allow those referring physicians to join the Tumor Board discussion remotely if desired.

“They’ll be able to see their patients through therapy, keep track of everything,” Dr. Poordad says. “We’re always available for communication. Everyone on this team prides themselves on offering our cell phone numbers to other physicians.”

Equally, the program is designed to ease the fear and stress for families working through liver cancer.

“We have social services there to be a resource and help guide families,” Dr. Poordad says. “Many of these patients are going to have therapies—some of them very extensive. We need to think of this as an opportunity not just for that patient but for the entire family.”

Innovation And Research

As a collaborative program with strong components in academic medicine and research, the Texas Liver Tumor Center has connections to both basic and clinical research into liver cancer.

“We have several basic scientists working to discover how to treat these cancers and how to categorize them a little better,” Dr. Poordad says. “We’re also doing some epigenetic studies to understand why the Hispanic population gets these tumors at a higher prevalence. But we do offer clinical research and some very cutting-edge therapies for patients whose disease may have advanced to the point where conventional therapies are not the best options. And that’s very comforting for patients and their families to know.”

Dr. Poordad was lead author on a series of clinical studies that made international headlines in recent years by showing that a combination of drugs was incredibly effective against hepatitis C, including cases in people with advanced disease and scarring.

These drugs had fewer complications than interferon, a powerful drug that was the standard of care.

And while uncovering why the problem of liver cancer is so much worse in South Texas than in other places is important, it’s just as important to find the disease quickly and get treatment for those who are diagnosed, Dr. Poordad says.

“I think because there’s such a lack of depth of knowledge about liver diseases, many of the patients have been misinformed,” he continues. “They get here with some preconceived notion about what they’re going to go through. I think many of them are pleasantly surprised that we have therapies to offer, and that many times it’s not nearly the ordeal they thought it might be.”

For more information about the Texas Liver Tumor Center, please call 210-743-4306, or toll-free at 888-336-9633.