Immunotherapy before surgery killed off liver tumors in one-third of patients, study finds

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Liver tumors died off in a third of patients enrolled in a study who received immunotherapy treatment before surgery, according to Mount Sinai researchers in New York City. The study was recently published in The Lancet Gastroenterology & Hepatology.

Liver cancer is one of the deadliest and most common cancers, the study’s senior author and associate professor of medicine (hematology and medical oncology) at the Icahn School of Medicine at Mount Sinai, Dr. Thomas Marron, told Fox News in an interview.  

A doctor shows the shape of a liver to a patient. (iStock)

"While we can cure it sometimes with surgery, unfortunately it often comes back—more often than most other cancers—and so one of the main reasons we did this trial was to find a way to decrease the likelihood the cancer will come back," Marron, who is also the director of the Early Phase Trials Unit at The Tisch Cancer Institute and holds a Ph.D. in Immunology, said in a release discussing the recent report.

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The researchers of the phase 2 trial found that immunotherapy given before surgery, known as neoadjuvant immunotherapy, may kill not only the tumor but also microscopic cancer cells that surgery may miss, according to the report. If missed, the cancer cells could cause cancer to metastasize or reoccur, Marron told Fox News and explained the immunotherapy treatment helped boost the immune system’s ability to fight off cancer recurrences.  

The Mount Sinai researchers administered two rounds of the immunotherapy agent, cemiplimab, to 21 early-stage liver cancer patients three weeks prior to surgery. Marron told Fox News that cemiplimab is an anti–PD-1 antibody that targets the tumor’s defense system. 

The medical oncologist explained that the tumor has a protein, called PDL1, that acts like a "stop sign" to the individual’s immune system, protecting the tumor from being attacked by the body’s immune cells. The cemiplimab breaks through the stop sign to attack the cancer, Marron said. He explained that cancer has different "stop signs" in different patients. 

3D illustration of human body organs with liver in red (iStock)

The researchers biopsied the tumor tissue before the immunotherapy treatment and after it was removed through surgery.  The physicians performed magnetic resonance imaging and blood, stool and tumor samples to study tumor death to see how the immune system was activated against the tumor.   

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Morran told Fox this was a unique opportunity to allow the researchers to see how the drug worked on the tumor in different patients and which patients benefited from the treatment and which did not. Marron said the overall goal of the researchers was to identify ways to decrease the likelihood the cancer would come back, and to identify biomarkers, or specific tests, to see which patients would benefit from this approach versus a different treatment regimen.    

"That is the goal, though there are many causes of liver cancer, and everyone’s cancer and everyone’s immune system is unique, so this therapy won’t work for everyone," Marron told Fox News.  

Marron added the various approaches could include a combination type of drug immunotherapy or immunotherapy with radiation, which are currently part of further clinical trials. 

According to the release, hepatocellular carcinoma (HCC) is the third-leading cause of cancer-related deaths worldwide. The researchers noted in the release that liver cancer surgery often appears successful, but in more than half of patients, the researchers stated the cancer comes back, due to either residual micrometastatic disease or in some cases an entirely new tumor. The study authors said this highlights the potential benefit of neoadjuvant therapy to improve survival rates.  

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In the study's release, Marron said, "Typically when cancer recurs it is no longer a curable disease. Larger trials in the future will aid in defining the utility, safety, and survival of neoadjuvant immunotherapy, specifically this type of PD-1 blockade."