Liver Disease:
de la Torre’s Dilemma
words by maryann brinley /
photograph by Brad Guice
Andrew N. de, la Torre, MD,
Associate Professor of Surgery, UMDNJ- New Jersey Medical School
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hy do we do clinical trials?” asks Andrew N. de la Torre, MD. “Number one reason: to help people and to improve the standard of care for patients with liver disease. My big goal is to decrease liver cancer deaths and the most cost effective way is prevention and early treatment of liver infections like hepatitis B and C.” With four active and two new trials about to be up and running, de la Torre is determined.
“Watch enough people die, stay up nights thinking of what works and what doesn’t, and you are driven to clinical trials, to advanced therapies and to strategies that offer patients the kind of help they can’t get anywhere else” — which is another reason he spends much of his pressured day doing clinical investigations: to bring patients to Newark. “Some of these trials are here, nowhere else, only here.”
De la Torre’s investigator-initiated, Phase I/II “Immuno-modulatory strategies to auto-vaccinate patients against primary and metastatic cancers in the liver” has generated calls from Colorado, Delaware, Kentucky, Virginia, Maryland, Ohio, Brooklyn, Manhattan and Long Island. “I have one 34-year-old participant, a guy with multiple primary liver cancers who had been treated elsewhere first and is now one of the 12 patients in our liver vaccine trial.” After several vaccination cycles, a year later, his last CAT scan shows no cancer. “We’re also recruiting patients with pancreas cancer that has spread to the liver. This part of the trial has yet to be financed. We’re working hard to get funding.”
Meanwhile, de la Torre is principal investigator of “Immuno-modulatory use of 1,25(OH)2D3 to induce long term tolerance in liver transplant recipients,” a trial that has enrolled 40 patients. And in collaboration with molecular biologist Sergei Kotenko, PhD, of the NJMS-UH Cancer Center, he is investigating the “Comparative role of type I and type III interferons in the pathogenesis of hepatocellular carcinoma” and has collected samples from over 80 patients. “We have just opened a phase I trial to use type III interferons in hepatitis C patients.”
Oncovir Biopharma is producing the drug Poly-ICLC for de la Torre’s vaccine trial but he also works with Roche, Merck, Onyx/Bayer, and Zymogenetics. He credits the support of the Healthcare Foundation of New Jersey, Roche, Gilead, UMDNJ Information Technology Group, Macy’s Foundation, and Onyx.
De la Torre explains an adjuvant is something that turns on the immune system. Two years ago, on the adjuvant trail, he felt as if he were beating his head “against a wall, making contacts with other researchers to find better ones. “In China, they have promising immune therapy for liver cancer. I’ve always been a believer in the immune system having a role in the body’s ability to eliminate cancer.”
By teaming up with Andres Salazar, PhD, a retired professor from the Uniformed Services University of the Health Sciences, in Bethesda, MD, he settled on Poly-ICLC, a very potent immune booster, for his vaccine trial about two years ago. Collaborations, he insists, are critical and he depends upon Kotenko in particular. “We met not here, but at a National Institutes of Health meeting. I’m a clinician. I read a lot of science journals, but I know my limitations.” De la Torre wouldn’t have been able to carry out his trials without the help of collaborators in radiation-oncology, interventional radiology, hepatology, and surgery. “My philosophy is: leave the door open. Welcome all collaborators because I can’t do it by myself.
“Look behind you,” he says. There on the wall is a magic-markered whiteboard: “My big picture, my road map. I drew it to remind me of what I’m trying to rebuild here. Do you realize when the Pope was shot in 1984, he had a severe case of blood transfusion-related hepatitis? The Vatican called The Sammy Davis Jr. Liver Institute at the New Jersey Medical School, here in Newark.” The prominent letters LDC in the center of the circle stand for “Liver Disease Center” with arms, squiggles and lines reaching out to represent areas like education, prevention, screening, anti-fibrotics, laparoscopic liver surgery — “the only program of its kind in New Jersey and New York City” — transplant, vaccines, and nanotherapy. “This is all geared to reduce liver cancer death rates through multiple ways — prevention, early diagnosis, advanced treatment, minimally invasive surgery, and education. Everyday I look up there to see where I am and where the holes are.”
On that education arm is a software program he developed to identify people in need of blood testing for hepatitis C and B infection. It speaks English, Spanish, and Creole, with Portuguese in the works. Using a touch screen kiosk, patients in waiting areas generate medical history reports for their doctors. De la Torre points out that eight out of ten people with hepatitis C or B are undiagnosed. Physicians often don't have the time or are hesitant to ask embarrassing questions about sexual behaviors or drug use, which account for 60 to 70 percent of hepatitis C and B infections. “The computer doesn’t flinch or blink an eye.” Patients wear headphones, so the exchanges are private. “This tool takes the stigma out of responding,” says de la Torre who is gathering information to build a liver cancer screening program. More than 700 people have taken the “audio-computed assisted survey interview” (Audi-CASI) in community based trials.
When de la Torre was a student at Johns Hopkins, he was taught not just to “make a difference,” but to make a big difference and focus on excellence, innovation and persistence. Having grown up a Latino in the Bronx and Queens, “I believe in the mission here in Newark because the need to make a difference is so incredibly high.”
So how does his typical day shape up? “Recover from all night surgery, gulp down two cups of coffee, call Dr. Ismael Castaneda, my indispensable research associate to update, organize, coordinate and implement our ongoing projects, either go to a patient-related clinical conference or see six to twelve patients in the office, review CD images of patients referred for liver cancer evaluation, surgery or clinical trials, gulp down another cup of coffee, call Maria Korogodsky, my PA, to find out who’s sick, write a paragraph on a manuscript, an IRB or a proposal, troubleshoot software code, catch up on my billing and RVUs (relative value units), gulp down another cup of coffee.”
Team members, past and present: Charles Cathcart, Carroll B. Leevy, Arun Samanta, Adam Peyton, Sohail Contractor, David Klyde, Sharon Gonzales, Pitro Kiza, Kirin Rao, Robert Bierworth, Maliha Ahmad, Ahmed Lasfar, Walid Abushahba, Dolly Razdan, Carol Bacon, Felix Ramos, Teresa Garcia, Liz Da Silva, Christopher Gangoo, Teri McNeil, Maria De Almeida, Adrian Fisher, Baburao Koneru, and Dorian J. Wilson.