I grew up in a family of physicians — my grandfather and my uncles were doctors, and the tradition continues today with my two brothers, my cousins, and me. I majored in biology at the American University in Beirut (AUB) and earned my medical degree there as well. In 1992, I joined the Yale School of Medicine for postdoctoral training, and it was there that I first became interested in gastrointestinal oncology.
I completed my fellowship and joined the Yale faculty in 2000. In 2001 I came to Memorial Sloan Kettering, where I started focusing on primary liver cancer — cancer originating in the liver. Liver cancer affects a diverse population from many cultures and economic backgrounds and is truly a global disease. It is one of the top five cancers worldwide, and mainly affects people in sub-Saharan Africa and Southeast Asia, where hepatitis B, a major risk factor, is endemic.
While it is not common in the United States, its incidence is increasing due to the silent epidemic of hepatitis C virus that we witnessed in the last few decades, the rise in the number of people with morbid obesity and diabetes, and the persistence of alcoholic cirrhosis — all risk factors.
I am proud to take on an advocacy role because research funding has lagged despite the worldwide impact of this disease. Liver cancer does not have a public-figure spokesperson raising awareness, and there is not much knowledge about it among patients and the public. One step I took to address this was co-authoring, with [Memorial Sloan Kettering hepatobiliary surgeon] Ronald DeMatteo, a book in lay language called 100 Questions and Answers About Liver Cancer. In addition, I speak frequently about liver cancer to groups at risk of developing primary liver cancer, such as patients infected with hepatitis C.
On the international level, I am involved with clinical trials we’re conducting with colleagues around the world, especially in Southeast Asia, which help us understand the challenges of managing the disease in different cultures. I have also helped with many projects under the auspices of the Elmer and Mamdouha El-Sayed Bobst International Center, now headed by [former Chair of Memorial Sloan Kettering’s Department of Surgery] Murray Brennan.
We have established a strong relationship with my alma mater in Beirut, with an ongoing faculty exchange and a monthly video-link session with the AUB physicians. It’s a lively, multidisciplinary discussion, where we teach them about the state of the art of cancer care here and they teach us about the risk factors and treatment practices in their country.
We are also trying to advance the field through research. My research focus is on incorporating small biological molecules into standard cancer therapies. In recent years, our group at Memorial Sloan Kettering led the initial efforts evaluating sorafenib (Nexavar®) in primary liver cancer. Sorefenib was ultimately approved by the FDA for that indication in 2007.
In a trial also based on work at Memorial Sloan Kettering and led by our group, we are now investigating whether combining sorafenib with the standard chemotherapy drug doxorubicin produces an improved outcome. We are proud as an institution to be the leaders of this first national effort of a large clinical trial in primary liver cancer, which is supported by the National Cancer Institute. I also serve as the vice chair of the national Hepatobiliary Task Force.
I’m excited by the prospect of other small-molecule drugs similar to sorafenib emerging from our program. Liver cancer is a very complex disease with two opposing forces in play — the cancer itself and the commonly associated liver failure.
Providing optimal care for the disease involves a collaborative effort with regular discussions among our multidisciplinary team, including the medical oncologists, surgeons, hepatologists, and interventional radiologists. I’m optimistic that we’ll not only develop new drugs but also learn more and more about how they work and thus best integrate them into clinical practice.
Memorial Sloan Kettering has provided me with a very supportive environment in which to develop as a clinician and a research investigator. The Center has also been important in my personal life — I met my wife, [medical oncologist] Eileen O’Reilly, here. We both appreciate the diversity at Memorial Sloan Kettering and the way everyone believes strongly in the purpose of the institution. People here pride themselves in what they do, and the mission binds us all together.