Dr. Tom London – Hepatitis B and Liver Cancer

StephenW

Hep B Talk is pleased to introduce Guest Blogger W.Thomas London, MD. Dr. London is internationally renowned for his many decades of work on hepatitis B and liver cancer, which started with his joining the research team  that discovered the hepatitis B virus. Dr. London has been at the forefront of liver cancer prevention and has written extensively about hepatitis B from the perspective of an epidemiologist, a clinician and a virologist. As founder and director of the Liver Cancer Disease Prevention Division at Fox Chase Cancer Center in Philadelphia, PA, he  developed one of the first successful community-based strategies to help people reduce their cancer risk through the early detection of chronic HBV infection. Dr. London has received the Distinguished Interdisciplinary Research Award  from the American Cancer Society and the Distinguished Scientist Award from the Hepatitis B Foundation where he currently serves as Vice-Chair of the Board and as the Senior Medical Advisor.
Liver cancer, hepatocellular carcinoma (HCC), is the 3rd most common cause of death in the world.  Little attention was paid to HCC in the United States until recently because it was thought to be rare, but now it is one of the few cancer types that is rising in incidence (number of new cases per year). It is now the most rapidly cancer in men in the US. The prognosis of HCC is poor; one year survival in the United States from the time of diagnosis is only 50%.  Detection of tumors when they are very small, less than 2 cm in diameter, and can be removed surgically is the best chance for cure.  Liver transplantation is often done if there is more than 1 tumor and the cancers are less than 3 cm in diameter.  Unfortunately, most HCCs are diagnosed when they are too large for successful surgical resection or transplantation.
Chemotherapy for HCC has been disappointing. Recently, the drug, Sorafenib (Nexavar), has been shown to be active against HCC, but it only extended survival time by a few months.  Thousands of drugs have been developed by the pharmaceutical industry for a great variety of conditions.  Of these, 983 have approved by the FDA.  That is they were tested in clinical trials, found to be safe and were beneficial for the purposes that they were approved
Scientists at the Hepatitis B Foundation and elsewhere have raised the question, are there drugs on the currently approved FDA list that are used for other purposes that might have a role in the treatment or prevention of HCC?  Recent publications suggest 2 candidates.  One is metformin (Glucophage), which is derived from the French lilac, and has been used in Europe since 1958 to treat Type 2 diabetes and in the United States since 1995. The other is propranalol, which is used to treat patients with cirrhosis who have varicose veins in the lower end of their esophagus (esophageal varices).
Diabetes is a recognized risk factor for HCC, particularly in persons who are obese and have a fatty liver. (Diabetics are also at increased risk of acquiring hepatitis B). Because patients with diabetes are often treated with metformin, investigators in China and France have looked at whether treatment with metformin lowers the risk of developing HCC.  By examining the records of diabetic patients who were treated with metformin or not, they observed that the risk of HCC was lower in the treated patients.  Furthermore, an experimental study of liver cancer in mice showed that metformin reduced the number and size of liver tumors.
Propranolol is used to lower the pressure in the portal vein and thereby in esophageal varices.  A group of physicians in France looked at the occurrence of HCC in patients with hepatitis C and esophageal varices who received propranolol treatment and those who did not.  There was about a 75% reduction in the incidence of HCCs in the propranolol treated patients.  Propranolol blocks receptors for epinephrine (adrenalin) and nor-epinephrine on cells in the body.  Such receptors are particularly rich on the surface of tumor cells, including HCCs. Experimentally propranolol has been effective in reducing the size and number of  several different kinds of tumors.
The studies that have been done so far are intriguing, but they are not conclusive.  Neither drug has been studied in a clinical trial to either treat established HCCs or to prevent HCC from occurring in the first place.  Such studies are in the planning stages.  Keep watching for progress on this front.

StephenW

乙肝讲座高兴地介绍客户的Blogger W.Thomas伦敦，MD。伦敦博士是国际知名的为B型肝炎和肝癌，他参加的研究小组发现乙肝病毒开始工作了几十年。博士，伦敦一直在预防肝癌的最前沿，并撰写了有关B型肝炎的广泛，从一名流行病学家，临床医生和病毒学家的角度。作为肝癌疾病预防科在宾夕法尼亚州费城福克斯蔡斯癌症中心的创始人和董事，他开发了第一个成功的以社区为基础的战略，以帮助人们减少他们患癌症的风险，通过​​对慢性乙肝病毒感染的早期检测。伦敦博士已收到来自美国癌症学会和从他目前担任董事会副主席和高级医学顾问服务的B型肝炎基金会杰出科学家奖，杰出的跨学科研究奖。

肝癌，肝细胞癌（HCC），是世界第三个最常见的死亡原因。很少注意支付给在美国的肝癌，直到最近，因为它被认为是罕见的，但现在它是一个对一些类型的癌症发病率上升（每年新发病例数）。这是现在在美国男性中最迅速的癌症。肝癌的预后较差，在美国每年诊断的生存时间只有50％。检测肿瘤时，他们都非常小，直径小于2厘米，可以手术切除是治愈的最佳机会。如果有超过1肿瘤和癌症是直径小于3厘米，往往是做肝移植。不幸的是，大多数肝癌诊断时，他们是成功的手术切除或移植太大。

肝癌化疗一直令人失望。最近，药物，索拉非尼（多吉美），已证明是对肝癌的活跃，但它只能延长几个月的存活时间。数以千计的药物已开发制药行业，一个伟大的各种条件。其中，983已被FDA批准。这是他们在临床试验中测试，发现是安全的和有益的，他们被批准的用途

在B型肝炎基金会和其他地方的科学家们提出的问题，是否有药物是用来作其他用途，可能有治疗或预防肝癌的作用，目前已获得批准的FDA的名单上吗？最近的出版物表明2名候选人。一个是二甲双胍（格华止），它是由法国丁香派生，并自1958年以来，在欧洲已被用于治疗2型糖尿病，自1995年以来在美国。其他propranalol，这是用来治疗肝硬化的患者，他们有他们的食道下端（食管静脉曲张）静脉曲张。

糖尿病是一种公认​​的危险因素，肝癌，特别是在谁是肥胖和脂肪肝的人。 （糖尿病患者也获得B型肝炎的风险增加）。由于糖尿病患者往往与二甲双胍治疗，在中国和法国的研究人员都看着与二甲双胍治疗是否降低肝癌的风险。通过检查记录或与二甲双胍治疗的糖尿病患者，他们观察治疗的患者中，肝癌的风险是较低的。此外，小鼠肝癌的实验研究表明，二甲双胍降低肝肿瘤的数量和大小。

普萘洛尔是用来降低门静脉压力，从而在食管静脉曲张。看着一群法国医生在肝癌的发生与丙型肝炎和普萘洛尔治疗和那些谁没有谁收到的食管静脉曲张患者。有普萘洛尔治疗的患者中，约75％，在肝癌的发病率减少。普萘洛尔肾上腺素和肾上腺素细胞在体内也不块受体。这种受体对肿瘤细胞的表面，包括肝癌，特别是丰富的。实验普萘洛尔一直有效的几种不同类型的肿瘤的大小和数量在减少。

迄今已完成的研究是耐人寻味的，但他们没有定论。无论是药物研究已在临床试验中，可以治疗肝癌或建立防止肝癌发生在首位。这样的研究是在规划阶段。保持看在这方面取得进展。

MP4

普萘洛尔
二甲双胍

983是？

StephenW

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983 drugs.

MP4

StephenW 发表于 2012-8-5 12:45
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983 drugs.

983 drugs？
more?

StephenW

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肯定FDA将批准更多的药物.

MP4

StephenW 发表于 2012-8-5 22:52
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肯定FDA将批准更多的药物.

THANK YOU