Pre-Op Treatment May Be Advance Against Deadly Liver Cancers

Jeffrey Foster heard a similar message loud and clear when he was first diagnosed by another doctor with hepatocellular carcinoma — the most common type of liver cancer — back in 2020.

At the time, the 68-year-old retired vet was told by his surgeon that "cutting out the mass then found on my liver doesn't mean the cancer wouldn't come back."

But at the same time, "the surgeon also told me about Dr. Marron and his immunotherapy trial," Foster recalled.

Marron, an associate professor of medicine, hematology and medical oncology at the Icahn School of Medicine at Mount Sinai in New York City, had begun to research whether immunotherapy could boost survival in those with less advanced liver cancer.

"Immunotherapy is a bit of an umbrella term for many different types of medicine that help the immune system do its job and attack cancer," Marron noted. "For liver cancer — and many other types of cancer — immunotherapies are now the mainstay of treatment for people with advanced disease, meaning for patients in whom surgery is not a potential cure."

Marron's idea was to start offering immunotherapy infusions to patients like Foster who have less advanced disease before they go under the knife.

The goal was "to help kill the tumor that we see," explained Marron, "as well as teach the immune system to recognize and kill any residual tumor cells that remain hidden after surgery that will [otherwise] eventually grow into new tumors."

Foster was told he would be "a good candidate" for the study's eight-session immunotherapy program, involving a medication called "neoadjuvant cemiplimab."

Immunotherapy before surgery a powerful strategy

"Dr. Marron explained they would do two infusion therapies before my surgery, three weeks apart," Foster said. "And then after the surgery there would be six more, also three weeks apart. So, a total of eight."

But the Long Island native hesitated at first, worried about the two-hour home-to-hospital commute each way and the long treatment slog.

"Each infusion takes about a couple of hours of time actually in the hospital at the infusion center," Foster added. "Because they have to do blood work, taking probably eight vials of my blood every time. And I have to wait for the drug to be mixed on the spot. And then the therapy itself was about a half hour of the infusion. And then I had to wait an hour afterwards to make sure I was OK."

In the end, a friend of Foster's — a neonatal nurse familiar with medical lingo and hospital protocols — asked him a simple question: "If the hospital was around the corner from your home, would you do it?"

The answer was yes. So, Foster began immunotherapy treatment, followed by surgery. By May 2021, all eight infusions were under his belt.

"They really monitored me very closely, and I only had two side effects," he noted. "A rash on my back and arms, which was very itchy, but which they told me about prior to doing it. And I lost some appetite a little bit. I probably lost about 20 pounds, and I'm a thin person."