Josep Llovet, MD
- PROFESSOR | Medicine, Liver Diseases
Josep M. Llovet is Director of the Liver Cancer Program and Full Professor of Medicine at the Mount Sinai School of Medicine, New York University (USA), and Professor of Research-ICREA in the BCLC Group, Liver Unit, IDIBAPS-Hospital Clínic, University of Barcelona. Professor Llovet obtained his degree in Medicine and Surgery from the University of Barcelona in 1986 and his PhD from the Autonomous University of Barcelona in 1995.
Professor Llovet has been President of the International Liver Cancer Association (ILCA) and Chairman of the European Clinical Practice Guidelines of management of liver cancer (EASL-EORTC). He has published more than 225 articles in peer-reviewed journals such as New England Journal of Medicine, Nature , Nature Genetics, Lancet, Cancer Cell, Journal Clinical Investigation, Journal of Clinical Oncology, Lancet Oncology, Gastroenterology and Hepatology (total citations 33.629, total impact factor 2234; h index 77), more than 40 chapters of books, and has delivered more than 450 lectures. Of note, he has been recognized as a) Top-1% cited researcher in Thomson Reuters, 2014, b) Recognized by Nat Medicine 2011 as first author of the most cited paper in all disciplines of cancer for the period 2008-09 (Llovet, NEJM 2008). During the last 5 years he acted as Senior Editor of Clinical Cancer Research, Special Editor of Gastroenterology and Journal of Hepatology and as Director of the Master in Translational Medicine at the University of Barcelona. He has been awarded with the International Hans Popper award (2012), August Pi i Sunyer Award (2010) and Josep Trueta award (2013). He is member of leadership committees in Mount Sinai (Executive Management Committee, Tisch Cancer Institute) and IDIBAPS (Executive Committee and Director’s Consulting Committee) and Educational Councilor, International Liver Cancer Association (ILCA).
His grant support for the period of 2010-14 includes a total of 23 grants (research 18; educational 5), among which he has been PI of 20, including international projects with competitive funding from the European Commission (FP7- HEALTH, HEPTROMIC, 2010-14; 3M € ), the US National Institute of Health (R01, 2008-13;1.25M $), the Spanish National Health Institute, I+D Program (SA; F-2010-16055; SAF-2013-41027:total: 445K € ) and from the Asociación Española Contra el Cancer (AECC, 2011-2016; 1.2M €). He is currently leading the HCC Genomic Consortium, which includes 6 academic institutions in the US and Europe. This Consortium has organized a tumor tissue bank of 600 fresh frozen tissues and >2000 samples of paraffin-embedded tissue from human hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (ICC), and rare liver tumors as fibrolamellar carcinoma (FLC) and hepatoblastoma along with clinically annotated data. Regarding his lab team, during these 5 years he has been mentoring 9 Post-Docs and 8 PhD students (2 presented their thesis).
MD, University of Barcelona
Hospital Germans Trias i Pujol
AASLD Fellowship Award
Director - ILCA School of Liver Cancer
Highly Cited Researchers
Josep Trueta award, Best scientist
International Hans Popper Award 2012, for excellence in basic and experimental Hepatology. Falk Symposium, Mainz
A.-Establishment of sorafenib as standard of care in patients with advanced HCC (Llovet, New Engl J Med 2008). This breakthrough achievement establishes sorafenib as first line treatment for advanced HCC, and represents the first identification of survival advantages with systemic treatments. Identified by Nature Medicine as the most cited paper in oncology 2008-2010. Adopted by American (AASLD) and European (EASL-EORTC) guidelines of management of HCC.
B.-Establishment of chemoembolization as standard of care in patients with intermediate HCC. Evidence-based establishment through randomized controlled trials [Llovet, Lancet 2002] and meta-analysis [Llovet, Hepatology 2003] of chemoembolization as standard of care in patients with intermediate HCC. Adopted by American (AASLD) and European (EASL-EORTC) guidelines of management of HCC.
C.-Guidelines of management of HCC and ICC: Chair of EASL-EORTC Guidelines, 2012 (J Hepatol, 2012; Eur J Cancer 2012), and co-author of ILCA Guidelines of management of ICC (J Hepatol, 2014)
D.-Clinical trials. Dr. Llovet has participated as principal investigator in several international clinical trials that aimed to assess the tyrosine-kinase inhibitor sorafenib as adjuvant treatment after resection or ablative therapy (STORM trial. 1200 patients, 220 centers), sorafenib in combination with chemoembolization (SPACE trial. 400 patients, 120 centers), sorafenib in combination with erlotinib versus sorafenib at first line of treatment (SEARCH trial. 1000 patients), and the VEGFR1, VEGFR2, VEGFR3 and FGFR multi tyrosine-kinase inhibitor brivanib as a second line in patients who failed in the treatment with sorafenib (BRISK trial. 350 patients). Some of these clinical trials were published: Bruix J, J Hepatol. 2012; Llovet JM, J Clin Oncol. 2013; Llovet JM, Clin Cancer Res. 2012; Raoul JL, J Hepatol. 2012; Zhu AX, JCO 2014; Burrel M, J Hepatol. 2012; Forner A, J Hepatol. 2012; Roayaie S, Hepatology. 2013.
We carried out several studies with the aim of deepening global understanding of the pathogenesis of HCC, a cancer with an incidence of 750,000 new cases yearly that ranks as the 3rd cause of global cancer-related death. Sorafenib is the sole systemic therapy for this disease, and thus, identifying novel drivers and targets for therapies remains a relevant unmet medical need. In parallel, we studied rare liver tumors that lack clear molecular understanding and effective targeted therapies such as ICC and FLC.
A. - Genomic studies and molecular classification of HCC
Following our previous research on molecular classification of HCC (Hoshida, NEJM 2008; Chiang, Cancer Res 2008; Hoshida, Can Res, 2009) we generated #1) A 186-gene signature from adjacent cirrhotic tissue with prognostic capacity (Hoshida et al., Gastroenterology, 2013). This gene signature identifies a subgroup of hepatitis C-related early-stage cirrhotic patients at high-risk of HCC development, which might be used for selection in chemo preventive studies. #2) A refined prognostic signature from tumoral tissue. After providing and integrative analysis of clinical, pathological and genomic signatures to predict outcome in HCC patients (Villanueva et al., Gastroenterology 2011), a 5-gene signature (HN1, RAN, RAMP3, KRT19, and TAF9) associated with disease-specific survival was generated and validated in four different Eastern and Western cohorts (Nault et al., Gastroenterology, 2013). #3) microRNAs-based molecular classification of HCC. We provided a miRNA-based classification of HCC according to miRNA expression profiles (Toffanin, Gastroenterology. 2011). We demonstrated also that miR-517a is an oncomiR that promotes tumor progression. Our finding offered the rationale for developing therapies targeting miR-517a for patients with HCC. In addition, by using a novel platform interrogating 2332 snoRNAs we identified aberrant overexpression of the locus DLK1-DI03 which included 45 miRNAs and 41 snoRNAs. The relevance of this locus was demonstrated in an animal model generated for that purpose which selectively overexpressed the locus and induced development of HCC at 6 mo. These findings demonstrated the accuracy of in vivo gene targeting in modeling human cancer and suggested future applications in studying tumors in diverse animal species. (Wang, PNAS, 2012).
B.- Oncogenic drivers and signaling pathways in HCC
The European project HEPTROMIC (www.heptromic.eu) based on cancer genomics was awarded with a European Commission grant (FP-7 Health grant No. 259744-2). The project was coordinated by Dr. Llovet and includes the participation of 6 research centers [M. Esteller (Spain), J. Zucman-Rossi (France), V. Mazzaferro (Italy), L. Zender (Germany), T. Golub (Harvard, USA)] and 2 small-medium enterprises that are involved in the transfer of knowledge to industry (Diagenode, Belgium and TCLand, France). Several articles were published as a result of this project: Vettert, Hepatology 2012; Keng, Hepatology 2013; Nault, Gastroenterology 2013; Nault, Nat. Commun. 2013. Among those, though, the most relevant define novel mutations identified by whole exome sequencing associated with epidemiological events such as HCV, alcohol and HBV infection (Nault, Nature Genetics 2015; sub). In addition by exploring the whole methylome we identified a) Methylome-based 35 gene signature with prognostic implications. This discovery has been protected with a patent filled on 2014: Methods for the prognosis of Hepatocellular Carcinoma (European Application Number: EP14382535.4), and b) identification of novel tumor suppressors by exploring the whole methylome (Villanueva, Hepatology 2015).
Following our previous publications aiming to dissect the role of signaling cascades in the pathogenesis of HCC (mTOR, Ras signaling), we have been exploring additional pathways such as 1) IGF signaling: Our integrative genomic analysis showed activation of IGF signaling in 20% of HCCs, particularly in tumors from the Proliferation subclass. Effective blockage of IGF signaling with A12 monoclonal antibodies supported the rationale for testing this therapy in clinical trials (Tovar, J Hepatol. 2010). 2) Wnt signaling Analysis of the Wnt pathway alterations at the transcriptome, immunohistochemical and DNA level in 642 HCCs revealed that Wnt pathway is activated in 49% of patients. We identified two subclasses of tumors with Wnt activation: a) the CTNNB1 subclass, characterized by mutations and nuclear translocation of β-catenin and by transcriptional activation of Wnt-related liver-specific genes, and b) the Wnt-TGFβ subclass, with deregulation of genes that typically activate the Wnt pathway and with WT β–catenin. (Lachenmayer, Clin Cancer Res. 2012). 3) Notch signaling. We generated transgenic mice expressing Notch in hepatoblasts and cholangiocytes, under the control of the albumin promoter and the enhancer of alpha-fetoprotein. These mice developed HCC with a penetrance of 100% at 12 months. Its transcriptome analysis allowed us to generate a gene signature that detects Notch activation in 30% of patients with HCC. In addition, we showed that blocking Notch activation in vitro using either a) inhibitors of γ-secretase activity or b) a dominant negative tool, significantly reduced cell proliferation. (Villanueva et al., Gastroenterology, 2012). 4) Tumor suppressors and HDAC inhibitors. We identify alterations in the expression and gene copy in histone deacetylases HDAC3 and HDAC5 in 334 HCCs. Treatment of several cell lines and HCC xenograft models with a pan HDAC inhibitor (panobinostat) alone or in combination with sorafenib, caused potent anti-tumor effects, affecting their survival (Lachenmayer, J Hepatol., 2012). In a parallel study by using whole methylome analysis and experimental functional studies we identified SMPD3 as a novel tumor suppressor in HCC (Revill, Gastroenterology 2013).
C.- Genomic studies and molecular classification of intrahepatic cholangiocarcinoma
Only 30% of ICCs are amenable for curative resection, while there is no standard of care for systemic treatment. We performed an integrative genomic analysis (transcriptome, SNP array and mutations) in 149 ICC samples and used next-generation sequencing for discovery of novel oncogenic drivers. The study supported by a grant from AECC (2011-2016) led to three main publications A) Molecular classification of ICC (Sia et al. Gastroenterology, 2013). We described a molecular classification of ICC defining two molecular classes: the inflammation class, characterized by the activation of pathways involved in inflammation, cytokines activation and STAT-3 activation, and a proliferation class, characterized by the activation of pathways involved in proliferation and survival (Ras pathway, mTOR pathway, MET pathway). We found that aggressive ICCs with poor prognosis are enriched in the ICC proliferation class. B) Role of IDH mutations in ICC development and progression (Saha, Nature 2014). IDH mutations are present in 17% of ICC cases. By using GEMM we showed that IDH mutations in hepatoblast prevent hepatocyte differentiation and induce cholangiocyte proliferation. Albeit as standalone genomic hit IDHmut do not induce ICC, on a background of RAS mutations, they increase oncogenesis providing the rationale for exploring IDH-targeted therapies for this orphan disease, and c) Identification of a novel oncogenic fusion FGFR2-PPHLN1 and ARAF mutations (Sia, Nature Commun 2014, in press). By applying RNA-seq and exome sequencing we discovered a gene translocation leading to an oncogenic fusion including FGFR2 with intact kinase domain. This fusion is present in 16% of cases and has transforming properties and responds to specific inhibitors. As a result of this finding we have been involved in the design of a phase II study aiming to test specific inhibitors in patients with ICC and FGFR2 molecular aberrations. In addition we have protected the IP of this discovery with a patent: Methods for Diagnosing and Treating Intrahepatic Cholangiocarcinoma (Application Number: US 61/876,451). Overall we described a novel landscape of 9 actionable mutations in ICC, which involves 70% of these patients.
D. - Molecular classification of fibrolamellar hepatocellular carcinoma .
Fibrolamellar carcinoma (FLC) accounts for less than 1% of liver cancers, and unlike HCC it develops in non-cirrhotic livers of children/young adults with unknown etiologic factors. Treatment options are limited to surgical intervention. We have provided an integrative genomic analysis from a large series of FLC patients revealing a molecular classification (3 subclasses), description of mutational landscape (DNAJB1-PRKACA fusion 79%, BRAC2) and proposing a prognostic signature (Cornellà, Gastroenterology 2014).
Mudbhary R, Hoshida Y, Chernyavskaya Y, Jacob V, Villanueva A, Fiel MI, Chen X, Kojima K, Thung S, Bronson RT, Lachenmayer A, Revill K, Alsinet C, Sachidanandam R, Desai A, SenBanerjee S, Ukomadu C, Llovet JM, Sadler KC. UHRF1 overexpression drives DNA hypomethylation and hepatocellular carcinoma. Cancer cell 2014 Feb; 25(2).
Bridgewater J, Galle PR, Khan SA, Llovet JM, Park JW, Patel T, Pawlik TM, Gores GJ. Guidelines for the diagnosis and management of intrahepatic cholangiocarcinoma. Journal of hepatology 2014 Jun; 60(6).
Saha SK, Parachoniak CA, Ghanta KS, Fitamant J, Ross KN, Najem MS, Gurumurthy S, Akbay EA, Sia D, Cornella H, Miltiadous O, Walesky C, Deshpande V, Zhu AX, Hezel AF, Yen KE, Straley KS, Travins J, Popovici-Muller J, Gliser C, Ferrone CR, Apte U, Llovet JM, Wong KK, Ramaswamy S, Bardeesy N. Mutant IDH inhibits HNF-4α to block hepatocyte differentiation and promote biliary cancer. Nature 2014 Sep; 513(7516).
King LY, Canasto-Chibuque C, Johnson KB, Yip S, Chen X, Kojima K, Deshmukh M, Venkatesh A, Tan PS, Sun X, Villanueva A, Sangiovanni A, Nair V, Mahajan M, Kobayashi M, Kumada H, Iavarone M, Colombo M, Fiel MI, Friedman SL, Llovet JM, Chung RT, Hoshida Y. A genomic and clinical prognostic index for hepatitis C-related early-stage cirrhosis that predicts clinical deterioration. Gut 2014 Aug;.
Sia D, Losic B, Moeini A, Cabellos L, Hao K, Revill K, Bonal D, Miltiadous O, Zhang Z, Hoshida Y, Cornella H, Castillo-Martin M, Pinyol R, Kasai Y, Roayaie S, Thung SN, Fuster J, Schwartz ME, Waxman S, Cordon-Cardo C, Schadt E, Mazzaferro V, Llovet JM. Massive parallel sequencing uncovers actionable FGFR2-PPHLN1 fusion and ARAF mutations in intrahepatic cholangiocarcinoma. Nature communications 2015; 6.
Cornella H, Alsinet C, Sayols S, Zhang Z, Hao K, Cabellos L, Hoshida Y, Villanueva A, Thung S, Ward SC, Rodriguez-Carunchio L, Vila-Casadesús M, Imbeaud S, Lachenmayer A, Quaglia A, Nagorney DM, Minguez B, Carrilho F, Roberts LR, Waxman S, Mazzaferro V, Schwartz M, Esteller M, Heaton ND, Zucman-Rossi J, Llovet JM. Unique genomic profile of fibrolamellar hepatocellular carcinoma. Gastroenterology 2015 Apr; 148(4).
Zhu AX, Rosmorduc O, Evans TR, Ross PJ, Santoro A, Carrilho FJ, Bruix J, Qin S, Thuluvath PJ, Llovet JM, Leberre MA, Jensen M, Meinhardt G, Kang YK. SEARCH: a phase III, randomized, double-blind, placebo-controlled trial of sorafenib plus erlotinib in patients with advanced hepatocellular carcinoma. Journal of clinical oncology : official journal of the American Society of Clinical Oncology 2015 Feb; 33(6).
Villanueva A, Portela A, Sayols S, Battiston C, Hoshida Y, Méndez-González J, Imbeaud S, Letouzé E, Hernandez-Gea V, Cornella H, Pinyol R, Solé M, Fuster J, Zucman-Rossi J, Mazzaferro V, Esteller M, Llovet JM. DNA methylation-based prognosis and epidrivers in hepatocellular carcinoma. Hepatology (Baltimore, Md.) 2015 Feb;.
Schulze K, Imbeaud S, Letouzé E, Alexandrov LB, Calderaro J, Rebouissou S, Couchy G, Meiller C, Shinde J, Soysouvanh F, Calatayud AL, Pinyol R, Pelletier L, Balabaud C, Laurent A, Blanc JF, Mazzaferro V, Calvo F, Villanueva A, Nault JC, Bioulac-Sage P, Stratton MR, Llovet JM, Zucman-Rossi J. Exome sequencing of hepatocellular carcinomas identifies new mutational signatures and potential therapeutic targets. Nature genetics 2015 May; 47(5).
Fitamant J, Kottakis F, Benhamouche S, Tian HS, Chuvin N, Parachoniak CA, Nagle JM, Perera RM, Lapouge M, Deshpande V, Zhu AX, Lai A, Min B, Hoshida Y, Avruch J, Sia D, Campreciós G, McClatchey AI, Llovet JM, Morrissey D, Raj L, Bardeesy N. YAP Inhibition Restores Hepatocyte Differentiation in Advanced HCC, Leading to Tumor Regression. Cell reports 2015 Mar;.
Villanueva A, Llovet JM. Liver cancer in 2013: Mutational landscape of HCC--the end of the beginning [review]. Nature reviews. Clinical oncology 2014 Feb; 11(2).
Llovet JM, Hernandez-Gea V. Hepatocellular carcinoma: reasons for phase III failure and novel perspectives on trial design [review]. Clinical cancer research : an official journal of the American Association for Cancer Research 2014 Apr; 20(8).
Llovet JM. Focal gains of VEGFA: candidate predictors of sorafenib response in hepatocellular carcinoma [review]. Cancer cell 2014 May; 25(5).
Llovet JM. Liver cancer: time to evolve trial design after everolimus failure [review]. Nature reviews. Clinical oncology 2014 Sep; 11(9).
Quetglas IM, Moeini A, Pinyol R, Llovet JM. Integration of genomic information in the clinical management of HCC [review]. Best practice & research. Clinical gastroenterology 2014 Oct; 28(5).
Pinyol R, Nault JC, Quetglas IM, Zucman-Rossi J, Llovet JM. Molecular profiling of liver tumors: classification and clinical translation for decision making [review]. Seminars in liver disease 2014 Nov; 34(4).
Abi-Jaoudeh N, Duffy AG, Greten TF, Kohn EC, Clark TW, Wood BJ. Personalized oncology in interventional radiology [review]. Journal of vascular and interventional radiology : JVIR 2013 Aug; 24(8).
Zucman-Rossi J, Villanueva A, Nault J, Llovet J. The genetic landscape and biomarkers of hepatocellular carcinoma [review]. Gastroenterology 2015;.
Bruix J, Han KH, Gores G, Llovet JM, Mazzaferro V. Liver cancer: Approaching a personalized care [review]. Journal of hepatology 2015 Apr; 62(1S).
Qi X, Jia J, Fan D, Han G. Brivanib for hepatocellular carcinoma trials: selection bias from barcelona clinic liver cancer stage? [editorial]. Journal of clinical oncology : official journal of the American Society of Clinical Oncology 2014 Mar; 32(9).
Pinyol R, Llovet JM. Hepatocellular carcinoma: genome-scale metabolic models for hepatocellular carcinoma [editorial]. Nature reviews. Gastroenterology & hepatology 2014 Jun; 11(6).
Pinyol R, Tovar V, Llovet JM. TERT promoter mutations: gatekeeper and driver of hepatocellular carcinoma [editorial]. Journal of hepatology 2014 Sep; 61(3).