Dr. Antonio D’Alessio wins ASCO award for promising study results on immunotherapy use in hepatocellular carcinoma

The American Society of Medical Oncology (ASCO) has awarded Antonio D’Alessio, resident in Medical Oncology at Humanitas University, for his promising results on the use of immunotherapy administered in the early stages of liver cancer. Thanks to this award, Dr D’Alessio will have the opportunity to present his work at the annual ASCO Congress, the world’s most renowned oncology congress, held in Chicago between 3rd and 7th June 2022.

Dr. D’Alessio, supervised by oncologist and researcher Dr. David James Pinato, is currently focusing his studies on the use of immunotherapy for treating liver cancer at Imperial College London, thanks to a scholarship from the European Association for the Study of the Liver. Antonio’s mentor, Professor Lorenza Rimassa    director of the Residency School in Medical Oncology at Humanitas University and renowned international expert on liver cancer, guided him in his decision to study liver cancer further.

“The innovation of my project – explains Antonio D’Alessio – lies in the attempt to use immunotherapy in the early stages of liver cancer, particularly in hepatocellular carcinoma. Currently, it is only administered to patients with metastatic or very advanced liver cancer. Instead, when a tumour is detected at an early stage, doctors perform surgery to remove it. Surgery is a radical and potentially curative treatment, but unfortunately, the risk of recurrence affects up to 70% of patients. The aim of my research project is to administer immunotherapy before surgery, thereby hopefully reducing both the tumour mass that will be surgically removed and the percentage of patients who relapse.”

Unlike traditional chemotherapy, which relies on the use of ‘toxic’ substances which kill cells and can cause widespread adverse effects, the immunotherapy treatment stimulates the immune system so that it can react and fight the tumour. In our immunotherapy protocol,” continues D’Alessio, “we administer two intravenous antibody treatments three weeks apart, after which the patient undergoes surgery. This protocol is well tolerated and not hard on the patient at all, either in terms of timing or in terms of side effects, and it allows us not to significantly delay surgery, while keeping the tumour under control. Twenty or so patients, mostly males, an average age of 65, have taken part in the protocol so far and the results obtained are very promising. Following just two injections of immunotherapy, the tumour has not progressed in any patient, indicating the excellent ability of immunotherapy to control it at an early stage. Moreover, in a good percentage of cases, the tumour shrinks, so that surgery is less invasive and more conservative. In other cases, the tumour disappears completely. Surgery is still planned nevertheless, as it is the standard treatment for early stage liver cancer.

Liver cancer can occur because of alcohol consumption, viral hepatitis, or metabolic conditions such as being overweight, obesity or diabetes.

“Tumours with a viral origin, explains Antonio D’Alessio, have shown to respond better to immunotherapy. These data, however, only exist with regard to the advanced metastatic disease, for which large-scale immunotherapy is currently used. To understand which patients with hepatocellular carcinoma might benefit the most from immunotherapy, we are looking for biomarkers that can predict the response to immunotherapy in various biological samples such as tumour, blood, urine and faeces, analysed before and after antibody administration. Among the various factors we are studying, there is the gut microbiota, which in some cases may be linked to a better response to immunotherapy.

Using immunotherapy in the treatment of liver cancer is a revolution. For years, there have been almost no therapies. Recently, however, there has been a boom in immunotherapy treatments for advanced or metastatic liver cancer, which have significantly increased the survival rate of patients. “Our next challenge at Imperial College London,” concludes Antonio D’Alessio, “is to use immunotherapy at an early stage too, with a multidisciplinary approach in collaboration with surgeons and radiologists. As we have already seen in the preliminary phase, this reduces the tumour diameter, potentially decreasing the number of recurrences and, thanks to translational analyses, it could lead to the identification of biomarkers that will establish in advance which patients will respond better to immunotherapy”.