Memorial Sloan Kettering physician outlines continental plan to close treatment gaps for liver cancer in Africa

Ghassan Abu Alfar, an attending physician at Memorial Sloan Kettering and professor of medicine at Weill Cornell Medicine, told an audience at an unspecified professional meeting that a continent‑wide effort is underway to define how clinicians in Africa should screen for and treat hepatocellular carcinoma (HCC) and to improve patient access to lifesaving care.

Abu Alfar said the initiative began with a 40‑question poll taken by about 500 clinicians that generated roughly 20,000 data points and was published in JCO Global Oncology. "We asked who you are, how you screen, how you stage, what therapies are available," he said, and concluded the current patchwork of guidelines and services leaves many African patients without effective options.

The survey found large variation across regions: some areas reported relatively high hepatitis B vaccination or treatment coverage, while surveillance and staging systems were inconsistent. Abu Alfar cited stark treatment gaps — liver transplant programs exist in only a few countries (he named Egypt and South Africa), many physicians report they cannot offer needed therapies, and access to systemic drugs is limited. "Immunotherapy or checkpoint inhibitors are available to barely 5 percent of our colleagues in Africa," he said, and availability of newer agents such as lenvatinib was reported at single‑digit percentages in many regions.

Abu Alfar credited prior work by the National Cancer Institute and others but argued that the NCCN harmonized guidelines, while a constructive step, included too few African clinicians and split North Africa from Sub‑Saharan regions in ways that may not reflect clinical realities. "We said: how about we build a continental guideline for liver cancer in Africa, by Africa, for Africa?" he said, describing a committee that includes clinicians from Mauritius to Ghana and Cameroon to Malawi.

To address methodological limits of the original poll (internet access and convenience sampling), Abu Alfar said the group is launching a more rigorous, bilingual (English/French) study with technical support from Microsoft and Avanade and sponsorship engagement from AstraZeneca. He emphasized academic independence and data protections: corporate teams working on the platform are separated from business units, and analysis will be led by academic investigators.

Abu Alfar also stressed ethical and legal safeguards for tissue sharing and data use. Recounting a legal case about preserved patient tissue and consent, he said proper consent, clear ownership arrangements and benefit‑sharing mechanisms are essential. He proposed models such as sponsors covering shipping and analysis costs with funds placed in escrow and returning value to African partners so that research yields local benefit.

On biology, Abu Alfar said the project will expand beyond service mapping to examine tumor immune microenvironments and genetic drivers across cohorts so that treatment recommendations reflect etiology (for example, viral hepatitis, NASH or aflatoxin‑linked tumors). The team plans to integrate cohorts from Korea, India, Pacific Islands, France and multiple African regions to identify immune and genomic signatures that predict response to therapies.

In question‑and‑answer exchanges, Abu Alfar said the study will document use of alternative and traditional medicine but will not attempt to test efficacy at this stage; the immediate priority is understanding access and referral patterns. He also named operational challenges — from obtaining signatures on journal paperwork to reaching clinicians in remote settings — and stressed the need for multidisciplinary input (legal, business, psychosocial) to make clinical improvements sustainable.

Next steps include expanding the survey with improved methodology, continuing meetings across African sites and engaging regulators and ministries to pilot business and legal models that retain benefit for African patients, Abu Alfar said. He invited clinicians to join the study through a QR code and said the group will coordinate with organizations such as the NCCN, WHO and the NCI on implementation and policy alignment.

The presentation did not announce specific changes to national health policy or new drug access programs; Abu Alfar described the initiative as a foundation‑building step intended to map practices, study tumor biology, and create ethically governed mechanisms for tissue and data sharing that could support future interventions.