Tments to Target Speciﬁ C Intracellular Mechanisms of the Liver Cancer

CLINICAL TRIALS Clinical trials are available for patients with advanced or intermediate stage disease, using new ablation treatment, new targeted agents, and combinations of treatments to target specifi c intracellular mechanisms of the liver cancer. Yale Cancer Center emphasizes the importance of clinical trials and continually strives to provide our patients with the most current therapies. In close collaboration with basic scientists, clinical research is focused on developing innovative appointments strategies to help eliminate, control, and palliate tumors in patients. We perform state-of-the-art genomic profi ling and laboratory explorations to determine the biologic weaknesses of the tumors and to develop better therapies. Many of these drugs are exploring new types of therapy and new combinations of therapies and many of our studies are available at our network of Care Centers. HOW TO MAKE AN APPOINTMENT For more information or to schedule an appointment with a member of the Liver Cancer Program, please contact 203-200-5487 (LIVR). Our goal is to ensure that each patient has an outstanding and positive cancer care experience. When you call, a patient intake coordinator will help to arrange your appointments so that you will see all of the specialists needed during an initial visit. We provide both in person and telehealth visits, although we recommend that the fi rst visit be in person, and at the main campus, as this will enable a better assessment of your overall conditions. We also work in close coordination with our Smilow Cancer Hospital Care Centers and we have hepatology clinics in Westport, Westerly, New Haven, North Haven, Bridgeport, and Danbury, where follow-up can be arranged.

Gary For Gary’s story: m.yale.edu/gary-story Gary I am delighted with the results and most impressed with the expertise For Gary’s story: and caring manner of the entire team. Every doctor, every nurse at m.yale.edu/gary-story p: 203-200-5487 | yalecancercenter.org | smilowcancer.org Smilow is so attentive, so amazing. They do everything they can to Marissa make you comfortable and are always there to answer your questions. For Marissa’s story: – Gary m.yale.edu/marissa-story Liver Cancer Program © 2021 Yale Cancer Center AT SMILOW CANCER HOSPITAL CLINICAL TRIALS Clinical trials are available for patients with advanced or intermediate stage disease, using new ablation treatment, new targeted agents, and combinations of treatments to target specifi c intracellular mechanisms of the liver cancer. Yale Cancer Center emphasizes the importance of clinical trials and continually strives to provide our patients with the most current therapies. In close collaboration with basic scientists, clinical research is focused on developing innovative appointments strategies to help eliminate, control, and palliate tumors in patients. We perform state-of-the-art genomic profi ling and laboratory explorations to determine the biologic weaknesses of the tumors and to develop better therapies. Many of these drugs are exploring new types of therapy and new combinations of therapies and many of our studies are available at our network of Care Centers. HOW TO MAKE AN APPOINTMENT For more information or to schedule an appointment with a member of the Liver Cancer Program, please contact 203-200-5487 (LIVR). Our goal is to ensure that each patient has an outstanding and positive cancer care experience. When you call, a patient intake coordinator will help to arrange your appointments so that you will see all of the specialists needed during an initial visit. We provide both in person and telehealth visits, although we recommend that the fi rst visit be in person, and at the main campus, as this will enable a better assessment of your overall conditions. We also work in close coordination with our Smilow Cancer Hospital Care Centers and we have hepatology clinics in Westport, Westerly, New Haven, North Haven, Bridgeport, and Danbury, where follow-up can be arranged.

he Liver Cancer Program at Smilow Cancer Hospital off ers an entire spectrum of therapies for primary liver cancers, also known as hepatocellular carcinoma (HCC) and HEPATOLOGY INTERVENTIONAL RADIOLOGY RADIATION ONCOLOGY intrahepatic cholangiocarcinoma (iCCA). Our team is dedicated to diagnosing liver cancer early, T The fi rst team you will meet after being referred to the program will likely be our dedicated hepatologists. The Interventional Radiology Program at Smilow Cancer Hospital provides additional treatment options for Radiation may be necessary for tumors that cannot be removed by surgery or liver cancer that has when treatment is optimal, and to applying the best treatment options for our patients, as well as Liver cancer is almost always associated with chronic liver diseases of variable severity and with personalized care of patients with liver cancer that cannot be surgically resected. Many patients with liver spread to other areas in the body. Patients who are cared for through the Liver Cancer Program at to discovering new, more eff ective treatments. a number of risk factors that must be addressed to block the progression of liver disease and to cancer can in fact benefi t from a more liver directed treatment approach. Interventional Radiology provides Smilow Cancer Hospital and need radiation oncology can feel confi dent that they are receiving the prevent the recurrence of the cancer. Our ability to apply curative treatments depends strictly on the defi nitive or palliative treatment using targeted, minimally invasive procedures performed under precision highest quality care from the most experienced team of radiation oncologists in Connecticut. Some function of the liver before and during the treatment. Hepatologists will assess liver function, address image-guidance. Loco-regional treatment is also the main modality to downstage liver cancer in patients listed of our available techniques include stereotactic body radiotherapy (SBRT) which is a non-invasive The incidence of liver and bile duct cancer is growing, and about 42,000 new cases are risk factors, and evaluate based on general condition, stage of the tumor and prognostic indexes if for transplant. These are some of the treatments performed, but the options available are more extensive: technique used to provide extremely high doses of radiation with a high level of accuracy, resulting in diagnosed each year in the United States. While the incidence is rising, new surgical, the patient is a potential candidate for liver transplant, and prepare the tumor board discussion. After less radiation delivered to surrounding tissue and fewer side eff ects. Transarterial chemoembolization (TACE): delivers chemotherapy through a catheter directly to treatment, our team of hepatologists will provide continued care to manage the underlying liver disease, interventional, and medical treatments are being added to our therapeutic armamentarium and • the tumor and is the most widely used primary treatment for HCC not amenable to curative preserve liver function, and monitor for possible recurrence of cancer. Hepatologists also work with PATHOLOGY are available to our patients. For some patients, these treatments can cure their disease, while treatment by excision or ablation. surgeons, interventionalists, and medical oncologists to manage liver function during the treatments. All Liver pathologists are an integral part of our team and of the liver tumor board and often help with for others, liver transplantation may be the solution. After treatment, our team of hepatologists hepatologists working in the Liver Cancer Program are certifi ed transplant hepatologists. If the patient is Ablation Therapy: is used when tumor excision, either by transplant or resection, is not feasible diffi cult and unusual cases. We are fortunate to have liver pathologists with experience in all kinds of • or advisable. Ablation can be performed percutaneously or, if necessary, through minimally provides continued care to manage the underlying liver disease, preserve liver function, monitor deemed a potential candidate for liver transplant, a dedicated team of transplant hepatologists will work common and rare liver diseases. Furthermore, the Department of Pathology off ers in depth analysis invasive or open surgery. Ablation may be particularly useful for patients with early-stage HCC for possible recurrence of cancer and re-treat, if necessary, while our medical oncologists apply with the patient and the family. that is centrally located in the liver and cannot be surgically removed without excessive sacrifi ce of the tumor, including genotyping. In patients with iCCA, genotyping is essential to guide novel medical treatments. systemic cancer treatment for those in need, as well as access to innovative medications through of functional parenchyma. SURGICAL ONCOLOGY AND TRANSPLANT SURGERY IRE (irreversible electroporation): a state-of-the-art minimally invasive cancer treatment that clinical trials. Treatment options for liver cancer can often be complex due to underlying liver function, extent, and DIAGNOSTIC RADIOLOGY • applies a high voltage of electrical pulses to induce precision targeted cancer death, while location of the tumor, and the overall health of the patient. Surgery often provides the best survival Liver imaging is a major component of our diagnostic armamentarium and requires specialized minimizing surrounding tissue damage in the liver. To achieve this outstanding level of care, the Liver Cancer Program at Smilow Cancer Hospital outcomes through resection (removal of the tumor) or liver transplantation and should only be done technology and a team of radiologists with skills in reading liver imaging. Most of the time liver cancer by skilled and experienced surgeons such as those in our Program. Our surgical teams provide Radioembolization (Y90): a minimally invasive procedure that combines embolization and diagnosis and staging is made based on dedicated dynamic imaging. Expert reading of the liver has assembled a dedicated group of specialists, including hepatologists, hepatobiliary • unparalleled clinical experience and specialty focus on liver cancer surgery. The technical approach radiation therapy. Tiny glass or resin beads fi lled with the radioactive isotope yttrium Y-90 are scan provides important ancillary information including liver volume, architecture, presence of portal placed inside the blood vessels that feed a tumor. and transplant surgeons, diagnostic and interventional radiologists, pathologists, medical is tailored to each individual patient. Our teams off er the entire spectrum of surgical care including hypertension, collateral/shunts, and ascites. Liver imaging can also detect liver steatosis, accumulation oncologists, and nurses. The team meets weekly at a NCI-designated Tumor Board to discuss complex, multisegment liver resection, and minimally-invasive surgical approaches such as robotic liver • Portal Vein Embolization (PVE): a technique that is performed before a liver resection to increase of iron, etc. For this reason, for all imaging performed at another institution, we require a second each patient’s diagnosis and reaches a consensus on the best personalized treatment plan. Our resection and laparoscopic ablation. Our surgeons frequently work in tandem with our interventional the size of liver segments that will remain after surgery. interpretation by our radiologists, that are also the main actors during our weekly tumor boards. For radiologists and hepatologists to optimize liver function before surgery, making surgery safer and selected cases, contrast-enhanced liver ultrasound is also available. guiding principle is to personalize and adapt care to the changing needs of the patient. recovery easier. MEDICAL ONCOLOGY Our medical oncology team provides experience and knowledge of innovative treatment options and SUPPORTIVE CARE It was a long journey, full of obstacles and setbacks. I always tell people For patients diagnosed with early stage disease, whose tumor cannot be removed with surgery investigational therapies. Chemotherapy is rarely used in the treatment of primary liver cancer, however Smilow Cancer Hospital places great emphasis on taking care of all our patients’ needs with the best that I was treated at the best hospital, with the best doctors. either because of the location of the tumors or because the liver has too much disease, liver there are now several options for targeted biologic therapies (a special type of oncologic therapy that medical care available and a network of supportive care services. Advanced practice nurses with They never gave up on me, and I am so thankful that they kept believing transplantation can provide defi nitive cure for both the cancer and the advanced liver disease that targets the changes in cancer cells that help them grow, divide, and spread) and for immunotherapy (a dedicated knowledge and skills related to the treatment of liver cancer are available to care for patients my life was worth saving. frequently accompanies liver cancer. Our transplant surgeons perform both cadaveric and living donor treatment that helps the body use its own immune system to fi nd and destroy cancer cells). Clinical trials throughout the continuum of their illness. Patients and their families are also provided with access – Marissa related transplants. Once the patient is actively listed, our transplant hepatology team will provide investigating immunotherapy combinations, and molecular targeted therapies are also available. to social workers to ensure psychosocial support during their treatment. Other available resources comprehensive pre-transplant care while the Liver Cancer Program will apply all available treatments to for our patients and/or families include nutritional counseling, physical therapy, art therapy, and control the progression of the tumor during the waiting time in the transplant list. pastoral support. he Liver Cancer Program at Smilow Cancer Hospital off ers an entire spectrum of therapies for primary liver cancers, also known as hepatocellular carcinoma (HCC) and HEPATOLOGY INTERVENTIONAL ONCOLOGY RADIATION ONCOLOGY intrahepatic cholangiocarcinoma (iCCA). Our team is dedicated to diagnosing liver cancer early, T The fi rst team you will meet after being referred to the program will likely be our dedicated hepatologists. The Interventional Oncology Program at Smilow Cancer Hospital provides additional treatment options for Radiation may be necessary for tumors that cannot be removed by surgery or liver cancer that has when treatment is optimal, and to applying the best treatment options for our patients, as well as Liver cancer is almost always associated with chronic liver diseases of variable severity and with personalized care of patients with liver cancer that cannot be surgically resected. Many patients with liver spread to other areas in the body. Patients who are cared for through the Liver Cancer Program at to discovering new, more eff ective treatments. a number of risk factors that must be addressed to block the progression of liver disease and to cancer can in fact benefit from a liver directed treatment approach. Interventional Oncology provides definitive Smilow Cancer Hospital and need radiation oncology can feel confi dent that they are receiving the prevent the recurrence of the cancer. Our ability to apply curative treatments depends strictly on the or palliative treatment using targeted, minimally invasive procedures performed under precision image- highest quality care from the most experienced team of radiation oncologists in Connecticut. Some function of the liver before and during the treatment. Hepatologists will assess liver function, address guidance. Loco-regional treatment is also the main modality to downstage liver cancer in patients listed for of our available techniques include stereotactic body radiotherapy (SBRT) which is a non-invasive The incidence of liver and bile duct cancer is growing, and about 42,000 new cases are risk factors, and evaluate based on general condition, stage of the tumor and prognostic indexes if transplant. These are some of the treatments performed, but the options available are more extensive: technique used to provide extremely high doses of radiation with a high level of accuracy, resulting in diagnosed each year in the United States. While the incidence is rising, new surgical, the patient is a potential candidate for liver transplant, and prepare the tumor board discussion. After less radiation delivered to surrounding tissue and fewer side eff ects. interventional, and medical treatments are being added to our therapeutic armamentarium and treatment, our team of hepatologists will provide continued care to manage the underlying liver disease, Transarterial chemoembolization (TACE): delivers combined chemotherapy with embolization preserve liver function, and monitor for possible recurrence of cancer. Hepatologists also work with PATHOLOGY are available to our patients. For some patients, these treatments can cure their disease, while • through a catheter directly to the tumor and is the most widely used primary treatment for HCC surgeons, interventionalists, and medical oncologists to manage liver function during the treatments. All Liver pathologists are an integral part of our team and of the liver tumor board and often help with for others, liver transplantation may be the solution. After treatment, our team of hepatologists not amenable to curative treatment by excision or ablation. hepatologists working in the Liver Cancer Program are certifi ed transplant hepatologists. If the patient is diffi cult and unusual cases. We are fortunate to have liver pathologists with experience in all kinds of Ablation Therapy: is used when tumor excision, either by transplant or resection, is not feasible provides continued care to manage the underlying liver disease, preserve liver function, monitor deemed a potential candidate for liver transplant, a dedicated team of transplant hepatologists will work common and rare liver diseases. Furthermore, the Department of Pathology off ers in depth analysis • or advisable. Ablation can be performed percutaneously or, if necessary, through minimally with the patient and the family. of the tumor, including genotyping. In patients with iCCA, genotyping is essential to guide novel for possible recurrence of cancer and re-treat, if necessary, while our medical oncologists apply invasive or open surgery. Ablation may be particularly useful for patients with early-stage HCC medical treatments. systemic cancer treatment for those in need, as well as access to innovative medications through that is centrally located in the liver and cannot be surgically removed without excessive sacrifice SURGICAL ONCOLOGY AND TRANSPLANT SURGERY of functional parenchyma. clinical trials. Treatment options for liver cancer can often be complex due to underlying liver function, extent, and DIAGNOSTIC RADIOLOGY IRE (irreversible electroporation): a state-of-the-art minimally invasive cancer treatment that location of the tumor, and the overall health of the patient. Surgery often provides the best survival Liver imaging is a major component of our diagnostic armamentarium and requires specialized • applies a high voltage of electrical pulses to induce precision targeted cancer death, while To achieve this outstanding level of care, the Liver Cancer Program at Smilow Cancer Hospital outcomes through resection (removal of the tumor) or liver transplantation and should only be done minimizing surrounding tissue damage in the liver. technology and a team of radiologists with skills in reading liver imaging. Most of the time liver cancer by skilled and experienced surgeons such as those in our Program. Our surgical teams provide diagnosis and staging is made based on dedicated dynamic imaging. Expert reading of the liver has assembled a dedicated group of specialists, including hepatologists, hepatobiliary unparalleled clinical experience and specialty focus on liver cancer surgery. The technical approach Radioembolization (Y90): a minimally invasive procedure that combines embolization and scan provides important ancillary information including liver volume, architecture, presence of portal • radiation therapy. Tiny glass or resin beads filled with the radioactive isotope yttrium Y-90 are and transplant surgeons, diagnostic and interventional radiologists, pathologists, medical is tailored to each individual patient. Our teams off er the entire spectrum of surgical care including hypertension, collateral/shunts, and ascites. Liver imaging can also detect liver steatosis, accumulation placed inside the blood vessels that feed a tumor. oncologists, and nurses. The team meets weekly at a NCI-designated Tumor Board to discuss complex, multisegment liver resection, and minimally-invasive surgical approaches such as robotic liver of iron, etc. For this reason, for all imaging performed at another institution, we require a second each patient’s diagnosis and reaches a consensus on the best personalized treatment plan. Our resection and laparoscopic ablation. Our surgeons frequently work in tandem with our interventional • Portal Vein Embolization (PVE): a liver regeneration technique that is performed before a liver interpretation by our radiologists, that are also the main actors during our weekly tumor boards. For radiologists and hepatologists to optimize liver function before surgery, making surgery safer and resection to increase the size of the segment that will remain after surgery. selected cases, contrast-enhanced liver ultrasound is also available. guiding principle is to personalize and adapt care to the changing needs of the patient. recovery easier. MEDICAL ONCOLOGY SUPPORTIVE CARE It was a long journey, full of obstacles and setbacks. I always tell people For patients diagnosed with early stage disease, whose tumor cannot be removed with surgery Our medical oncology team provides experience and knowledge of innovative treatment options and Smilow Cancer Hospital places great emphasis on taking care of all our patients’ needs with the best that I was treated at the best hospital, with the best doctors. either because of the location of the tumors or because the liver has too much disease, liver investigational therapies. Chemotherapy is rarely used in the treatment of primary liver cancer, however medical care available and a network of supportive care services. Advanced practice nurses with They never gave up on me, and I am so thankful that they kept believing transplantation can provide defi nitive cure for both the cancer and the advanced liver disease that there are now several options for targeted biologic therapies (a special type of oncologic therapy that dedicated knowledge and skills related to the treatment of liver cancer are available to care for patients my life was worth saving. frequently accompanies liver cancer. Our transplant surgeons perform both cadaveric and living donor targets the changes in cancer cells that help them grow, divide, and spread) and for immunotherapy (a throughout the continuum of their illness. Patients and their families are also provided with access – Marissa related transplants. Once the patient is actively listed, our transplant hepatology team will provide treatment that helps the body use its own immune system to fi nd and destroy cancer cells). Clinical trials to social workers to ensure psychosocial support during their treatment. Other available resources comprehensive pre-transplant care while the Liver Cancer Program will apply all available treatments to investigating immunotherapy combinations, and molecular targeted therapies are also available. for our patients and/or families include nutritional counseling, physical therapy, art therapy, and control the progression of the tumor during the waiting time in the transplant list. pastoral support.