How the Black Death Shaped Today’s Patients, Real-World Liver Cancer Outcomes

Physician's Weekly Podcast

The 14th-century bubonic plague killed up to half the population in Europe, the Middle East, and North Africa. It has been hypothesized that such a deadly disease may have provided a selected event for genetic variants that protect against infection. People with protective versions of certain genes would be more likely to survive and pass on those variants to future generations. Yet pinpointing such variants has been a challenge. An NIH-funded team of researchers, led by Drs. Hendrik Poinar (McMaster University) and Luis Barreiro (University of Chicago) sampled DNA from the remains of more than 500 people who died before, during, and after the Black Death, which raged in 1348 to 1349. Dr. Barreiro, explains his research, which found genetic variant enriched by the Black Death contribute to Crohn’s and other autoimmune disorders.

There have been some big breakthroughs in the treatment of liver cancer the last 2 years, raising the question of whether non-trial populations of patients do as well as those reported in the major clinical trials. We speak with Cha Len Lee, MD (University of Toronto), about therapy with atezolizumab and bevacizumab improving recurrence-free survival in patients with hepatocellular carcinoma (HCC) following surgical resection or ablation, according to results from the phase 3 IMbrave050 clinical trial (NCT04102098). As this combination therapy is finding its way into practice, Dr. Lee performed a study to assess the efficacy, safety, and value of esophagogastroduodenoscopy with regard to this combination therapy in the real world.

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Additional reading:

Klunk J, et al. Evolution of immune genes is associated with the Black Death. Nature. 2022 Nov;611(7935):312-319.

Kudo M, et al. Efficacy, safety and patient reported outcomes (PROs) from the phase III IMbrave050 trial of adjuvant atezolizumab (atezo) + bevacizumab (bev) vs active surveillance in patients with hepatocellular carcinoma (HCC) at high risk of disease recurrence following resection or ablation. ASCO, June 2-6, 2023, Chicago, USA. Abstract: 4002

Hack SP, et al. Future Oncol. 2020 May;16(15):975-989.

Finn RS, et al. N Engl J Med 2020; 382:1894-1905.

Lee C

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